Working together to build chiropractic's future.

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August 2010—July 2011

Annual Report

In

Practice

In Practice is produced by the Nebraska Chiropractic Physicians Association (NCPA). The NCPA is a professional organization representing doctors of chiropractic in the state of Nebraska. Its mission is to advance and promote the chiropractic profession.

Contents 2 NCPA Board of Directors 4 NCPA Dues Reduction 4 Army OneSource Initiative 6 NCPA Income and Expenses 7 NCPA Income and Expenses Budget 8 NCPA and the Husker Sports Network 9 NCPA Wants to Give You an iPad 3G with Smart Cover 10 The Patient Protection and Affordable Care Act 13 An Association Discount for Long-term Care Insurance through Northwestern Mutual 15 2012 NCPA Conventions 17 SecureCare Activities and Direction 17 New Coventry Health Care Fee Reimbursement 17 Accreditation through URAC 18 SecureCare Quality Management Committee Report 18 SecureCare Board Application Requirements and Process 19 Utilization Management Update

Working together to build chiropractic’s future. —Lou Andersen CEO, Nebraska Chiropractic Physicians Association

n c p a b o ar d o f d i r e c t o r s

As I reflect on the past year, I am struck by the abundance of

Elections for the NCPA Board of Directors’ positions, which terms were up in 2011, were held during the NCPA convention in Kearney in August. Below is a list of the current NCPA Board of Directors: Dr. Robert Krugman, President

Dr. MaryLou Camenzind, President-Elect

Dr. David Timmerman, Vice President

Dr. Jeffrey Johnson, Secretary

Dr. Jeffrey Freeman, Treasurer

Dr. Michael Christensen, Past President

Dr. Mark Wurth, Omaha District Rep.

Dr. Jeremiah Rethwisch, Omaha District Rep.

Dr. Ben Buettenback, Lincoln District Rep.

Dr. Brad Stauffer, Southeast District Rep.

Dr. Aaron Rickert, Northeast District Rep.

Dr. Troy Wilson, South Central District Rep.

Dr. Allyn Sutton, Central District Rep.

Dr. Sam Mark, Western District Rep.

Dr. David Kassmeier, At Large Position

Dr. Troy Brainard, At Large Position

important work accomplished by NCPA team members—leaders, staff, committees and work groups, consultants, business partners and doctors across the state. We worked together to advance the chiropractic profession.

The NCPA holds a unique place within the realm of state associations in America. The advocacy work of our association is supported by SecureCare, Inc., our wholly owned chiropractic managed care company. SecureCare plays a vital role in providing funding and financial support to the association. More importantly, it provides our insurance company partners with a dependable chiropractic network with appropriate utilization management services. Without SecureCare, the insurance companies we serve would seek network management services elsewhere. Most likely from organizations that are much less balanced in their approach to managing utilization. As you read through this report, you will enjoy learning of the many gains we made together during the last fiscal year on behalf of this great profession. I hope you will conclude we have been good stewards of your financial investment in this organization and have earned the trust of generations of chiropractic physicians. Lou Andersen CEO, Nebraska Chiropractic Physicians Association

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N e B R A S K A C h i R o p R AC T i C p h y S i C i A N S A S S o C i AT i o N

AWARDS AND WiNNeRS

NCPA Dues Reduction As you are probably aware at the recent Kearney convention, our board approved a member dues reduction for fiscal 2012, (August 1, 2011 through July 31, 2012). for the 2011-12 year, the regular membership dues are now $750, John Morey and the advance pay option is NCPA Chief Financial Officer $600. both of these options are $100 less than before. no changes for first and second year or semiretired doctors dues were made. Any doctor who has already paid the advance option at the previously established higher rate will receive an appropriate refund from the accounting department in october. for regular members paying on a preset installment plan, (quarterly or monthly) the preset amount will continue as set, but a refund check of $100 will be issued by the end of october. n

congratulations to Dr. Mike Christensen, who was named chiropractor of the year at the August convention. dr. christensen was also recognized for his service to the ncpA as outgoing president. Dr. Robert Krugman accepted a gavel as he begins his new role as ncpA president. Dr. Brook Bowhay was presented a commitment to excellence Award in recognition of his dedication to the chiropractic profession. Dr. Doug McConnell was the lucky winner of the ncpA raﬄe for a trip to this year’s husker bowl game! Dr. Heather Wilkins was also a lucky winner of an Apple ipad at our drawing in Kearney.

