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November 2006

  
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COCSA Rejects CCGPP Draft

In a stunning and bold move the Congress of Chiropractic State Associations (COCSA) has unanimously rejected the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), Low Back Draft.  This rejection comes in spite of the fact that COCSA was the group that commissioned the committee (CCGPP) in the first place.

Members of the CCGPP made a detailed presentation to the delegates of COCSA this past week resulting in many questions and some pointed concerns.  Many of the delegates were concerned that the draft document, called the Low Back Draft, but referred to on the CCGPP website as "Chiropractic Best Practices" was far from a representation of the practice of chiropractic and made much of subluxation and wellness care being outside the idea of a "best practice".    The concern was that this document as presented would be the catalyst for malpractice suits, Board actions, and severe claims reductions for a large segment of the practicing population. 

In order to act on their concerns, the members of COCSA created the statement below and voted unanimously to adopt this as their current stand.

CONGRESS OF CHIROPRACTIC STATE ASSOCIATIONS

November 11, 2006

The organizations comprising the membership of COCSA cannot support the current draft of the CCGPP low back document, and agree that it should not be published as distributed for review.

The COCSA member organizations recommend to the COCSA Board that CCGPP consider the suggestions collected during the forum provided at the Annual Meeting of COCSA November 9-10, 2006 in Baltimore, and attempt to incorporate the following:

  1. Consider the written recommendations received and make appropriate revisions to the current draft to allow for the concerns, additions and omissions to be considered and follow this procedure for future drafts.
  2. Change the name of the Document to truly reflect the intent and appropriate use of the document.
  3. Ensure expanded input allowing the duly elected CCGPP representatives to truly act as liaisons between member organizations and the CCGPP Board.
  4. Consider redrafting the document’s overview and introduction to make it easier to read and understand, including a shorter, more concise narrative, written in non-academic language with bullet points for better understanding.
  5. Provide that the process remain open to allow other organizations and researchers and concerned stakeholders be included in the process.
  6. Consider rewriting the research compilation to make it more user friendly to those affected.
  7. Ensure that the commentary process will be well advertised in advance so that the stakeholders will be fully engaged.
  8. In the absence of higher levels of evidence and research, consider the use of the clinical experience and case studies/course studies.

Among the many areas of concern was the section of the CCGPP document that dealt with x-ray.  This section basically made the taking of x-rays for any other purpose but the search for pathology, a non acceptable practice.  This would mean that chiropractors who took x-rays for structure, or the determination of subluxations would be outside these guidelines.  (see article below)

This vote does not mean the CCGPP efforts are dead.  Since its inception this group has obtained outside funding and now works autonomously of COCSA, the association who first formed the CCGPP. 

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ICA Calls for DC Review of Chiropractic X-ray Guidelines for Subluxation Assessment

Below is a letter by Dr, Deed Harrison, with a follow up by ICA president Dr John Maltby.  The intent of this letter is to summon chiropractors who care about the correction of subluxations to take action and participate.  Please read the letter below and participate.

Dear ICA Colleagues and Friends,

If you take x-rays for the analysis and/or quantification of spinal subluxation then you need to take action and we need your assistance. We recently completed a comprehensive Spinal Radiography Guideline for Subluxation Analysis in Chiropractic Practice. These guidelines are termed:

Practicing Chiropractors’ Committee on Radiology Protocols (PCCRP) for Biomechanical Assessment of Spinal Subluxation in Chiropractic Clinical Practice

These guidelines are in direct competition/opposition to current attempts to restrict Chiropractic Radiography to “Red Flag Only” cases. Do you want to be outside the ‘standard of care’ for taking x-rays for subluxation assessment? If not please go to www.pccrp.org and review the guidelines and COMPLETE THE SURVEY. On the home page there are instructions for you.

The PCCRP guideline committee performed a comprehensive literature search (1963 references in total) and prepared the 350 page document. The PCCRP guidelines are the Evidence Based Support for subluxation analysis via x-ray as performed by a large percentage of practicing chiropractors.

We need you to evaluate these guidelines and complete a survey for us at www.pccrp.org.  Without a large number of completed surveys from Practicing Chiropractors, these guidelines will not have the impact that is needed.

The PCCRP committee did their part and now it’s time for Practicing Chiropractors to assist by completing the SURVEY at www.pccrp.org.  Together we can make a difference.

Respectfully submitted,

Deed E. Harrison, DC
PCCRP Guidelines Chair

PS:

This is without question, ICA’s highest immediate priority. We not only want your input, it is needed to complete this vitally important mission. Your cooperation is sincerely appreciated.

