ChiroSecure's Best Of Live Events

ChiroSecure's Best Of Live Events

You ' re in Good Company

Volume one

26 of ChiroSecure's Best Of Live Events

*Some of the thought leaders that participate in  ChiroSecure Live Events.

www.chirosecure.com (866)-802-4476

A number of doctors have asked us for transcripts of some of our most watched Live Events and we thought you may also be interested in some of these. Simply go ahead and click on the title(s) of the ones you are interested in and download the transcripts. Dr. Lora Tanis – Pediatrics the Right Way ………………………………….…………….Page 3 Dr. Foxworth 5 Most Dangerous Things You Face ……………………………..….…..Page 20 Reputation Management & Reviews ……………………………………………….………..Page 43 Dr. Dennis Marchiori Palmer Gallup Poll ……………………………………….….……..Page 75 Avoiding and Surviving Medicare Audits ……………………………………….…..……..Page 114 Kim Klapp Team Approach To Lower Risk ………………………………………………..Page 145 Vaccine Awareness ……………………………………………………………………………..…..Page 161 Dr. Dean Smith – Evidence Based Practice …………………..………………….………..Page 179 Life University Research Supported by ChiroSecure ………..…………………….…..Page 209 Dr. Dan Murphy Informed Consent A Real Experience ……..……..………….……..Page 234 Dr. Sam Collins, PQRS Made Simple ………………………………..………………….……Page 250 Dr. Amanda Apfelblat – Pediatric Practice ………………………………………….……..Page 306 Dr. Eric Plasker – Lifelong Patients ………………………………………………..…….…..Page 324 Dr. Hess and Dr. Viscarelli Building Relationships – Minimizing Risk ….….…..Page 338 Randy Monroe - The Malpractice Suit ………………………………………………..….…..Page 350 Dr. Ken Murkowski – 25 Ways To Lower Risk ………………………………………..…..Page 359 Edie Hofmann HIPAA – Simple Steps To Compliance ………………………….……..Page 399 Bill Esteb – Patient Expectations ………………………………………………………..……..Page 410 Email Problem or Opportunity with Jean Eaton …………………………………..……..Page 455 Bharon Hoag Live Event Medical Necessity ………………………….……………………..Page 488 Dr. Pat Gentempo Philosophy …………………………………………………………….……..Page 505 Dr. Tedd Koren Patient Education …………………………………………..…………….…..Page 517 Sam Collins – What Triggers an Audit ……………………………..………………….……..Page 555 Dr. Heidi Haavik Subluxation Research ………………………………………..……………Page 596 Dr. Dean DePice – The Associate Driven Practice …………………….………..………..Page 602 Dr. Stu Hoffman – Informed Consent ………………………………………………………..Page 625

The following is an actual transcript of the ChiroSecure Live Event with Dr. Stu Hoffman and Dr. Lora Tanis. We do our best to make sure the transcript is as accurate as possible; however, it may contain spelling or grammatical errors. If you have any questions about the transcript or would like to request any transcripts from our previous shows, feel free to contact us at 866-802-4476

Dr. Stu Hoffman:

Hi everybody, Dr. Stu Hoffman, president of Chiro Secure. I'm here today with you on a really special show. I'm so honored to have Dr. Lora Tanis. I've known Lora for so so long, I have nothing but the upmost respect for her, she's brilliant. And we're talking today really about pediatrics the right way. But Lora, one of my favorite things about Lora, is she has been so dedicated to the International Chiropractor's Association and the ICA's council on chiropractic pediatrics. We both grew up in that world and that's how I originally met Lora many years ago. But Lora also oversees the curriculum of the diplomate program for the ICA pediatric council. And she's spoken at numerous conventions, and conferences, and symposiums. She's also the examiner for the International College of Chiropractic Pediatrics. Which is the testing body for the diplomate in clinical chiropractic pediatrics. She's a reviewer on the journal of clinical chiropractic pediatrics, and she's a practicing doctor. She is so busy, we have tried to get this show done so many times, and between her schedule and my schedule, I'm just really happy to have her on today. And one of the things that I want to really touch on today is the fact that so many of us in our profession are dealing with pregnant women, and young babies, all the way through people as seniors. But we're talking very specifically about the children today, the different age groups, and how to actually take care of different age groups. And one of the things that Lora and I had discussed is talking about an actual history on these children. And that's something that I think may even be foreign to some of the doctors. In taking care of families, why even have a history on a child? So let's just get right into it. I want to introduce you to the crowd Lora, and just start off by talking about what makes our approach a little bit different. And just thinking about history and forms and things of that nature. Hi everybody, and thanks Stu for having me on. I know it's been a long time since we've been trying to get this on the air, but I really appreciate you bringing this topic to light. It's very near and dear to my heart as you know. I just would like to say before we start the show that it would be my pleasure to make available to those watching, a sheet that they can download from Chiro Secure of most frequently asked questions during history and exams. For areas of let's say pregnancy, birth history, maybe some neonatal types of questions. Because I find those would be the most common questions that most chiropractors are either not familiar with asking, or possibly do not have information within their office to even know to ask these questions.