Army OneSource Initiative Army onesource is a secretary of the Army initiative to provide comprehensive community support and service delivery for soldiers and their families, regardless of branch of service or geographic location. While the Army, and the entire military for that matter, “takes care of its own,” because of multiple theaters of operation, multiple deployments, sustained operations and more than 1.6 million soldiers currently deployed, the Army has acknowledged the need to incorporate community partners to support our heroes and their families. in partnering with Aos, a two-course 7 ceu program is being offered to d.c.s nationally to help them understand the unique challenges of military life. These courses are being offered free of charge. upon completion, the d.c. will be given a certification and also some marketing tools. eventually they will be listed on a national database for providers/services that the

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military can use based on their Zip codes. The purpose of these programs is not about free care. Those who do not have coverage or who have insurance such as tricare/champus that do not currently cover chiropractic services would be charged no differently than cash patients. We will shortly have some exciting news from one of cocsA’s vendors, chiRoheAlth usA, with regard to those without coverage. in the meantime, this is about best practices … learning the unique challenges facing not only our military but also their families, and doing what chiropractic does best. There will be new and exciting updates coming with this program in the near future, and further ceus available for clinical care and also nutritional support. n

We should be flAtteRed, RiGht? it has been said that one of the

greatest forms of flattery is to have someone copy what you do. We have all seen the commercial where the little boy stands in the mirror, face slathered with shaving cream, mimicking his father shaving. how cute! in 1982, i was a recent graduate just starting my practice in Reno, nevada. chiropractic, through chester Wilk and four other chiropractors, was engaged in a major antitrust suit against the AMA and 10 other affiliated colleges and associations. terms such as “quackery” and “unscientific” were not uncommon adjectives used to describe chiropractic. The AMA board of trustees document presented at trial was quoted “to first contain, and then eliminate the profession of chiropractic in the united states.” Any M.d. who had any professional relationship with a chiropractor, such as accepting referrals, could be subject to strong sanctions, including loss of hospital privileges. chiropractic was also referenced as a cult. As you all know, chiropractic won that battle through the courts, and now our profession and hVlA spinal manipulation have gained significant acceptance in the health care field as well as the insurance industry. our more recent chiropractic graduates no longer hear those adjectives that were common “back in the day.” M.d.s and d.c.s share not only professional courtesies and patients but also offices. today, we are engaged in another battle. other health care providers are claiming the exact same thing we were attacked for: hVlA spinal manipulation. They are not only claiming it, they are attempting to take it over. in the 1960s, our chiropractic colleges made a decision to increase our educational requirements to receive a “doctor of chiropractic” degree by having states legislate increased educational requirements for d.c.s to be able to obtain licenses in their respective states. fear was that potential students would no longer want to enter chiropractic because of the increased financial and time demands this would place on these students. to the surprise of not only the chiropractic colleges who attracted more motivated students, but also the AMA, this risky decision made

chiropractic that much more acceptable to the public at the same time increasing public safety and the welfare of the patients we serve. These now competing health care providers are trying to take the short cut. They do not want to place the same educational demands on their own profession. They want to offer weekend seminars to “enhance their musculoskeletal practice” by learning hVlA manipulation. yes, i believe some of the weekend seminars were offered at a holiday inn express. They want to circumvent the 401 process, which is the legislature’s way of making good public policy in matters that they do not have adequate medical knowledge. if you care about what the previous generation of d.c.s have fought for, then i am asking you to make a difference in your own sphere of influence. public awareness of the issue is important. educate your patients. Get involved in educating your respective state legislators. our state association needs more dedicated doctors to take over the fight, which is not anywhere close to being over. if you need more information on this, your modern-day battle, contact the ncpA office. hVlA manipulation in the hands of an uneducated, untrained professional is the same as the little boy standing next to his dad mimicking shaving with a dull plastic butter knife. however, in this case, he would have in his hand a straight-edge razor. Are we as a profession going to just sit by and watch that happen? your association is not. Are you going to sit back and let this happen to the unsuspecting public? or are you just flattered? dr. Robert Krugman President, Nebraska Chiropractic Physicians Association In Practice


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N e braska C h i r o p ract i c P h y s i c i ans A ss o c i at i o n

NCPA Income and Expenses

NCPA Income and Expenses Budget

for Year Ending July 31, 2011

for Year Ending July 31, 2012 Payment from Other Convention Exhibitors

Payment from Other Convention Exhibitors

$43,911 (4%)

$37,692 (4%)

Convention Fees from Members

Convention Fees from Members

$137,506 (12%)

Sources of Income

$123,930 (12%)

SecureCare Net Income (Available to NCPA)

$304,670 (27%) SecureCare Contributions to the Conventions

$170,000 (15%)

Investment Earnings Net of Fees

$185,766 (16%)