Yours in Service,
John K. Maltby, DC, FICA
ICA President

 

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"Chiropractic Best Practices" My Two Cents.

Having just returned from the recent Congress of Chiropractic State Associations (COCSA) meeting in Baltimore, I can tell you that the topic of concern was the "Low Back Draft" submitted by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP).  This document, which  is called "Best Practices" and can be found and reviewed from the CCGPP site at www.ccgpp.org has been the hot topic in chiropractic and has drawn much condemnation from a growing list of organizations and experts in chiropractic. 

I will leave the review of this document in the capable hands of those who have studied it in more detail than I, as I had my fill of that sort of work in the first go around with the Mercy Document.  But, what I'd like to vent about is the concept itself of guidelines or best practices. 

First, let me start out by saying that I'm curious if the term best practices means the best practice, as in a doctor's practice, or the best procedures in a practice.  In reading over the CCGPP document, I started to doze off long before I was able to answer that question.  However, I believe the term refers to the overall practice.  If this is the case, I do not understand the need for a 163 page document to determine the best practices.

It seems to me, that if you want to determine the best practices, just look at the busiest ones!  Hey, aren't the best restaurants the busiest ones. Ok, so you say you want it to be evidence based, well then just go and taste the food.  Patients are the ultimate determination of what is best.  So if we want to see what constitutes a best practice in chiropractic, just look at the busiest ones!  If you do you will find that they are almost all exclusively subluxation based.  Additionally, you will find that these real best practices are largely or entirely cash practices.  This means that the people who really count, the patients, pay for their chiropractic care at these real best practices.

The second thing that gets me in the whole CCGPP document thing is who died and made these so called experts supreme fat cats over what was a best practice?  Has anyone been to their practices?  Do they see a volume of people, or are they too busy telling the rest of the profession what they should be doing to have a best practice?

Why are some people of the mind set that the public is so stupid that they could not determine what a best practice looks like.  Here's a hint.  If I go to a restaurant, and the food and/or service is unacceptable, I don't go back, and neither will anyone else.  If I like the food, I return and send others.  The best restaurants are usually busy!

This may sound overly simple, but sometimes we seem to get so caught up trying to impress scientists that we forget that it is the patients who really count.  If we apply the same scientific criteria to the logic of having a document, can anyone show proof that the creation of guidelines has made patient care better? (I mean for the patient, not the insurance carrier who wants guidelines to cut claims.) Is there evidence that those who use the Mercy Guidelines help more people?  I would think just the opposite.

These exercises in academic masturbation have never gotten one patient better.  In fact I know they have prevented thousands from receiving the chiropractic care they needed by denying benefits and creating a situation where care was stopped because some reviewer, with a document told the patient the care wasn't medically necessary.

So, for me there is a simple solution.  Let's form a commission of mathematicians to create a real chiropractic "Best Practices".  All these experts would have to do is COUNT!  When they found the ten busiest chiropractic practices, we know what really constitutes a "Best Practice."

 

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Chiropractic in the News

Want to know what is going on in the world of chiropractic?  Don't have time to review the world wide web for all the news on chiropractic?  To help keep you informed, Now You Know offers this "Chiropractic in the News" section in each edition of The Information Age email newsletter. This feature provides the title and links to the various news items of interest to chiropractors. To see the actual articles, please click on the headline links below.

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NYK Upcoming Seminars and Shows

We would like to thank the many associations, organizations and groups that have us speaking on their programs. Dates permitting, we would love to participate at your Association or Society convention as well. If you are interested in having us at your program, please contact us at either nowyouknow@nowyouknow.net or call us at 1-800-695-8937. Below is a list of programs and speaking engagements we have scheduled in the near future.

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Now You Know Internet Educational Services

Now You Know Websites:  Now You Know is the largest provider of individual websites to the chiropractic profession. Our website service includes your choice of 33 templates, over 800 pages of content, "Ask the Experts" videos, and many other educational features that make an NYK website the best value in patient and community education. Check out the ever growing list of features on our website at: www.nowyouknow.net,  then click on "Website Service".

Now You Know Email Newsletter Service: The NYK email newsletter delivers current and hard-hitting articles on health and chiropractic issues emailed directly to your patient's inbox.  If you want to keep your patients informed, this email newsletter service is unsurpassed in chiropractic.  But there is more.  The NYK email newsletter service is really two services in one!  With the NYK email newsletter service, subscribers can also easily send bulk emails out to their entire patient list. So, with the NYK email newsletter service, not only do your patients get the great stories and articles from the NYK Newsletter, but they can also get updates created by you!

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