Dr. Lora Tanis:

The one thing that I really want to talk about today, that you and I have talked about in the past, is history and exam and how very important it is for us as chiropractors to understand that history is super important in the life of a child. It gives us clinical information as to what was going on while the child was in the womb of the mother prior to them entering our office for chiropractic care. I think that it is important for the chiropractor to understand that there are certain exposures during pregnancy that can affect the neurological well being of a child that we may see in our practice. And for that reason, we need to talk to the mother about several issues, not only maybe any traumas that she sustained during pregnancy, but whether or not it was a planned pregnancy. Whether or not there was any use of medication, or recreational drugs, or alcohol, which we all know can impact the developing baby that she is carrying within her womb. And secondary to your question is also an exam form. I know that in lecturing all over the United States and all over the world, several chiropractors do not have age appropriate exam forms in their office. And each child, depending on their age, has different clinical findings, or different types of exams that would be appropriate or normal for their age. And those are some of the things that we need to be aware of as chiropractors as well, is when we're doing the examination, are we doing the appropriate exam for that child? Are these exam findings normal for age, and when do these exam findings go away? But those are some of things that today, when we spend this short time doing this webinar, that would be important to your viewers. And Lora, I can already imagine so many people that are watching this are saying to themselves, "What the heck are you talking about for an exam or a history?" I have mothers bring in their kids, I check them, one leg may be shorter than the other, I palpate them, whatever, and I go on adjust them, I'm only a chiropractor, why do I need all of that additional history and information? Well, you know me, I never believe that we are only just chiropractors. We are health care physicians. We are chiropractors, not only do we assess subluxation within patients, but we are fully taught and capable of looking at conditions, and diagnosis, and red flag warnings, and abnormalities within patients. So I don't think as a profession we should ever short change ourselves into being just the chiropractor. Because I believe that patients access our office because we are a hand on, educated, kind of like all knowing profession when it comes to anatomy, physiology, subluxation, outcomes. Put it this way, in a different light we are not medicine, we are chiropractic, but we are certainly trained to know more than just detection of subluxation and correction of that. And I totally agree with you. And from a risk management perspective, my concern always is if we have any patient that comes into our office, all of a sudden they have a health crisis, but they were in our office at a similar time. It always becomes an association between the chiropractor and that health crisis, and a lot of people like to place blame. And if we have an infant come into the chiropractor and all of a sudden they're autistic, or some neurological challenge

Dr. Stu Hoffman:

Dr. Lora Tanis:

Dr. Stu Hoffman:

shows up and we didn't do anything to recognize that there may be some red flags or whatever, then we have put ourselves at risk. Not the baby so much, because we know how safe what we do can be. But we do jeopardize our own self based on something that is unforeseen and we have no control over. If we don't have any information other than, well the baby I'll just check and adjust the atlas. Stu I agree with you. I mean, the last thing that I ever want to have is the conversation over a malpractice case with you. As you are my malpractice carrying company. Because I know the first thing that you would ask me is where's your documentation. And that's the point that I want to get across today. So let's talk about this a little bit in the pediatric population. Lora, let me just add something, because you brought up a very good point about documentation. And a lot of the doctors don't realize that most of the states have very specific requirements to maintain their license about documentation for a new patients, and for existing patients. And there is usually no identification or differentiation based on age. Either they're a patient or not and you do need documentation. So I'm glad you raised that as well, but go ahead. Documentation is vital, because documentation for us is also going to be the reason that we make our differential diagnosis. Or the decision as to whether or not we're going to care for that child in our practice. So I'm going to go back to the statement you made about maybe cause and effect. A child has said condition, was also seen by a chiropractor around the same time, was this related to a chiropractic incident? As you know, quite a bit of studying in the recent past has been on safety and pediatrics. There was the [inaudible 00:09:59] study and there's other studies through Safety Net and Dr. Katie Pulman that are looking at safety issues. And as of right now, that information shows that chiropractic care is safe for pediatric patients. But it is something that's being studied very vigorously right now in the chiropractic world. But my concern is, is that we always want to stay in that realm of being safe for pediatric care. But we have to do our due diligence to make sure that no adverse event occurs within our practices. And that's going back to history and examination. If we look at, for instance, if we look at a mother who potentially had mediation during her pregnancy. We all know that medications have different classifications and can adversely affect a child in utero. So we would want to know that information, especially if let's say that baby comes into the office presenting with persistent crying since birth. We have to know, is the persistent crying really colic, which we're all quite familiar with and we see frequently in a chiropractic office. Or is this cry at a much higher pitch, or a much higher decibel which could indicate some sort of underlying neurological condition.

Dr. Lora Tanis:

Dr. Stu Hoffman:

Dr. Lora Tanis:

I mean a cry is not always a cry Stu. Just because it's been diagnosed by a pediatrician as colic, I have seen many cases in my practice where what is

diagnosed as colic is not colic at all. And we can't rely on someone else's information to do our job. We need to be thorough, we need to take the appropriate history, we need to do the appropriate exams, we need to document that information before we adjust these children. Because heaven forbid this be a neurological situation for that child, we adjust them, that child has a seizure which is unrelated to chiropractic care, but you're now thrown in the mix as a chiropractor. Either for failure to diagnose, failure to refer, or potentially you may have caused the incident. And that's why history is so important because we could list the medications, or we could list alcohol, or we could list drugs, we could list injury accident in that history. So it could show some sort of potential cause and effect in the history that may have led to the situation at hand with the child that presents in your office. That's really potent information. So Lora, what kind of questions do you ask to the parent when the child comes in? When the child comes in, I mean I will talk to the mom briefly about her pregnancy. With the things that I've already mentioned with that. And just to see if there was any intervention during the birth process, was the mother ... Should I say, did the mother have an emergency C-section, was she induced in labor, was this just natural going into labor, was there assisted delivery? All these things could indicate potential trauma to that child, even during the birth process. So we want to talk about not only the pregnancy, but also how was the birth. Was it traumatic at all, what did we learn from this? The other thing that I would ask Stu is to look at photographs. I am a big proponent of looking at photographs for clinical information. Every person now has a phone with the capability of taking a picture or taking video. So I use that as clinical information to see, are there postural abnormalities, was there distortion of the head, was the any ptosis or distortion of the eye, the face, the mouth. Which could indicate a potential underlying condition or injury. Was there any bruising, was there any swelling? You know, did the baby have a postural preference. These are all things that I look at through what I call my video diary, or my video history, or my photographic history. Then I will ask the parent of course why they are presenting to a chiropractic office. And ask whether or not what their concerns are for that day bringing that child in. Is it because the child is not feeding well, is because they're fussy or irritable? Is it because the child has torticollis or a flattened head? But there's always a reason that that parent is going to bring that child to your practice. And you know what, we can all hope that it was all well in this care, but unfortunately that's not usually the first reason a pediatric patient shows up in your practice. They do usually show up with some sort of symptom. Yeah. And I know it can go both ways based on educating the pregnant woman, and or father. I don't want to discriminate against aware males in the audience. You also mentioned earlier Lora, about age appropriateness. And when we talk about pediatrics, we all I think gravitate toward these infants. You know, giving

Dr. Stu Hoffman:

Dr. Lora Tanis:

Dr. Stu Hoffman:

them the best shot at a healthy life. But what would be different if they were four, five, six, seven, eight years old. Because those questions may still be relevant I would assume. But we would steer a little bit differently wouldn't we? The questions are always going to be relevant. Because once we get into let's say toddler age, school age, a lot of times we are going to see certain situations that might be related more to traumas. You know, walking, bicycle riding, you know normal childhood activity that might result in a trauma. And that might be your first contact with the child in your practice. But again, when you ask the history questions, they will give us information about ... Let's take that child and let's say we had a baby that had developmental hip dysplasia or some sort of his dysplasia. As that child becomes an early walker, becomes preschool age, is there any type of lower leg deformity that we see when we're doing a gait analysis that might relate to an abnormal intrauterine position, or a early newborn infant type of condition that wasn't appropriately managed. Or it's been in a watch and wait type of situation. So the history always relates to the child. Because it's my opinion that if you leave something, especially orthopedic, over the years in a watch and wait type of process, something will adapt in that child's body to accommodate for the abnormality early on. So maybe that's going to be why this child trips and falls all the time, or doesn't have an appropriate gait, may have balancing types of issues. But everything in my opinion always stems from the very beginning of life to where that child will present within your chiropractic office. So what I'm hearing from you is the old style ... You know in adults we call it rack em and crack em. You know just get em in, adjust something, and move em on out. When it comes to children of any age, it is just as important, if not more important to have a thorough understanding of what transpired before you ever met them. So that you can actually look at the global picture and see what's going on in their life. But not even just now, it's a predictor for the future. And I can understand that. Is that what I understood from you? Absolutely. I mean, Stu, I'm not happy with 80% of the people getting better. I want the 20% that quote on quote don't get better in chiropractic care because I think as a profession we can do better to increase our odds in that 20%. You know the days of like rack em stack em crack em are over. We are so much more than that as a profession. We are extremely well educated, we're good at diagnosis, we're good at exam, we just need to sometimes sharpen up our skills and maybe the areas we feel less competent to handle. You know we're not all going to be specialists in every area of chiropractic, or human anatomy, or human frame, but we need to be the best in the populations that we serve. I want to give you an example of exactly what you're talking about, how I see things that start from early on that progress to older ages of children. So we take a child that, let's say had an intrauterine constraint. Or just let's say the baby was stuck in an awkward position within the mother's womb through the pregnancy. The child's born and the child has a torticollis, which we're all very

Dr. Lora Tanis:

Dr. Stu Hoffman:

Dr. Lora Tanis:

familiar with torticollis. The torticollis is not appropriately treated, so it's semi- unresolved. And then what happens? The child winds up getting ear infections on the side of the torticollis because we have this persistent muscle spasm and decreased lymphatic flow on that side. So now we have a child that's taking multiple antibiotics. Then the child may have tubes, may not have tubes, continue to take antibiotics. They start to get a little older, the eustachian tubes change direction, the ear infections aren't as prevalent, and we wind up with sinus infections, or we wind up with mastoiditis. It's because the correction is not taking place, we're just adapting and growing to really have a differing condition based on something that may have started as early as day one for that child. And what is so cool about being a chiropractor is we can see these things when we are educated and aware. Prior, or not even prior, we can say prior to most other health care providers, but most don't even look to connect the dots. And that is something that, to me, that's exciting about what we do. And I love the fact that you bring that to the table in terms of educating the doctors. And we talked about the history now, what about an actual examination? How does that go for you? Examinations. For reference for chiropractors out there that do not have age appropriate exam forms, Dr. Peter Fish, who has written a textbook on pediatric chiropractic. The ICA has access to Dr. Fish's book, but along with that book was a CD too that I have had in my office since the beginning of my pediatric education. And on that CD are exam forms. And they're broken down into age appropriate forms, there's a history form on there, pregnancy form, there's some growth charts on there. But there's a multitude of different forms that the chiropractor who doesn't have forms in their office could access. They can get a copy of this CD, they can purchase it, it's not terribly expensive. But it gives them a starting point to implement exam forms and history forms within their practice. It also helps to organize. I always tell chiropractors, it helps organize your mind. What forms would be appropriate for that age group? You know, are we doing Kemp's test, and SLR on a three week old? Well that's an inappropriate test for that child. But you may very well be able to use that on your 11, 12 year olds with reliability. So there are forms out there that are broken up into age groups that doctors can access. I would recommend something as simple as that implementation. And then just print those forms off, take a look at them, familiarize yourself with the tests that are on there for the different age groups. And those are just really simple things that you can put in your practice. I'm still looking for a really good electronic health record that deals with pediatrics in chiropractic. I've not found one at this point in time so I recommend using paper charting and then just digitally scan that into your patient's chart. And then you can keep your daily notes in your electronic record.

Dr. Stu Hoffman:

Dr. Lora Tanis:

Dr. Stu Hoffman:

And when you are taking care of a new patient, what kind of contraindications or red flags pop up for you? For me, Stu, I have an interesting practice as you know. I see a lot of children with tremendous special needs. So I see a lot of children that have neurological impairment, I see children with intrauterine strokes. And these are all things that if you're a chiropractor, and you're opening your doors to these children, you have to understand how to examine these kids. This isn't about laying that child on a table and doing an adjustment, it's about knowing what adjustment is appropriate for the underlying condition that that child may have experienced prior to coming into your office. So for me, things that are abnormal in a neurological exam will throw a red flag. Certain history questions, children with certain genetic disorders that would have predispositions to ligament laxity's, or collagen disorders, are all those red flags that you have to look at. Does it mean that the child can't get adjusted? Well no I don't believe that it does. Even though if you look at certain textbooks they'll say things out there that children with hydrocephali, or meningomyelocele are contraindicated for chiropractic. I don't believe it's contraindicated, but I believe you need to dot your I's, cross your T's, do a thorough examination, and figure out how you can care for that patient effectively and safely. And that means modifying what you do as a chiropractor. And that in itself is the exact point of the show today. Because we both agree and advocate that we want everybody adjusted. If they're breathing and they show us any indication of subluxation, we want them adjusted. But that's not enough. We have to know where to adjust them, how to adjust them, and be responsible. And I think that's the maturity of the conversation that we're trying to have with the profession right now that may have been lacking for a period of time. But time changes, and I think that the message is clear that we do need to be a responsible physician. Yes, that physician is chiropractor, but we're a licensed health care provider responsible for another human being. And we want to do the best job possible for them for their immediate needs. But as you so well described, for their future needs that they may not even ever realize that they had, or would have, had they not come to you. And that may be a little too assertoric for some people, but adjusting people is what we all do. And when I was in practice, active practice, I had a family practice. We saw lots of children. And I can actually say that I was one of those people that did not do what a lot of the things that you've shared today. And I was unaware. We did great, we had great results overall, but as you said, is 80% enough? And I'm thrilled that we can put out this message together because I'd like our doctors to become better educated and more aware. And how can they find this information? Because there's a lot of pediatric seminars going on these days, it's big business in the profession. Where do they get this kind of information?

Dr. Lora Tanis:

Dr. Stu Hoffman:

Dr. Lora Tanis:

Well, I would always look to the ICA pediatric council Stu. I have had the absolute pleasure of being involved with that council for probably at least a good fifteen years. I graduated from the first program in 1996 and I have been active with the council and held a position within the council for probably the last, I don't know, maybe 13 to 15 years. But the one firm foundation that that council stands on is excellence in education. It is the number one goal of the ICA pediatric council to provide education to our fellow brothers and sisters in chiropractic that is responsible, reliable, and result proven over time. We are founded on academics and education because the first and foremost goal for us is to let us be chiropractors and let us influence the health and welfare of children. But do it with the upmost safety. So the ICA pediatric council is a great reference. There are textbooks out there on pediatrics that are great reference sources. But those are the areas that I would go to. I would look at, if you're a chiropractor getting pediatric education, I would look at who is giving this seminar, and also what are the credentials behind the doctor giving this seminar? Because I think that's important too, do they have post-graduate training? Do they have post-graduate certification? Are they a diplomate within pediatrics? Are they a fellow within pediatrics? Because those would be the doctors out there that are on the cutting edge of the research as well as the care of children. You mentioned the ICA pediatric council. Again, near and dear to me. I've been an ICA member and supporter since I was a student, so we're talking probably in the high 30 years range. And I've spoken at the pediatric council in the past. And I do find what you said, that it is more academic. Just like we're trying to bring to the table today. There are other groups out there, no doubt, and anything that we're discussing is not any disparaging thing to anybody else. But I do see that there is a different emphasis. A different focus on not just the marketing approach and yeah, let's take care of kids. But as you called it the academics of it in terms of how. Not just why. Once we know the why we should be willing to do whatever it takes to learn the how. And that's what I think may be unique and different about the ICA's pediatric council. And I do want to put a plug in for them because it has been so important to me personally as an individual within the profession and as a member of the ICA, to be proud of that organization and how long it has been doing what it's been doing. Others have popped up and they've become very very popular. And popular is great, but foundation is critical. And that's what I think you're bringing to the table today. As maybe you didn't come as a representative of the ICA pediatric council, but you happen to be one. So I want to not exclude that in any way, because let's face it, we are the ICA program, Chiro Secure, and you happen to be just as dedicated as I am in a different area and a different approach. And I love you for that, and I have nothing but encouragement. No matter what anyone has done in the pediatric world, that they do get involved in the ICA pediatric council. They should be a member and they should take the courses and learn this information, which is something that you triggered in my head when I asked the question.