Sources of Income

$289,993 (29%) SecureCare Contributions to the Conventions

$170,000 (17%)

Member Dues

Investment Earnings Net of Fees

$289,316 (26%)

$113,500 (11%)

$17,454 (2%)

$258,000 (26%)

$30,000 (4%)

Office, IT and Operating Costs

Travel and Conferences

$15,380 (2%)

Office, IT and Operating Costs

$73,115 (10%)

$71,152 (9%)

Building Rent

$96,521 (13%)

Member Dues

Membership Communication and Education

Travel and Conferences

Expenses

SecureCare Net Income (Available to NCPA)

Convention Related

$343,945 (45%)

Expenses

Building Rent Convention Related

$97,249 (12%)

$332,438 (42%)

Payroll Allocation from SecureCare

$108,708 (14%)

Payroll Allocation from SecureCare

$122,252 (15%)

Legal, Lobbying and Political Action Related

Legal, Lobbying and Political Action Related

$119,744 (16%)

Total Income

$1,131,170

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TOTAL Expenses

$759,487

$124,880 (16%)

Increase in Fund Balance

$371,683 (33%)

Total Income

$993,115

TOTAL Expenses

$793,351

Increase in Fund Balance

$199,764 (20%)

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N e B R A S K A C h i R o p R AC T i C p h y S i C i A N S A S S o C i AT i o N

NCPA and the Husker Sports Network

NCPA Wants to Give You an iPad 3G with Smart Cover

There have been a few recent, exciting developments in the marketing program for the ncpA. We will be participating in the husker sports network radio broadcasts as we have in the past. We will be utilizing Roger Craig as our main spokesperson. in addition, Dr. Tom Rohrick Advertising and Ahman Green will act as a coMedia Department spokesperson for our campaign. We are very excited about the addition of another very pro-chiropractic athlete to our group of spokespeople. They will carry the message well for us, as they have a very strong belief in chiropractic care.

so, now you are asking yourself what’s the catch. Well, there isn’t one. We are simply asking you to help move chiropractic forward by helping your patients sign up for chiroVoice, and in return, the doctor who signs up the most patients between fall convention Dr. Brad Stauffer NCPA Legislative Committee and december 31, 2011, will win an ipad 3G with smart cover, and his or her staff will each win a $200 gift card (up to a maximum of three employees).

We occasionally get questions in regard to our continued involvement with husker sports network. The reason why we continue to participate is that the majority of our doctors are in favor of the ncpA having some type of statewide advertising program. After extensive research, this is the most cost-effective and efficient way for us to have some visibility for chiropractic throughout the entire state. demographic statistics also indicate that this is a positive affiliation. in the past, we have investigated using an ad placement agency to place our ads in local markets, and this more than doubled the cost of our current program. in addition, use of the husker sports network allows us to effectively cover the entire state. Affiliation with the university of nebraska also gives credibility to our program, and many nebraskans feel a strong allegiance to the university. in fact, the university of nebraska foundation recently started a fundraising campaign with a target goal of $1.2 billion. (yes, billion!) Affiliation with the husker sports network and the university of nebraska is very positive for the image of chiropractic in nebraska. in addition to husker sports network, we have added a new program to our campaign, an affiliation with the nebraska school Activities Association. The ncpA is now the title sponsor for the Academic All-state Award. These awards are given out in the fall, winter and spring. Approximately 6,000 awards per year are given to outstanding high school students and student/athletes throughout the state. Awards are given based on athletic achievement and 8

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NCPA is now the title sponsor for the Academic All-State Award presented by the Nebraska School Activities Association.

performance in the classroom. These awards are not limited to athletic participation; they are also given for speech, band, music and other nonathletic events. in addition, we will have high visibility on the nsAA website, which receives approximately 16 million hits per month. other tangible benefits of this program include our presence at nsAA championship events, print ad material in state championship programs and television advertising during state championship events. if your local media has not run any type of information about our new sponsorship of this program, there is a recent press release that is available on the nsAA website. please inform them of our involvement and request that they present the material in their respective media outlet. other doctors have done this throughout the state, and chiropractic is getting recognition for this sponsorship. in addition, at the end of each sports season, your local media should be listing the names of recipients of the nebraska chiropractic physicians Association Academic All-state Award. if your local media is not listing the local recipients of this award, please notify them. This is an honor for these students and athletes, and they deserve to be recognized. Thanks for all your support of the marketing program. As always, if you have suggestions, please do not hesitate to contact us. n

With health care reform moving forward, the future of our profession may at some times rest on our ability to mobilize our patients to put pressure on legislators, but that isn’t the only reason it’s so important to get your patients enrolled in chiroVoice. As nebraska doctors, we can now use chiroVoice to make our patients’ voices heard at the state level as well. Recent fights in the nebraska legislature are likely to return; scope of practice for both chiropractic and physical therapy are at a public hearing level and insurance exchanges are being formed. We know that nebraska chiropractors and our patients will need their voices heard, and there is no easier way to make that happen.

