Spine Manipulation compared to NSAIDS-Spine J Vol 38, No 7 2013

A proposed administrative simplification rule from the Department of Health and Human Services would move the ICD-10 compliance date to Oct. 1, 2014, and establish the long-delayed health plan identifier.

The rule also would adopt a data element to serve as an “other entity” identifier for entities that are not health plans, providers or individuals, but need to be identified in standard electronic transactions. Further, the proposed rule also would require “organization covered” health care providers who are prescribers to obtain a National Provider Identifier.

These are physicians or other practitioners who are not covered entities under HIPAA because they do not conduct standard transactions. The 2004 final NPI rule encouraged these providers to obtain a NPI but did not mandate it. In the new proposed rule, HHS acknowledges pharmacies have had issues with getting claims processed because of the lack of a NPI, a problem that has become more troublesome under the Medicare Part D prescription drug benefit program.

The proposed rule has a 30-day comment period starting the date of publication, followed by a final rule published in due course (no time set). The final rule has an expected effective date of Oct. 1, 2012, contingent on when the rule actually comes out. But by targeting October and only having a 30-day comment period, the feds are looking at a fast-track rule making process. The proposed rule is available here and will be published April 17 in the Federal Register.

---

British Medical Journal Debates Spinal Manipulation; ACA President Comments to ABC News

Last month, the British Medical Journal (BMJ) released two articles debating spinal manipulation. The case against spinal manipulation was led by Neil O'Connell, a lecturer at the center for research in rehabilitation at Brunel University in Uxbridge; and the case for spinal manipulation was led by David Cassidy, DC, a professor in the department of epidemiology at the Dalla Lana School of Public Health at the University of Toronto. Dr. Cassidy is one of the foremost authorities on the safety of spinal manipulation and is also the lead author of a ground-breaking 2008 study published in Spine. Dr. Cassidy's research concluded that there is no greater risk of vertebrobasilar artery stroke following chiropractic cervical manipulation than there is following visits to a primary care medical physician. The study--the most comprehensive to date on this issue--analyzed nine years' worth of data amounting to 110-million person years. It suggests that in very rare cases there are patients with a stroke in progress who seek chiropractic or medical care for neck pain, which is an early symptom. The stroke may follow the chiropractic or medical intervention but is not caused by it.

The BMJ articles also attracted interest from the mainstream press. ACA President Keith Overland, DC had the opportunity to contribute to an ABC News story about the debate. Dr. Overland put the risks associated with spinal manipulation in context by stating that, "There's still a lot of residual bias against the profession ... Yes, there's risk of every medical procedure, but we need to move away from health in a bottle."

For patients who may have questions regarding the topic, ACA offers its members key points to share on the Cassidy study and also a link to a monograph by NCMIC that summarizes research on the topic and helps put the issue into perspective.