Dr. Stu Hoffman:

So before we start to close down Lora, is there any words of wisdom for somebody that hasn't really been in this market place? Meaning taking care of children as much as they want to. I was just in a few different places in the last week or two, speaking. And people come up and they talk to you, because I talk about pediatrics too from a risk management perspective. And they'll come up and they'll say, man ... One woman specifically just on Saturday said, "I just moved back to this area and I had a great pediatric practice, and now I'm having a little bit of a struggle getting it going." And that's from a million different reasons. But the people that want to get involved in pediatrics and learn more and more, how do they get started? You know, what's the first step from your perspective? I think the first step is understanding how important it is to adjust a child. You and I both know that the health of children is not what it was almost 30 years ago when I started chiropractic. We have so many children with so many needs at this point in time that we as chiropractors need to step up to the bat, and we need to educate the public on what chiropractic brings to the table as far as health care is concerned for these children. And I'm not taking drug care, I am talking health care. And every piece of information that we were taught nutritionally, naturally, subluxation, we need to bring it to the table and we need to put that out into our communities. But I think what chiropractors really need to understand is in the first year of life we have the greatest impact through chiropractic adjustments, in my opinion, to affect neuroplasticity. And that is the brain development and rewiring for these children. And to me Stu, if I had my choice, I would have every single baby that was ever born evaluated by a chiropractor to make sure that these kids start out with all the positives, and not the negatives. Because I want to see optimal brain growth and development in children so that they can be the best person that they can possibly be as they grow up. The next level is up to age three, and then age five, and then by age eight we start to lose the ability to make those really large impactful neurological changes in the brain. So I think people need to understand why we need to see kids. Because if you understand what your purpose is, the goal is easy. Because you have like focused yourself on the importance of the job that you're going to do. I think being a part of the community, I had the pleasure of working with palmer students in the business center two weeks ago when I was on campus talking to them about how do you start a practice, how do you become the authority of chiropractic in your town that you work on? And that's being part of your community. And giving to your community, not just taking from your community. So one thing I suggested to them to do, and it's another thing that I've done, is talk about ... Anybody can use this, but we did a car seat little lecture called you're driving me crazy. And it was all about car seat safety for children, and having your local police department or fire department come in and check car seats in the parking lot of your clinic. Be part of the community, let people know that you're all about child welfare, and child health, and healthy practices.

Dr. Lora Tanis:

We support a lot of, and have supported a lot over time, a lot of the sports programs in town. Donating to every function that goes on in the town from little kids up to high school kids. But being part of your town, educating them on the benefits of chiropractic, educating them on the benefits of overall health and wellness and the vitalism that we as chiropractors enjoy ourselves. Why would we keep that gift to ourself? When we're living our own healthy lifestyles, why would we not want to share that with the people in our community and help be a part of their [inaudible 00:37:33] to raise healthy children. But a lot of it is education, and it's what I call sweat equity. It's being out there, being present, being a part, give give give rather than sitting back and expect to be take take take. You're so refreshing and it's really nice because we go back to, you have to understand the why we do what we do, and then become a master of the how we do what we do. And when you talk about outreach and being part of the community, one of the phrases that has stuck with me for probably 25 years is, outflow creates inflow. And it doesn't always come back. You know people put stuff out to get back, and as you said, you really need to go and give not put out to get back, but to give. And when you do it for the right reasons and from, I like to say from your heart, it always comes back. It may not come back directly from there, but I know that if you go and do a lecture somewhere, maybe nobody signs up and runs to you to come into your office. But all of a sudden you get back to the office and you had a dozen new phone calls of people that want to come in to you that never happened before. So outflow always creates inflow and getting involved and doing it for the right reasons, I respect and appreciate. And that has nothing by the way to do with a pediatric practice, it has everything to do with your practice and whatever focus you want to make on that practice. And last but not least, I just want to touch on not necessarily you, but you mentioned these kids are subjected to all kinds of things that maybe 30, 40, 50 years ago we weren't subjected to. Whether it be the enormous amount of toxic vaccination that they get, and this isn't a vaccination show. The amount of drugs that they get. As you said, maybe they wind up developing an infection in their ears, there's so many reasons from a structural perspective that that can happen. The foods, rather than breastfeeding I actually saw something on TV ... Actually it was on YouTube of a TV show that this woman came on how breastfeeding is bad for you. So we'll give them chemicals instead. So all of these things that happen, and yet we have chiropractors that want to put drugs in our own profession. But we do have to get to these kids with whatever it takes. As a chiropractor I believe it's our moral responsibility to educate as you talked about. Your community, the families in your community, your patients, as to how getting those little ones in gives them the greatest potential for their health moving forward. And you've demonstrated that over and over again. And today you were so precise in the message and I really appreciate that. And maybe we'll be revisiting again on a situation like this, but I just wanted you to know how much I appreciate all of what you shared with the audience and how much