Most of us don’t take the time to stop and think how much a change in federal or state law can alter our practice. We need to remember that anything we have today can be taken away, and if we don’t protect our own right to practice, we will have only ourselves to blame.

so, what are we asking of you? Rather than asking your patients to sign up as we have in the past, we need you to help them get onboard. please have your patients fill out the form recently distributed by the ncpA to get information from your patients, and then have your staff enter that information on the chiroVoice site at www.chirovoice.org or fax it to the AcA at the number provided. if your staff enters your name as the doctor on the signup form, then it will count toward the contest. The AcA will be tabulating the results, and the doctor with the most patients signed up between the recent fall convention and december 31, 2011, will be the winner. We realize you are all busy, but that’s exactly the point. We want to make sure you stay that way. Most of us don’t take the time to stop and think how much a change in federal or state law can alter our practice. We need to remember that anything we have today can be taken away, and if we don’t protect our own right to practice, we will have only ourselves to blame. so, please help out in this effort and once again make nebraska a model for the nation by showing the rest of the country how much support there is in our state for chiropractic. please look back at the recent information you received on this program via email from the ncpA for more information. if you need a new copy of the forms, you are welcome to email me at [email protected]. please take the time to think about how much all this can mean to the future of your practice. The time to act is now, not when a crisis develops. by then it will be too late! n

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The Patient Protection and Affordable Care Act On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (PPACA) into law. The overall goal of the new law is to expand coverage, control health care costs and improve health care delivery Dr. Ritch Miller Nebraska Delegate, American systems. Now, various federal Chiropractic Association departments and agencies, most notably the Department of Health and Human Services (HHS), are charged with implementing the mammoth 2,400-page bill, promulgating regulations, rules and directives, which are meant to convey the “congressional intent” of the underlying legislation. With health reform law passed, the focus now turns to implementation. Implementation will be ongoing, multifaceted … we must be aggressive. We must ensure that doctors of chiropractic are fully woven into the fabric of the law. To this end, we will ensure that ACA and Summit partners: • Coordinate and work with Congressional champions and directly with officials in HHS and other agencies to make regulations as strong as possible; • Expand knowledge of and support for Summit priorities among key members of Congress; and • Work with relevant third parties to obtain support for and validation of Summit positions. As the implementation process continues to unfold, ACA Government Relations (GR) remains an extremely

active presence on Capitol Hill and within executive branch agencies. We are advocating on each of the profession’s priority issues and the related concerns that have emerged in recent months. The Road to Implementation ACA GR has submitted comments to the administration on several key items. Among them: • Accountable Care Organizations; • The grandfathering status of health plans; • Proposed rules for bonus payments to primary care providers; • Rules on co-pays for preventive care; and • Development of state-based exchanges. ACA GR has attended meetings with high-level staff members at HHS to discuss issues relevant to the chiropractic profession with regard to health care reform. The most recent meeting occurred in May with the Principle Deputy Assistant Secretary in HHS’ office of Planning and Evaluation. This office will be key in crafting the proposed rules on exchanges and essential benefits. In late April, ACA GR and members of ACA’s leadership met with the HHS Secretary’s office to discuss reform implementation and Medicare issues. ACA presented our case that the Medicare regulation in question is bad for patients, bad for the ability of D.C.s to function within their scope of practice, inconsistent

With health reform law passed, the focus now turns to implementation. Implementation will be ongoing, multifaceted … we must be aggressive. We must ensure that doctors of chiropractic are fully woven into the fabric of the law. 10

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With regard to health care reform efforts, a unified voice from the chiropractic profession is imperative. with overarching Medicare policy and probably an error. The meeting was positive and productive. In early April, ACA GR and members of ACA’s leadership met with the HHS Office of External Affairs. This meeting was facilitated through the office of Sen. Joe Lieberman (I-CT). The Office of External Affairs is an office set up by Secretary Sebelius shortly after enactment of PPACA to serve as a conduit between stakeholders and HHS. While these people are not personally involved in much of the regulation writing, they do communicate with those who do, and assist stakeholders in reaching these people. Continuing to meet face-to-face with administration officials and submitting well-crafted comments in response to proposed regulations are key ingredients to ensuring that doctors of chiropractic are well positioned in the changing health care environment. Ensuring that state organizations are well engaged in reform implementation is imperative; this, of course, includes the NCPA. The ACA’s Health Care Reform Task Force, which I have served on since its inception about two years ago, has developed a comprehensive resource titled “The Case for Full Inclusion” that provides D.C.s with the information and talking points needed to communicate to policymakers the critical and important role that D.C.s can play in improving patient care and decreasing health care costs. “The Case for Full Inclusion” http://www.acatoday.org/content_css.cfm?CID=4445 provides specific guidance for doctors to get involved in the development of state-based insurance exchanges. It also provides a leave-behind document, which clearly communicates how D.C.s can fill the workforce gap and

serve as primary care providers, and it provides talking points on issues ranging from the nondiscrimination provision to the D.C.’s role as a wellness and prevention provider. This resource gives doctors and state chiropractic organizations the tools they need to advocate for the profession on a state level. With recent proposed regulations, HHS is deferring to states on a number of issues. The deference to states makes the involvement of D.C.s on the state level even more critical. It is important to note that “The Case for Full Inclusion” has also been shared with the Chiropractic Summit for review. With regard to health care reform efforts, a unified voice from the chiropractic profession is imperative. That unified voice must adopt universally the persona of the overriding point that chiropractic care is not an add-on; it is not a service; it is a profession of primary care physicians who examine, diagnose, treat, manage, comanage and refer. That unified voice must include supporters, our patients, families and friends by helping them sign up for ChiroVoice at www.chirovoice.org. Those who sign up will receive reminders about when, what and why to contact their elected officials, both state and federal. With a few clicks, they can contact their elected officials automatically. Thank you to the NCPA leadership for making this a priority by having a contest for signing people up. We need this support for both national and state issues. Please make this a priority in your office. Recent and Ongoing Activities (August 2011) • Keeping the membership informed, engaged and empowered will be a central focus of the ACA GR activities for the foreseeable future. Implementation of the health care bill has already begun, and we will need to monitor and respond to various rulemaking proposals for the next several years. • The Summit will be developing a list of action items for state associations to keep them honed and on message during the entire implementation process.

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An Association Discount for Long-term Care Insurance through Northwestern Mutual • Grassroots strategies will be developed and deployed on an “as needed” basis during the implementation process. ACA will continue to issue nationwide grassroots “Alert Bulletins” (also to be used as a “template” by cooperating state associations). • PARCA coalition activities (office visitations, etc.) continue and are ongoing. • Gephardt Government Affairs activities will be utilized to their maximized potential to ensure that our priorities are adopted during the regulatory process. • Series of regular video updates to membership will continue during the implementation process. • Series of regular email updates to membership will continue during the implementation process. • More emphasis placed on ACA avenues of communication (ACA News, Week in Review) in featuring reform-related stories and features. • Continued coordination of all groups and information exchange via the Summit and other communications activities. Key Provisions Included in the Patient Protection and Affordable Care Act • Nondiscrimination in health care; Sec. 2706: No health plan or insurer may discriminate against any health provider acting within the scope of that provider’s license or certification under applicable State law. This will ensure that insurance companies cannot unfairly exclude doctors of chiropractic from practicing under the capacity of their training and licensure on a federal level. Provision is a federal protection applicable to ERISA and other plans established or regulated under the bill. Just as the HIPAA protections now apply across the board, the nondiscrimination provision will be applicable to all health benefit plans, both insured and self-insured. National health care reform is designed to eventually cover 30 million uninsured

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Americans. The nondiscrimination provision will, over time, apply to those individuals. However, that number pales in comparison to the approximately 55% of workers currently covered by self-insured plans who will be affected by Sec. 2706. The potential impact in this regard cannot be overstated. Earlier this summer, the National Association of Chiropractic Attorneys (NACA) categorized Sec. 2706 as one of the greatest legislative achievements in the history of the chiropractic profession. • Community Health Teams; Sec. 3502: D.C.s named as potential members of community health teams to support the development of “medical homes.” These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care. Community health teams are integrated teams of providers, including primary care providers, specialists, other clinicians and licensed integrative health professionals, as well as community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included in these patient-centered and holistic teams. • National Health Care Workforce Commission; Sec. 5101: D.C.s are specifically included as part of the National Health Care Workforce Commission defined as “Health Care Professionals,” and schools of chiropractic are also included in the health professional training schools definition. The Commission is tasked with providing comprehensive information to Congress and the administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs. n

Living into your early 70s used to be common; now increasingly, more people are living into their 80s and 90s. Improved medical care, combined with better nutrition and a more active lifestyle, tends to result in longer and healthier lives. Marty McGuire