Dr. Stu Hoffman:

I appreciate and respect our friendship and what you do for the profession. It means a lot to me personally. So I just want to thank you for being here today. Thanks Stu for having me. As you know, this is what I eat, drink, and breathe all day long, is chiropractic. And if what you're doing with this program effects one chiropractor out there that can effect one child's life, it's always worthwhile. Like we can't reach them all, but let's just reach some. Because then some of those are going to reach some of the others, and we are going to continue to build on this great profession. But we are going to continue to make a difference in the life of a child, one child at a time. So thank you so much for having me today. Lora, based on what you just said, I have to add one thing to the show. When I was in Maine this weekend, one of the stories I told is that our great grandmother went to Willie Weisberg in the Bronx. I don't know, maybe in the 1920's or something, and she happened to be the one person in our spread family that lived to the oldest age. And she had gone to the chiropractor all those years ago and went periodically throughout her life. And I've told this story, which I almost never do. And two brothers came up to me and they said, "Oh my God, I can't believe you talked about him." My great grandfather went to him in the 1930's and brought my father who was maybe five years old or whatever at the time. And he had a line around the block of people just waiting to see him. And here we go, you're talking about the message getting to one person, but these two brothers are chiropractors because their father is a chiropractor, because their great grandfather went to Willie in the Bronx all those many years ago. And how do you find two people in totally different areas, different walks of life, both chiropractors that all have family that went to this one gentleman who probably was awesome at what he did and had such an impact. So I hope that others create that impact for their patients as my great grandmother had for her. So thanks again, I wish you all a great day and please stay tuned. And as always, like us on Facebook and certainly download our free Chiro Secure app on your smartphone.

Dr. Lora Tanis:

Dr. Stu Hoffman:

Frequent Ques+ons DC’s should ask during History Intake The following informa+on is to provide you with a star+ng point if you currently don’t have a history form in your office that covers pregnancy, birth and the neonate-infant pa+ent. I have included a sec+on about neonatal exam and some references that might be helpful. Saturday, June 3 rd 2017, the ICA Pediatric council will be hos+ng a 1 day seminar in Tampa, Florida that will include history taking and exam performance as well as condi+ons, treatment and technique.

Pregnancy History: Was this a planned or unexpected pregnancy Natural or Fer+lity History of medical condi+ons or gene+c disorders History of Alcohol or drug use. (prescrip+on, OTC or recrea+onal) History of trauma (prior to or during pregnancy, MVA) Birth History: Hospital, Home, Midwife, Birth Center Induced or Natural start to labor, Age Vaginal, VBAC, Planned Caesarian, Emergency Caesarian Assisted with forceps or vacuum extrac+on Anesthesia Fetal Distress, Meconium staining APGAR Score

Neonatal-Infant History: Age at birth, weight, height, head circumference History of trauma in-utero, birth or post birth

Presen+ng condi+on (not ea+ng well, sleeping well, gas, reflux, tor+collis, persistent postural abnormali+es, preferred feeding posi+ons, gene+c disorders..to name a few) Family health history Baby health history (fevers, rashes, seizures, NICU stay, when released from hospital or birth center…) APGAR Bo`le, breast fed, formula (lactose, soy, amino acid base, homemade) How many wet and soiled diapers Vaccines and any reac+ons (fever, crying, seizures, respiratory changes, change in affect…) Toddler-School age History will include above ques+ons but is more reflec+ve of the intake form you currently have. Pay par+cular a`en+on to ques+ons about trauma, ea+ng, vaccines, illnesses, milestone development, gait…

EXAMINATION Neonatal exams:

Height, weight, head circumference, skin color, birth marks, cranial nerve exam, ROM, check movement (symmetrical-bilateral), tone, ortolani, barlows, allis, moro reflex, sucking reflex, roo+ng, galant, perez, fencer, acous+c blink, scarf sign, palmer/plantar grasp, Babinski, DTR, eyes, ear, abdomen, mouth (tongue +e), head shape and cranial bones-sutures. There are several more tests that could be important for your pa+ent but this is a great start.

REFERNCE MATERIAL: Online videos University of Utah Medical Center Chiroprac+c Care for the Pediatric Pa+ent (CD with exam forms too); Dr. Peter Fysh, ICA Pediatric Diplomate Program, ICA Annual Conference on Pediatrics

Pediatric Chiroprac+c; Dr. Claudia Anrig/Dr. Gregory Plaugher

Pediatrics 101 Hours: 9:00 a.m. – 5:00 p.m. Want to learn the basics of how to look after infants and children? Come to this one day seminar taught by Dr. Lora Tanis, a full-time practitioner and one of theworld’s foremost instructors in pediatric education. ICA Council on Chiropractic Pediatrics June 10, 2017  Marriott Tampa Airport  Tampa, Florida

WHAT YOU WILL LEARN • How to take a history • How to do an examination • Spinal anatomy review • Common pediatric conditions

• How to adjust an infant • Red Flags in adjusting

WHO SHOULD ATTEND? • DCs interested in advanced pediatric education but not sure if they want to commit to a 3-year program • DCs seeking to learn the right procedures of examination and adjusting • New practitioners

• DCs wanting to refresh their clinical knowledge and skills • DCs caring for kids but not confident about adjusting neonates 7 hrs CE credits to be applied for by Palmer College only in FL, GA, SC, AL.

ABOUT THE SPEAKER

adjuster, Dr. Tanis believes that practitioners should be educated in more than just technique and that the care DCs provide this special patient population should not only be appropriate but always safe. Her lectures always get high ratings because she is able to correlate the academic/ theoretical material to her extensive and unique practice experience of more than 25 years ranging from premature babies to kids with spe- cial needs. She enjoys teaching and sharing her knowledge with colleagues. Dr. Tanis has a busy private practice in W. Milford, New Jersey.

Dr. Lora Tanis is one of the foremost pediatric practi- tioners in the world. She has a passion for caring for infants and chiropractic. She loves what she does and her reputation as an excellent chiropractic pediatrics practitioner has been built on integrity, service and continual learning. A graduate of Palmer College, Dr. Tanis was among the first group of DCs in 1996 to graduate with a Diplomate in Clinical Chi- ropractic Pediatrics (DICCP). She currently serves as Chair of the ICA Council on Chiropractic Pediatrics and is an instructor for the DICCP program in the US, Canada and Australia/NewZealand. A skilled

Limited seating. Register Early! To register by phone call 571-765-7554 or 1-800-423-4690. Online at www.icapediatrics.com

June 10, 2017 PEDIATRICS 101

FYSH

REGISTRATION FORM Name _________________________________ Address _____________________________________ City _________________________ State ______________________Zip _________________________ Email address ___________________________________ Phone # ______________________________ College (for students) ________________________________ (Expected year of graduation) __________

2nd Edition

FEES

□ DC

$199

□ DC ICA Member $179 □ DC ICA Pediatrics Council Member $179 □ Student $ 79 □ SICA Member $ 59

$35 additional for CE Credits ( AL, FL, GA, SC applied for) Registration: $ ________ CE credits : $ ________ TOTAL: $ ________

Payment by: □ Check □ Am Express Account # _______________________________ Exp Date _______________ CVV ____________ Cancellation policy: Registration refunded less 15% administration fee. Register by phone: 571-765-7554 By fax: 703-351-7893 or 703-528-5023 □ Visa/Mastercard

By Mail: ICA Council on Chiropractic Pediatrics 6400 Arlington Blvd, Suite 800 Falls Church, VA 22042

The following is an actual transcript of the ChiroSecure Live Event with Dr. Stu Hoffman and Dr. Ray Foxworth. We do our best to make sure the transcript is as accurate as possible; however, it may contain spelling or grammatical errors. If you have any questions about the transcript or would like to request any transcripts from our previous shows, feel free to contact us at 866-802-4476.

Dr. Foxworth:

Why is it okay for Blue Cross, Aetna, and Cigna to all pay us a different fee for the exact same code? I can't have a different fee for my cash patient or my Medicare patient for their non-covered services. As I started doing my homework and because I'd been involved with creating a network here in the states. What I found was, there is a way to do this. If the doctors don't write anything else down today, write down this acronym, DMPO. It stands for a Discount Medical Plan Organization. Hi everybody, Dr. Stu Hoffman back again with another important topic. As you know I always try and review things that come up in the context of you calling me over issues that happen in your office. Today is no different. I have so many calls based on asking for refunds from patients, to discounting fees, to doing it weekly, to prepaid plans. All of those different areas of concern and they should be. Today I have Dr. Ray Foxworth who is the president of Chiro-Health USA. He has been a friend of mine and Chiro-Secure for a number of years now. Ray is a certified medial compliance specialist. He served for over 20 years on the Medicare Carrier Advisory Committee and four years as the staff chiropractor for the GB Sony Montgomery VA Medical Center. How many people can say that? This guy knows his stuff. He has done so many things in our profession, but also for our profession. In fact a number of years ago. I think it was about five years ago. I was approached about Ray's program, Chiro-Health USA. I've had some mixed feelings about working with people like Ray doing what he does. The reason is, I was taught by a number of attorneys, that so many of these programs have not been done in a legal, proper manner. I took Ray's program and I sent it off to some of our attorneys, who did a full approach in terms of investigating whether or not it was in compliance because there are so many regulations, which I'm sure he'll touch on today. Ray has done his homework. I have nothing but 100% confidence in him and Chiro-Health USA, which is why we're talking to him today. From my experience, having dealt with prepaid plans being one of the guinea pigs dealing with that 35 years ago, or maybe 34-35 years ago. I know that there are so many ways to go about this. It can be a problem and a risk in your practice. I want to bring Ray on. Ray, I understand that you started Chiro-Health USA as a result of a problem in your own practice? That's how so many of us have done things in this world. Can you tell me what that problem that you had was and how it led to you forming and developing what I think may be the largest program of its kind in the chiropractic profession, Chiro-Health USA.