While it is encouraging, an extended life brings with it the increased likelihood of experiencing a long-term illness. To effectively preserve our dignity and freedom of choice, tomorrow means carefully considering our options today. Financial Representative Northwestern Mutual

Diagnosed with Parkinson’s disease, actor Michael J. Fox and boxing legend Muhammad Ali remind us that life-altering events can occur at any age. In the end, how well you protect your assets could have much to do with the future happiness and material security of your family. What Is Long-term Care? Long-term care refers to a broad range of services available to individuals who have lost some level of independence and need help with daily activities that most healthy people take for granted. This necessary assistance is often the result of a chronic illness—one in which modern medical science has developed treatments but no cures. Arthritis and Alzheimer’s disease are two common chronic illnesses.

How is Long-term Care Different from Other Medical Care? Rehabilitative medical care due to acute conditions is different from long-term care. When medical care is the result of an acute, or short-term medical condition (e.g., hip replacements, strokes or cancer), a hospital stay is often necessary to help stabilize the condition. If patients have not made a full recovery, they are normally discharged to the care of a nursing facility, or to the supervision of professional home care. With these types of conditions, Medicare (for qualifying individuals) or private-pay health insurance will usually pay for rehabilitative care. When Will Someone Need Care? There is no single way to identify when or if someone will need long-term care. Every case is different due to the type of illness or injury, who can provide the necessary care and the financial resources available. Understanding the types of illnesses and injuries that create the need for long-term care is important. A chronically ill individual generally has either a physical or a cognitive impairment. Physical Impairment Activities of daily living (ADLs) are the most common measurement for physical ability. Most of us take these activities for granted.

“We have found long-term care insurance to be one of the best forms of asset protection available. Anyone 50 years or older should not be without long-term care insurance. Purchasing it at the right age has been one of the best investments we have made.” —Dr. and Mrs. Daryl D. Wills

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The ADLs requiring assistance typically occur in a specific order as depicted in the continuum model below: Bathing

}

Dressing

}

Toileting

}

Transferring

Least Impaired Person

}

Continence

}

Eating

Most Impaired Person

When assistance is needed with ADLs, some individuals may simply require that a health care practitioner remain within arm’s reach to ensure that the activity is completed safely. This is referred to as standby assistance. As the care recipient’s needs increase, someone may be needed to physically assist with completing the required activity. This is referred to as hands-on assistance. Cognitive Impairment When a cognitive impairment exists, individuals are frequently able to complete the physical activities but may not remember how or when to complete them. This level of impairment is usually segmented into three categories: • Short- or long-term memory • Orientation as to person, place or time, and

• Deductive or abstract reasoning. This situation tends to require intervention by a third party to ensure that the activities are completed safely. Common examples of a cognitive impairment are Alzheimer’s disease, senility or dementia. What Can I Do to Protect Against a Long-term Care Need? Maintaining a healthy lifestyle and receiving annual checkups at your doctor’s office are effective ways of minimizing that risk. However, even these steps cannot eliminate a long-term care event from happening to otherwise healthy people, or prevent the normal effects of aging. By working with a knowledgeable and trusted agent, you can learn how long-term care insurance may help protect you against the costs of long-term care. Today’s long-term care insurance policies offers freedom of choice when it’s needed mostand at a fraction of the cost that might be incurred by paying out of pocket. Would You Be Ready? If you or your loved one should need long-term care services, what impact would that have on you and your family? Where would you want to receive care services?

“My financial goals are simple: Invest safely and grow steadily, while ensuring that my family will always be protected and financially sound. Having Northwestern Mutual products in my portfolio ensures solid financial growth, while protecting my family’s future if the unexpected should happen. My wife and I are comfortable knowing our future is secure with Northwestern Mutual and its team of advisers.” —Dr. Michael Christensen

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You have options, and long-term care insurance can help cover the expenses your medical insurance or Medicare may not. NCPA is now pleased to offer Northwestern Long-term Care Insurance coverage as part of your association member benefit package. I will be meeting with members to discuss the new benefit. Please contact me to set up a time to meet, and for more information and details. My number is (402) 390-8246. Association Multi-life Discount Through Northwestern Mutual’s association multilife discount program, member doctors will have access to an additional 5% discount on their long-term care insurance premiums, in addition to the already available 30% spousal or companion discount. Tax Deductibility for Business Owners The deductible limits under Section 213(d)(10) for eligible long-term care premiums includable in the term “medical care” are as follows: 2011 Deductible Limits Age

Deductible Limits

Up to 40

$ 340

41 - 50

$ 640

51-60

$ 1,270

61-70

$ 3,390

71+

$ 4,240

Source: IRS Revenue Procedure 2010-40

Additional Resources Enter the following link to view a 25-minute audio-video presentation about long-term care: http://www.learnaboutlongtermcare.com/ n

2012 NCPA Conventions The dates and locations of both our 2012 conventions are set! Make your plans now to attend. Spring: March 1-4, 2012 CenturyLink Center - Omaha 455 N. 10th St. Omaha, NE 68102 FALL: August 9-12, 2012 Embassy Suites - LaVista 12520 Westport Parkway LaVista, NE 68128

NCPA Articles and Bylaws As you know, SecureCare recently modernized and updated its Bylaws and Articles of Incorporation. In the near future, we will begin a similar project for NCPA Bylaws and Articles. You will be invited to participate in webinars to review the updated documents, ask questions and provide input. The general membership will be asked to vote on the proposed changes.

Thoughts and Ideas Requested We are asking for your feedback, thoughts and ideas regarding our biannual convention report publication. The goal of this publication is to improve communication and provide accurate information based on the NCPA conventions. Please contact Linda Wortman at [email protected] to submit your comments.

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SeCuReCARe

SecureCare Activities and Direction

in An effoRt to coMMunicAte betteR With ouR doctoRs,

you are holding the first issue of a biannual publication, which will be sent out after each convention. We hope that this will keep you better informed of the changes and policies securecare is making to remain competitive in the ever-changing health care marketplace.

it has been my privilege to serve in some capacity on the scc (and ppn) boards since 1999. besides dating myself, it also gave me some perspective on how our company has changed over the last two decades. in my opinion, scc has never been more accurate, transparent, fair and professional than it is today. The challenges we have faced over the last four to five years have enabled us to grow in an environment that has recently been caustic to most chiropractic practices in the united states. securecare currently has almost 1,000 providers in its network throughout nebraska, iowa and neighboring states. We have a unique and successful business model that is being executed by an extremely talented staff. With your continued support and understanding, we will continue to promote and strengthen our noble profession.

understanding securecare’s business model and its business purpose is essential. securecare has two distinct customer sets. first, we serve doctors of chiropractic. our providers need a supportive organization, access to marketcompetitive commercial contracts and support when issues arise. secondly, we serve commercial insurance companies. currently, securecare serves 90% of the commercial market in nebraska. insurance companies look to securecare to provide a comprehensive network of providers whose utilization of patient benefits is appropriately managed. over the course of the past two years, securecare has transformed its entire business process. our providers have

New Coventry Health Care Fee Reimbursement

dr. bill bruening President, SecureCare Ann Bruns

Director of Business Development

Visit SecureCare’s new website at www.securecarecorp.com.

GReAt news for all nebraska securecare doctors! As most of you know, effective August 15, 2011, coventry national network entered into a business agreement with state farm for autoliability claims in nebraska, and reimbursement moved from billed charges to the coventry health care of nebraska fee schedule.

lou Andersen, ceo of securecare, negotiated and then signed an amendment with coventry health care of nebraska that changes the level of reimbursement to “90% of eligible billed charges.” for claims incurred with dates of service after september 15, 2011, going forward you can expect the new reimbursement schedule. some lag time is anticipated on coventry national’s part as it loads the new reimbursement methodology into its payment systems. check your claims carefully as some may have to be reworked. if you have any questions, please do not hesitate to email me at [email protected]. n

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In Practice


realized a significant reduction in administrative friction. The vast majority of our providers are free to care for patients according to their assessment of medical necessity. our utilization management programs focus on a small number of providers. securecare’s unique business model and systems have drawn attention from many other states. At this time, we have plans to expand to iowa, ohio, Kentucky and illinois in an attempt to assist other state associations. As part of this process, we have created several new operating divisions: securecare of iowa, securecare of ohio, securecare of Kentucky and securecare of illinois. n

Accreditation through URAC uRAc is the nation’s largest accreditor of specialty organizations, and for the first time securecare is seeking accreditation for the health provider credentialing program. uRAc, an independent, nonprofit organization, located in Washington, d.c., is well known as a leader in promoting health care quality through its accreditation and education programs. uRAc offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system. They provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, uRAc ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. The uRAc accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards. by applying for uRAc accreditation, securecare is demonstrating a commitment to quality and accountability. securecare fully expects to achieve this symbol of excellence by the end of first quarter 2012. n

In Practice


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S e c u r e C ar e

SecureCare Quality Management Committee Report In response to our current accreditation through URAC, SecureCare has officially established a Quality Management Committee (QMC). The committee includes the following SecureCare members: Scott Misek, D.C. - Director of Quality Management, Mark Knoll, Dr. Scott Misek Director of Quality Management D.C. and Brian Stevens, D.C. The purpose of the Quality Management Committee Program is to guarantee the delivery of the highest quality possible in the level of care and service provided to all members of contracted plans. To ensure this level is achieved and/or surpassed, the QMC will routinely monitor and evaluate several functions of SecureCare, including provider relations, clinical documentation, credentialing and utilization management. To that end,

the QMC will implement Quality Improvement Programs (QIPs) periodically to measure quality, and to pursue opportunities for improvement and problem resolution.

Meet the Utilization Management Committee

Recent quality improvement programs include the development and distribution of provider report cards. These report cards compare and contrast the provider’s clinical profile with his or her colleagues and clinical benchmarks set by SecureCare. Lastly, the Quality Management Committee surveyed the membership on its knowledge and use of outcome assessment tools in its practices, and provided education on this topic during the March 2011 convention.

our insurance partnerships are strengthened. Dr. Mark Knoll and Dr. Scott Misek

The Quality Management Committee is dedicated to providing the best chiropractic network to our insurance partners. We encourage our member doctors to submit ideas for improvement of our network. n

SecureCare Board Application Requirements and Process • Curriculum Vitae (CV). Identifying information to include: Name, education, IPA, all insurance provider affiliations, work and practice history, number of years as SecureCare Corporation (SCC) member, state licenses held, any sanctions or investigations of license. • Full disclosure of any board membership in any other chiropractic or IPA groups, present or past. • Nebraska practice history: When licensed When joined SCC

These committee members represent the leaders of our profession in Nebraska and Iowa whose goal is to create an insurance environment where chiropractic can flourish, while perform the day-to-day UM functions, but our UM committee sets the policy.

Dr. Mark Knoll

UM Committee Chairman

Dr. Bill Bruening, SecureCare President

Dr. Scott Misek, SecureCare Director of Quality Management

Dr. Rand Petersen, SecureCare Vice President

Dr. Mark Hanssen, Past NCPA President

Lou Andersen, SecureCare CEO

Dr. James Abel, SecureCare board member

Dr. Mark Knoll, SecureCare Medical Director

Dr. Russ Van Hemert, SecureCare of Iowa board member

Benchmarks Have Increased • Allowed dollars/visit has increased to $61.00 from $56.00 • Two standard deviations above the mean for allowed dollars/patient for six months has increased to $695 from $675 • This was done in coordination with Blue Cross Blue Shield of Nebraska (BCBSNE) and is due to the 2.5% raise in the Network Blue fee schedule effective July 2011 and the overall increase in the network averages Provider Report Cards

• Same information for out-of-state doctors in their respective state. • Letter from SCC credentialing department stating in good status. • Copy of current state licenses. • Application must include 25 signatures of current SCC members in good standing. Once the application is received and reviewed by staff for completeness, it will be presented to a Recommendation/ Search Committee, which will report to the board biannually (at the spring and fall conventions). The report will include the names of applicants together with the committee’s recommendations. This committee will be appointed by the current NCPA president. The entire board

Utilization Management Update

is required to vote to seat a member. This would be done at the meeting closest to the expiration of a current board member’s term. A majority vote of the board would result in the member being seated. Board members whose terms are up would be required to complete the same application process if they want to be considered for reappointment.

• Reports cards for the January-June 2011 period have been distributed • Please use this reporting tool to compare your practice profile to your peers in Nebraska Goals and Objectives of SecureCare UM • SecureCare UM is a process that controls medical spend, while maintaining fairness for our providers • As new policies are developed and existing policies are improved, the underlying theme and commitment of

the UM committee is to create fair process for all of our providers • The SecureCare UM process oversees 100% of the doctors in our network; however, only 5% of providers are being impacted by its effects Zero Tolerance Policy on Circumventing Infinedi • Infinedi data is used to manage UM and bill our doctors the correct percentage in order to run our business • Safeguards are in place to detect doctors who are not using Infinedi for all SecureCare claims • If a doctor is found willfully circumventing the Infinedi system, it will be grounds for immediate termination from SecureCare Projects to Improve the UM Process for Our Doctors • Infinedi is working on a secure doctor portal where SecureCare doctors will be able to log on with an individual password and view their own data • Infinedi plans to have this operational by mid-2012 n

In Practice


19

In Practice August 2010—July 2011

13215 Birch Drive, Suite 200 Omaha, NE 68164 Phone: 402-934-4744 Toll-Free: 1-877-GO CHIRO FAX: 402-934-4908 www.nechiropractic.org