Dr. Hoffman:

Dr. Foxworth:

Sure I'll be glad to Stu. Thank you so much for allowing me to speak to your family if you will. I really enjoy these conversations rather than presentations. I'll be happy to share that story with you. You know there's a saying that necessity is the mother of invention. I had a necessity in my practice. It was the result of what I've historically called my most painful day in practice. I was taking car of a patient Miss Jones, like all of us do. She was a cash patient at the time. I was seeing her, her husband, and a couple of kids. Back at that time I was probably charging 35, $40 a visit. I'm happy, they're happy. The world is good. Then Miss Jones was involved in an auto accident. I did what most any doctor would do. I billed my PI fee out to the auto carrier. A few weeks later, the lady went through treatment. She comes in a few weeks later, with some papers in her hand. I walk into the room with one of my staff. There she is sitting there and you just know something's wrong. I'm a very astute guy so I said, "Miss Jones you look like something's wrong." This nice little lady that I've seen for literally years walks up to me and says, "Doc, I saw what you charge the insurance companies." Taps me on the chest and says, "It's guys like you ripping off the insurance companies that keep my family from affording healthcare." That was a kick in the gut. I said, "No, Miss Jones. It's guys like me that bend over backwards to help folks like you that don't have healthcare, but I made a serious mistake. I never let you know what my actual fees were and that I was really trying to help you. That'll never ever happen to me again." Stu, that's when I started looking at why is it okay for Blue Cross, Aetna and Cigna to all pay us a different fee for the exact same code? I can't have a different fee for my cash patient or my Medicare patient for their non-covered services. As I started doing my homework and because I'd been involved in creating a network here in the state. What I found was there is a way to do this. If the doctors don't write anything else down today write down this acronym, DMPO. It stands for a Discount Medical Plan Organization. Chiro-Health USA is a network that contracts with a Discount Medical Plan Organization, which by the way are regulated by the departments of Insurance. They follow the exact same network model as Blues, Aetnas and Cignas. When you offer discounts as part of a DMPO member and a provider in our network, that's what makes offering discounts to patients if you're doing that. That's what makes it compliant at literally every level of regulation we have from our border examiners all the way up to the OIG. It came [crosstalk 00:06:34] out of a very painful day. That's what I found to be the most effective model to help our doctors and help our patients. Ray, let's talk about that for a minute because any of us that have been around the block a couple of times understand exactly what you're referring to. Not only do the patients not only appreciate what we do. Some of the patients have no problem going to the neurologist. The first visit is $700 just for the consultation, this and that. You charged a whole $60 and they have a problem. I get it. They also come to us as chiropractors sometimes after they've been to all

Dr. Hoffman:

of the others. You're the one ripping off the insurance companies, without them having any point of reference how the insurance companies just don't pay their bills properly. Then they have the right to come back a year later and decide, "Well, I want my money back." That's all a risk to the provider. When we talk about these Discount Medical Plan Organizations, that's what I loved about what you do because when I'm talking to doctors on the phone and they're telling me why they now have a problem with a patient it is almost always because they weren't clear in communicating what to expect, what the fees were, just as you indicated. It always seems to lead to an upset. Art of it is because the doctor is afraid to tell them how much they charge, and or the doctor thinks it's okay that if they have an insurance plan, it's one fee. If they have a cash plan, it's another fee. They think that's okay to just do. You're talking about a whole different world of being in compliance making this actually work on behalf of the doctor, but really on behalf of the patient. What does make these DMPOs, that model legal? Okay. The DMPO model, is it's nothing that I created, trust me. As I did my research what I found is that most health insurance companies, the Blues, Aetna, Cigna, even United Healthcare. They also operate a DMPO, a Discount Medical Plan Organization. Those entities are regulated by the Department of Insurance. When you look at the mechanisms for offering discounts. I may have my actual fee. Let's say, whatever service is it's $100 a visit. If I'm part of Blue Cross, there's the contractual network discount as part of my agreement. The challenge with having a PI fee, a cash fee, Worker's Comp fee, mother, father, sister, brother fee is ... Dr. Larry Markson used to say, "It's a dual fee schedule." What we need to understand as a profession, there needs to be one fee, your actual fee. Hospitals use what's charged a charge master. That's why they know to charge a patient $27.17 for a Tylenol. They bill everybody the same, but these contractual network discounts are what makes this legal. Quite frankly there's maybe other ways to discount. When you're using the type of plan that's owned by the insurance companies, and regulated by the Department of Insurance, that is the safest and simplest way that we know of to be able to offer discounts. If it's okay for Blue Cross, Aetna and Cigna to all pay us different, then you use a discount medical plan that's owned by an insurance company, it's hard to take anyone to task for being part of a network and offering discounts because that is the gold standard. The contractual network discount. That's the best way I know of to answer that. I don't know of a plan that works better than one that's actually regulated over 34, 35 states now. Right. Basically you're just accessing the system that already exists and is recognized by the government really and bringing it into the chiropractic world so that the doctors can access this and have a legal mechanism to work with different classes of patients. Is that my-

Dr. Foxworth:

Dr. Hoffman: