The Wisconsin Chiropractor
Fall 2013 The Official Publication of the Wisconsin Chiropractic Association Volume 48, Number 5THE AFFORDABLE CARE ACT IS HERE—SORT OF.
What chiros need to know when the Exchanges go live.
By Barbara Zabawa
REMEMBER THE KALAHARI
Observations and insights from WCA’s annual fall conference
By WCA Executive Director John Murray
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WCA BOARD OF DIRECTORS President Rod Lefler, DC Vice President Brenda Holland, DC Treasurer Marshall Lysne, DC Secretary Eugene Yellen-Shiring, DC Directors
Leo Bronston, DC, District 4 Tom Burlage, DC, District 5
Bruce Davis, DC, District 2 Tom Donohue, DC, District 1
Clint Dorn, DC, District 3 Matthew Johns, DC, District 6
Thomas Kaus, DC, District 1 John Wilke, DC, District 4
WCA STAFF
Executive Director
John Murray
Education & Marketing Director
Jen Wiest
Accounting Manager
Steven Maerz
Communications Manager
Joe P Hasler
Membership & Administrative Services Coordinator
Shaina Krueger
The Wisconsin Chiropractor is the official
publication of the Wisconsin Chiropractic Association, located at:
521 E. Washington Ave. Madison, WI 53703
Educational programs, products or services advertised in this publication do not imply approval or endorsement by the WCA. Material may not be reprinted without the expressed
written permission of the WCA.
Let me start by thanking you, the reader, for opening up this latest issue of the Wisconsin Chiropractor. We put a lot of work into this issue, and we hope that you find it at once informative and readable. I also want to thank the WCA and its members for giving me the opportunity to be your editor. I’m honored to have the
position, and I hope you’re glad to have me. Of course this just the beginning. As I become more comfortable in the position, not to mention more familiar with the chiropractic profession, I hope to return the Wisconsin Chirpractor to its roots as a must-read manual for practitioners here in the state. If more than a decade of utilizing chiropractic care has taught me one thing, though, it’s that miracles don’t happen over night. I’m assessing this publication and making the necessary adjustments. We’ll get there eventually. In the meantime, all I ask for is patience and feedback. Let me know how I’m doing. Thanks again and watch this space for continuuing developments as we attempt to bring you a publication fitting of the WCA’s tradition of excellence and committment to the profession. –JPH
A note from the editor
In this issue
4
5
6
8
10
14
21
23
25
Wischiro News Watch
In Memory Of Economic Survey Results
WCA Help Desk Fall Convention Recap
Guide to Obamacare Take the Pricing Survey Continuing Education Classifieds
Wischiro News Watch
Citing potential cost savings and seeking to avoid taxes and penal-ties from the Affordable Care Act, Governor Scott Walker announced last month that his administra-tion intends to study shifting state employee health benefits from the current competitive HMO model to a self-insured program. Early in October, Walker met with health executives and other stakeholders to discuss the potential switch.
A report last year from Deloitte said the state could save $20 million by paying benefits for state workers directly and assuming the associated
risk of insuring them. Deloitte also reported that Wisconsin’s current model of “managed” HMO competi-tion keeps costs down and saves the state between 4-5 percent per year.
Perhaps most significantly for chiropractors, such a switch could force some of the 236,000 state em-ployees to change health care pro-viders and pay more for services.
“WCA is tracking this proposal closely,” Executive Director John Murray said. “We stand ready to advocate agressively on behalf of our members and their interests.”
Source: Wisconsin State Journal
State to study self-insuring public workers
A proposal by Representative Andy Harris (R-Maryland), a congressman and a physician, would eliminate a key equality-guaranteeing provision of the Affordable Care Act (PPACA). Section 2706 of PPACA prohibits insurers from discriminating against practitioners acting within the scope of their state license, if the insurer covers the services when provided by a different class of practitioner. Harris’s legislation would remove this portion of the new federal health law.
Introduced on July 24, 2013, the bill was referred to the House Committee on Energy and Commerce, where it remains as of press time. No hearings are presently scheduled, but the AMA and other advocacy groups continue to promote its passage.
For the sixth year running, Stan-dard Process, the Palmyra-based producer of whole food nutritional supplements, has landed on the
Wisconsin 75, an annual listing
compiled by Deloitte, which spot-lights the state’s top privately held companies. The 84-year old com-pany has 315 employees and con-tinues to supply safe, high quality dietary supplements made from certified organic produce grown on the firm’s 450-acres of farmland.
HR 2817 Stalled
AMA-backed bill allows
healthplans to discriminate
against chiropractors
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PROVE IT!
Visit www.facebook.com/wichiropractic to “Like”
our page and watch for more from the WCA.
Standard Process
Adds Another Honor
In Memory Of
Wallace Wachsmuth, DC
Wallace “Wally” Wachsmuth received his doctorate of chiropractic from Logan Chiropractic in 1950, following his honorable service in the U.S. Army during the final years of World War II. For 47 years, until his retirement in 1997, he practiced at one of Wausau’s oldest chiropractic establishments. He cared deeply for his patients and for the profession, and was an active leader of the Wisconsin Chiropractic Association.William Borrmann, DC
An original diplomat from the International College of Kinesiology, Dr. William Borrmann practiced chiropractic in Wisconsin for sixty years. A native of Milwaukee, Dr. Borrmann is fondly
remembered in the Fox River Valley as a dedicated caregiver, not only devoted to his work and his patients, but also to his wife, his family and his country.
Galen Scharer, Sr., DC
Dr. Galen Scharer was a devoted family man, farmer, sportsman and a pillar in his community. Much respected in his field, he served the chiropractic needs of the Owen-Rib Lake area for more than four decades before his retirement in 1992. Prior to entering the profession, Dr. Scharer served in Europe during World War II. He attended the
University of Wisconsin and completed his education after the war at Palmer College of Chiropractic in 1948 before opening his practice in Owen.
Chiropractors from every cor-ner of the state converged in six Wisconsin cities this month for their respective WCA District Meetings. Agenda items and ma-jor talking points included acu-puncture legislation and Gover-nor Scott Walker’s self-insurance proposal. According to WCA Executive Director John Murray, who attended all six meetings, the discourse was both pleasant and vigorous and he commended the many members who arrived ready and willing to participate. “These district meetings are a fan-tastic way for WCA members to get to know one another,” Murray said. “More importantly, they provide the opportunity to come together and discuss the issues facing the chiropractic profession.”
Murray reported that all six district meetings were well-attended and productive, and he encouraged members to consider checking out future gatherings.
On behalf of the WCA, Murray also congratulated Doctors Clint Dorn, Brenda Holland, John Wilke and Gene Yellen-Shiring, all of whom were re-elected to represent their regions on the WCA Board of Directors for the next two years.
Board reps re-elected at District Meetings
1923 - 2013
1927 - 2013
1924 - 2013
Dr. Clint Dorn addresses the Northeast District Meeting at Titletown Brewing Co. in Green Bay.
Legal action targets 46 Minnesota Chiros
Illinois Farmers Insurance Co. has filed a $1.9 million lawsuit in federal court alleging 46 chiropractors and an Edina, Minn.-based MRI firm colluded to defraud Minnesota’s no-fault car insurance system. The allegation claims practitioners ordered unnecessary medical procedures in exchange for kickbacks—disguised as fees for leasing phones, fax machines, copiers, equipment and internet access—from Mobile Diagnostic Imaging. According to the complaint, Mobile Diagnostic Imaging paid more than $220,000
to practitioners on a so-called “Chiro Roster” in payments ranging from $700 to $15,400. Insurance officials in Minnesota blame the state’s no-fault insurance law, which requires insurers to pay up to $20,000 for medical expenses related to auto accidents, regardless of who or what caused the damage.
Unlike its neighbor to the west, Wisconsin operates under a tort system. This means, in the event of a car crash, someone must be deter-mined to have caused the accident.
The Numbers
Income
Increased Income Decreased Income Was Level
33% 33% 34% $350,000 $500,000 $261,000 $320,000 $291,000 SE SC SW NE NC NW $261,000 $103,140 $118,424 $90,917 $99,595 $102,000 SE SC SW NE NC NW $95,684 $103,596 $65,545 $86,833 $74,348 $112,000 $106,826 $118,839 $117,548
2013 Economic
Survey Results
Total Respondents: 161
Income Trends 2013 v. 2012Top DC Income By District
Avg. DC Income By Experience
Avg. DC Income By District
Wis Avg.
$61,533 $120,971 $61,400 $143,217 $108,500 $82,125 $78,071 $112,696 $116,000 $98,500
SE SC SW NE NC NW
$141,000 $83,600
2006 2007 2008 2009 2010 2011 2012 2013
Avg. DC Income By District/Gender
Avg. DC Income 2006 to 2013
$66,074 $122,523 $81,000 $123,714 $97,400 $100,476 $102,667 $79,182 $81,000 $126,000
Avg. DC Income By School/Gender
Sole
Practitioner
DC
as
Associate
DC
PartnershipinDC
Ind. Contractoris$107,458 $58,846 $163,417 $61,000
Avg. DC Income By Practice Type
The Numbers
2013 Economic
Survey Results
The Numbers are only as
good as the sample size.
The more responses, the
better the data.
---Please take a moment
to fill out and return
the 2013 WCA Pricing
Survey on p. 21
North-western National
Palmer Logan Other
Female/MaleFemale/MaleFemale/MaleFemale/MaleFemale/Male Female/Male
Female/Male Female/Male Female/Male Female/Male Female/Male
$102,525
WCA Help Desk
Q
: A patient visited my clinic on a recent Monday morning suffering from significant
lower back pain, which first arose following a work-related accident the week
be-fore. Over the weekend, before she saw me, the patient had visited an urgent care clinic,
where an MD prescribed her medication for pain relief. I began chiropractic treatment
Monday, but the next day human resources at the patient’s employer informed her that
because she had already seen a doctor—the urgent care MD who prescribed the pain
medication—her visit to my office, and subsequent treatment for the injury would not be
covered under Worker’s Compensation. Her employer also informed her that she should
see an occupational therapist instead. Is this legal and what can be done if it is not?
Q: What Is PQRS?
The Physician Quality Reporting System (PQRS) program is a Medicare reporting system whereby eligible professionals, including doctors of chiropractic, report data on condition-specific measures for covered Physician Fee Schedule services. The Patient Protection and Affordable Care Act made participation in PQRS mandatory beginning in 2015. Providers who participate in the PQRS program between 2011 and 2014 are eligible for incentive payments if they successfully perform and satisfactorily report data to the Centers for Medicare and Medicaid Services (CMS) regarding quality mea-sures related to their Medicare patients. Conversely, providers who are not satisfactorily participating in PQRS by the 2013 reporting period—from Jan. 1, 2013 to Dec. 31, 2013—and beyond will face a penalty of having their Medicare reimbursement decreased by 1.5 percent beginning in 2015. In 2016, the payment decrease will be 2 percent and will be based on PQRS reporting in 2014.
Q: How Do I Participate?
No registration is required to begin participating in PQRS. It is best to start by familiarizing yourself with the qual-ity measures doctors of chiropractic need to report.
These measures are:
• Measure #131: Pain Assess-ment and Follow-Up
• Measure #182: Functional Outcome Assessment
To receive an incentive bonus for par-ticipating in PQRS, you must report sat-isfactorily on both measures. You must also successfully perform both measures. To participate in PQRS you will be asked to place G codes on your claim. The G codes will correlate to an action that was taken (or not taken) by the provider. You will need to report Measures 131 and 182 on every visit, for every Medicare patient who is at least 18 years old, where you have reported CPT code 98940, 98941, or 98942. In 2013, you must satis-factorily report on both measures at least 50 percent of the time, and successfully perform each measure at least once, to qualify for the incentive bonus.
Q: What Measures Do I Report?
Measure #131: Pain Assessment and Follow-Up
The purpose of this measure is for CMS to collect data on when a pain assessment is conducted, using a standardized tool, and a reassessment is planned when pain is present. Examples of standardized pain assessment tools include, but are not limited to: Brief Pain Inventory, Faces Pain Scale, McGill Pain Questionnaire, Multidimensional Pain Inventory, Neuropathic Pain Scale, Numeric Rating Scale, Verbal Descriptor Scale, Verbal Numeric Rating Scale, and Visual Analog Scale.
Providers are asked to report wheth-er they provided a standardized pain assessment to the patient and if they documented a follow-up plan which includes a reassessment of the pain (when pain is present). A follow-up plan must include a planned time to reassess the patient for pain and may also include documentation of future appointments, education, referrals, or notification of other care provid-ers, as applicable.
Mind your PQRS
WCA demystifies the
four-lettered enigma
Measure #182 Functional Outcome Assessment
The purpose of this measure is for CMS to collect data on when functional outcome assessments are conducted, using a standardized tool, along with the creation of a treatment plan based on the deficiencies found. Examples of standard-ized functional outcome assessment tools include Oswestry Disability Index, Roland Morris Disability/Activity Questionnaire, Neck Disability Index and Physical Mo-bility Scale. Documentation of a current functional outcome assessment must include identification of the standardized tool used. The use of a standardized tool assessing pain alone, such as the visual analog scale, does not meet the criteria.
Providers are asked to report whether they conducted a functional outcome as-sessment of the patient and whether they documented a care plan when functional outcome deficiencies have been identified. A care plan describes expected/planned activities based on identified deficien-cies. The intent of the measure is for the functional outcome assessment tool to be utilized at a minimum of every 30 days, but reporting is required each visit due to coding limitations. Therefore, for visits occurring within 30 days of a previously documented functional outcome assess-ment, the code G8942 should be used for reporting purposes.
A
: No. This is not legal. Patients have the right to see whichever health care
provider they choose, provided the treatment is medically appropriate. When
issues pertaining to Workers Compensation arise, WCA advises that the patient
contact the Wisconsin Department of Workforce Development directly and request
to speak to an administrative law judge (ALJ). This is accomplished by calling the
Workers Compensation Division main line at 608-266-1340. The patient is able to
speak to the the ALJ regarding their rights under workers compensation and pose
questions related to the specific situation they face. Of course, as always, we encourage
chiropractors, and/or chiropractic office staff, to contact the WCA first with any questions.
WCA Help Desk
G8730 Pain assessment documented as positive utilizing a standardized tool + documented follow-up plan. Provider assessed patient for pain using a standardized tool, documented a positive assessment and also documented follow-up plan specifically stating a planned reassessment of pain.
G8731 Pain assessment documented as negative, no follow-up plan required. Provider assessed the patient for pain, documented a negative assessment. No additional documentation required.
G8939 Pain assessment documented, follow-up plan not documented, patient not eligible/ appropriate. Provider assessed patient for pain using a standardized tool, documented a positive assessment, but did not document a follow-up plan because the patient was not eligible due to one of the following reasons:
•Patient unable to express himself due to severe mental and/or physical incapacity;
•Patient is in an urgent or emergent situation and delayed treatment could jeopardize patient’s health.
G8442 Documentation that patient is not eligible for a pain assessment. Provider documented patient was not eligible for a pain assessment. Patient not eligible due to the following reasons:
•Patient unable to express himself due to severe mental and/or physical incapacity;
•Patient is in an urgent or emergent situation and delayed treatment could jeopardize patient’s health.
G8732 No documentation of pain assessment, reason not given. The provider did not assess the patient for pain and there is no documentation the patient was not eligible.
G8509 Documentation of positive pain assessment; no documentation of a follow-up plan, reason not given. Provider assessed patient for pain, documented a positive assessment, but did not document a follow-up plan or a reason the patient was not eligible.
G8539 Documentation offunctional outcome assessment using a standardized tool and documentation of a care plan based on identified deficiencies on the date of the functional outcome assessment. Provider performed a functional outcome assessment, using a standardized tool, and documented a care plan, including goals based on the deficiencies found.
G8542 Documentation of a functional outcome assessment using a standardized tool; no functional deficiencies identified, care plan not required. Provider performed a functional outcome assessment, using a standardized tool. No documented care plan because no functional deficiencies identified.
G8543 Documentation of a functional outcome assessment using a standardized tool; care plan not documented, reason not given. Provider performed a functional outcome assessment, using a standardized tool, but did not document a care plan.
G8942 Documented functional outcome assessment and care plan within the previous 30 days. Provider has documented a functional outcome assessment, using a standardized tool, and a care plan, including goals based on the deficiencies found, within the last 30 days.
G8540 Documentation that the patient is not eligible for a functional outcome assessment using a standardized tool. Provider documented patient was not eligible for a functional outcome assessment. Patients are not eligible due to the following reasons: •Patient refuses to participate
•Patient unable to complete the questionnaire
G8541 Functional outcome assessment using a standardized tool not documented, reason not given. The provider did not perform a functional outcome assessment and there is no documentation the patient was not eligible.
2013 Fall Convention Recap
H
ow would I describe theWCA Fall Convention, my first as your new executive director? Initially, I could sum it up in one word: Exhausting. From Thursday to Sunday, we managed to bring you four days of high value education offerings, riveting speakers, vendor engagement and networking opportunities. After the festivities died down and the WCA staff and Board of Directors finally caught its collective breath, we had
the opportunity to reflect on the weekend and reassess what went down in the Dells. As a result, another one word description came to mind: Gratifying. Over the next few pages, I’ll tell you five reasons why. And when you’ve finished with my take, I encourage you, as always, to provide your own feedback. Improving the convention and trade show and keeping it worthwhile for WCA members is a priority of mine, but I need your help in that process.
Record attendance
Nearly 500 attendees saw firsthand the value our annual Fall Convention. As usual, our education programs were a major draw. In the always evolving health care landscape, staying on top of new requirements and rising trends is crucial. To that end, the WCA strives to provide members and nonmembers alike with the opportunity to learn from true experts and renowned1
leaders in their respective fields. In addition to our exceptional education line-up, though, we also brought in an impressive cast of marquee speakers (See No. 2) and assembled a trade show featuring a diverse mix of product and service vendors from across the country. The location, Kalahari Resort in the Wisconsin Dells—with its waterpark, on-site entertainment and stellar amenities—didn’t hurt, either.
Marquee Speakers
Hosting the Chancellor of the Palmer College of Chiropractic was an honor in and of itself. We were hugely fortunate to have Dr. Dennis Marchiori address our gathering, and his message was spot-on. His presentation on building a chiropractic identity was a call to arms for for the profession in 2013 and offered valuable direction for every DC in the room. Of equal importance is what his attendance says about the relationship between
the WCA and Palmer. As a statewide membership association that
draws many of its members from that esteemed institution, having a collaborative relationship with the leadership and students there is critical to our success. Having Chancellor Marchiori with us at the Kalahari only strengthened an already strong bond.
Dr. Michael Simone, Chairman of the American Chiropractic Associ-ation, also graced our convention with his presence and shared his
By John Murray, WCA Executive Director
2
valuable perspective on the nation-al chiropractic scene. He stressed the importance of strong, mem-ber-driven organizations such as the ACA and the WCA. A strong collaborative partnership with the ACA will be critical going forward as the profession enters some very choppy political, regulatory and economic waters. Throughout the weekend, Dr. Simone remarked several times that he was immense-ly impressed with the energy and enthusiasm of our state association and its members.
Financial success
You read the heading correctly. The WCA Fall Convention and Trade Show was a financial success. Why does it matter? Let’s start with a clarification: The WCA is a non-profit organization. This means every penny generated beyond cost goes straight back into the products and services we provide to you as members. When you attend a WCA education program, you invest in yourself in more ways than one. By filling our vendor
space and maximizing convention sponsorships, we make our convention a success and generate the critical resources required to provide the many other products and services you expect from the WCA. I thank you for attending our fall convention and trade show, and for investing in a strong state chiropractic association.
Transparency &
Accountability
A key concern, expressed by many WCA members both to me and to the Board of Directors, is
3
4
Clockwise from top left: Trade show scene, CT of the Year Melissa Gaffney, John Murray and Nutri-Dyn’s Ron Ehli, WCA Members chat.
For the complete WCA Fall Convention Photo Album
the need for greater transparency and accountability. That’s the main reason we scheduled the annual meeting of the WCA, express-ly required in the associations bylaws, during the best-attended day of the convention, at the most convenient time of day, during our annual awards luncheon.
As WCA members, you have every right to know how your state association is run. You deserve the opportunity to ask questions of the people you have empowered to run it. I
compare it to the annual share-holder meeting of the Green Bay Packers where shareholders can direct questions at the people running that organization. Our members asked a number of excellent questions during the meeting. The discussion was robust and constructive. I en-courage members to attend the annual meeting at future fall conventions, and urge you all to bring your questions and ideas on how to ensure WCA contin-ues to serve your needs.
Personal relationships
Call me old school, but I still believe in the handshake. It was an immense pleasure to finally meet so many WCA members in person. Looking your new executive director in the eye and voicing your concerns directly to him is a critical step in getting to know and learning to trust the man you’ve chosen to lead your association. I look forward to continuing the many dialogues we started together at this year’s fall convention.
5
T
his fall, a new era in healthcoverage began. Starting on October 1, individuals and small businesses began purchasing health insurance through the so-called “Insurance Exchange” for coverage beginning January 1, 2014. The initial open enroll-ment period runs until March 31, 2014. After that, open enrollment periods for the Exchange will occur annually between October 15 and December 7. The first day of 2014 also marks the date on which the Affordable Care Act requires most individuals in the United States to have health in-surance or face a penalty on their tax return. In 2014 that penalty could be the greater of $95 or 1 percent of taxable income. Pen-alties increase gradually to the greater of $695 per adult or 2.5 percent of taxable income in 2016.
For chiropractors, the Exchang-es bring opportunity for acquiring
new patients and helping shape the delivery of health care to bring more value to the system.
The Benchmark Plan
Wisconsin’s Benchmark Plan is the largest plan by enrollment in the largest product by enroll-ment in the small group market in Wisconsin. That plan is offered by UnitedHealthcare and is dubbed the Choice Plus Definity HAS Plan
A92NS. Importantly for
chiroprac-tors, the Benchmark Plan covers chiropractic care for manipula-tive treatment. It does not place any limitations or restrictions on manipulative treatment provided by chiropractors. Therefore, any of the Qualified Health Plans offered on Wisconsin’s Exchange must, at a minimum, offer the same cov-erage for chiropractic care as the Benchmark Plan. Qualified Health Plans are free to offer additional benefits, but, at the very least, all the plans offered on the Exchange
must cover unlimited manipulative treatment by chiropractors.
Wisconsin’s Benchmark Plan also covers outpatient rehabilitation ser-vices, such as physical therapy. Such services are limited to 20 visits and must be performed by a “Physician” or by a licensed therapy provider. The Benchmark Plan defines a physi-cian as “any Doctor of Medicine or Doctor of Osteopathy who is prop-erly licensed and qualified by law.”
The Wisconsin Chiropractor’s Guide
to the Affordable Care Act
By Barabara Zabawa, WCA Legal Resource
The Benchmark Plan defines
“Manipulative Treatment” as:
The therapeutic application of chiropractic and/or
osteopathic manipulative treatment with or without
ancillary physiologic treatment and/or rehabilitative
methods rendered to restore/improve motion, reduce
pain and improve function in the management of an
identifiable neuromusculoskeletal condition.
Inside This Guide
Which Plans are Where? p. 15
What’s a Qualified Health Plan? p. 15
Exchange Enrollment Outlook p. 16
Maximizing the Exchanges p. 17
Source: Office of the Commissioner of Insurance
Common Ground Healthcare Compcare Health Services Dean Health Plan
Molina Healthcare WPS Health Plan (Arise)
Waukesha County
Dean Health Plan Group Health Coop. Physicians Plus Unity Health Plans
Dane County
Compcare Health Services Security Health Plan WPS Health Plan (Arise)
Marathon County
Gundersen Health Plan Health Tradition Health Plan
La Crosse County
The variety of plans available on the Exchanges differs on a coun-ty-by-county basis. Here are some of the offerings Wisconsinites will find in a selection of six counties. For the comprehensive list of every health plan provider in all 72 Wisconsin counties, please visit www.wichiro.org. Health Tradition
Security Health Plan
Eau Claire County
Common Ground Healthcare Compcare Health Services Molina Healthcare
WPS Health Plan (Arise)
Winnebago County
Which plans are where?
A Qualified Health Plan is an insurance plan that is cer-tified by the Exchange, provides Essential Health Bene-fits and follows established limits on cost-sharing. The
Essential Health Benefits are ten categories of
bene-fits that constitute the minimum level of coverage that insurers in the individual and small group markets must offer beginning January 1, 2014. The following service categories comprise the Essential Health Benefits:
1) Ambulatory patient services 2) Emergency services
3) Hospitalization
4) Maternity and newborn care
5) Mental health & substance use disorder 6) Prescription drugs
7) Rehabilitative & habilitative services/devices 8) Laboratory services
9) Preventive/wellness services & chronic dis-ease management
10) Pediatric services
Insurers must not impose annual or lifetime dollar limits on Essential Health Benefits. The Affordable Care Act requires plans offering individual and small group coverage must provide coverage of Essential Health Benefits, but exempts large group plans (i.e., more than 50 employees) from offering such coverage.
However, if a large group plan covers any Essential Health Benefits, the plan is prohibited from imposing annual or lifetime dollar limits on those benefits. To provide direction as to whether a package of benefits meets the Essential Health Benefits standard, the Af-fordable Care Act requires each state to have a “Bench-mark Plan.” All plans in the individual and small group markets in a state must offer, at a minimum, benefits that are substantially equal to the benefits offered in the Benchmark Plan, including covered benefits, lim-itations on coverage, and prescription drug benefits.
Exchanges
Explained
Federal rules define the “Ex-change” as a governmental agency or non-profit enti-ty that meets the applicable standards and makes Qual-ified Health Plans available to qualified individuals and qualified employers. Indi-viduals and Small Business-es will be able to accBusiness-ess the Ex-change through the website www.healthcare.gov.
Exchanges may be operated in one of the following three ways:
1) by the State (State-Based) 2) by the Federal government (Federally-Facilitated Exchang-es, or “FFEs”)
3) by a State-Federal partner-ship (State-Partnerpartner-ship Ex-changes).
The three methods of operation offer different levels of control to states, with the most con-trol going to States that choose the State-Based model and the least control going to States that select the FFE model. On November 16, 2012, Wisconsin selected the FFE model, mean-ing that the federal govern-ment will establish and operate the Exchange. Wisconsin is far from alone: more than half of the states have opted for FFEs.
(See “Exchanges“ on page 18)
However, the Benchmark Plan notes that “any podiatrist, dentist, psy-chologist, chiropractor, optometrist, clinical social worker, marriage and family therapist, nurse practitioner, professional counselor or other pro-vider who acts within the scope of his or her license will be considered on the same basis as a Physician.” Thus, as long as a Chiropractor acts within his or her scope of practice, he or she could provide and be reimbursed for outpatient rehabilitation services of-fered through plans on the Exchange.
Indeed, state statutes prohibit insurers from excluding coverage for diagnosis and treatment of a condition by a chiropractor acting within the scope of his or her license if the plan covers diagnosis and treatment of the condition by a licensed physician or osteopath. In addition, the Affordable Care Act added language to the Public Health Service Act, which, similar to Wisconsin law, prohibits discrimi-nation by an insurer of practitioners acting within the scope of their state licenses—such as chiropractors—if
when provided by a different class of practitioners.
It is possible practitioners could use this provision to argue for equal reim-bursement for covered services that are provided at the same level of qual-ity, but such use remains to be seen. It should also be noted that a bill was introduced by Representative Andy Harris on July 24, 2013, H.R. 2817, to repeal Section 2706. The ultimate fate of that bill is unclear at the moment. In any event, any plans offered in the Ex-change that cover services provided by an MD or DO should also cover those services if provided by a Wisconsin-li-censed chiropractor acting within the scope of his or her license.
Enrollment Outlook
Just how many Wisconsinites will enroll through the Exchange?
In September the Wisconsin
State Journal reported there may be
about 800,000 Wisconsinites seeking coverage from the Exchange. Of that group, about 500,000 are currently uninsured.
Another 180,000 buy
500,000
Uninsured Wisconsinites
180,000
Insured, but likely to switch
92,000
Transitioned from Badgercare
25,000
On soon-to-be defunct HIRSP
800,000
insurance seekers
Exchange Enrollment Outlook
Who are they?
source: The Wisconsin State Journal
insurance on the individual market and may begin
switching over to the Exchange after October 1, 2013 to
take advantage of premium tax credits and cost-sharing subsidies (discussed below). Approximately 25,000 of those residents will be switching from Wisconsin’s current high-risk insurance plan, HIRSP, which ceases to exist on December 31, 2013. Finally, approximately 92,000 people will be shifted from Medicaid to the Exchange
because of Wisconsin’s new Medicaid eligibility standards created in the last state budget. The new eligibility standards lower income eligibility for adults in the BadgerCare program to 100 percent of poverty level, or about $11,490 annually, down from 200 percent, or about $22,980 a year; however, about 82,700 childless adults who make less than the poverty level would be added to the program.
These 800,000 individuals are possible insured patients for chi-ropractors, depending upon how
popular the Exchange becomes. How many of these 800,000 actually participate in the Ex-change will depend upon a number of factors, such as the availability of health plans on the Exchange, the cost of those plans, and promotional efforts/assis-tance offered to help people buy coverage on the Exchange.
The Wisconsin Office of Com-missioner of Insurance (OCI) recently released information about the number of Wisconsin plans expressing interest in participating
(Obamacare continued from p. 16)
(See “Obamacare” on page 19)
The Exchanges present two
unique opportunities for chiro-practors to enhance their practice.
First, chiropractors should take advantage of the Affordable Care Act requirement that Qualified Health Plans must ensure network adequacy. This standard is set forth in 45 CFR §§ 156.230. Specifically, this section requires Qualified
Health Plans to maintain a network that is sufficient in the number and types of providers to assure that all services will be accessible without unrea-sonable delay. The Centers for
Medicare and Medicaid Services (CMS) will monitor network adequacy through complaints filed with the agency; thus, con-sumers who complain to CMS that a Qualified Health Plan does not have sufficient types of providers in the plan may
subject that plan to CMS review. Hence, if a consumer believes
that a Qualified Health Plan has an insufficient number of chiropractors in its network, the consumer can complain to CMS which may prompt the plan to increase the number of chiropractors in its network.
Second, the Wisconsin Benchmark Plan covers not only manipulative services provided by chiropractors, but also any covered service that would otherwise be covered if per-formed by a medical doctor or osteopathic physician, so long as that covered service falls within a chiropractor’s scope of practice. Under Wisconsin law, the scope of practice for chiropractors is more limited than for medical doctors or osteopathic physicians. For example, Wis. Admin. Code §
Chir 4.05 prohibits chiroprac-tors from prescribing drugs or administering substances sub-cutaneously. Chiropractors are also limited in the types of im-aging services they may pro-vide. Even though prescription drugs and many imaging services would be covered under the Benchmark Plan, because chiropractors are un-able to provide those services, patients will not benefit from receiving those services from chiropractors until the scope of practice for Wisconsin chiropractors is broadened. At a time when hundreds of thousands of patients are likely to gain insurance cov-erage through the Exchange,
chiropractors can seize the moment by expanding their scope of practice to meet an increased demand for quali-ty health care service.
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(Exchanges Continued from p. 16)
There are also two types of Exchang-es relating to who the Exchange servExchang-es:
1) Individuals
2) Small Businesses (otherwise known as the Small Business Health Options Pro-gram, or “SHOP” Exchange).
Starting in 2014, individuals can select from a number of health plan options coverage. Within those plan options an individual must choose a desired amount of cost-sharing. This amount depends upon whether an in-dividual chooses a Bronze Plan (which pays 60% of healthcare expenses), a Silver Plan (the plan pays 70% of healthcare expens-es), a Gold Plan (meaning it pays 80% of healthcare expenses), or a Platinum Plan (which pays 90% of healthcare expenses). Individuals will be responsible for cover-ing the remaincover-ing percent of health care expenses, up to a maximum out-of-pock-et amount for all plans for in-nout-of-pock-etwork coverage. That maximum out-of-pocket limit functions as a cap on the amount in-dividuals must pay towards deductibles, coinsurance and copayments. It does not apply to premiums, non-covered services, or cost sharing for out-of-network pro-viders. The out-of-pocket-limit is tied to the limits in high-deductible plans that are eligible to be paired with a Health Savings Account. Those limits are cur-rently about $6,000 for self-only cover-age and about $12,000 for family covercover-age. In 2014, small businesses (employers with fewer than 50 employees, as defined in Wis-consin) may offer a single health plan option from the choices available in the Federal-ly Facilitated SHOP Exchange, rather than a choice of plan options. Starting in 2015, small employers will be able to offer
quali-in the Exchange and the percent increase in premium payment in the individual market. In all, 13 insurers in Wisconsin applied to be Qualified Health Plans in the Individual Exchange and 9 insur-ers applied to be part of the SHOP Exchange.
According to the 2013 Wisconsin Health Coverage Option Report by Citizen Action of Wisconsin, based on this participation level, 100% of all Wisconsin citizens will have at least two insurance company options available to them on the Individual Exchange. Dane and Fond du Lac counties will have the highest number of plans from which to choose at six each. It should
be noted that although United Healthcare and Humana did not express interest in participating in the Exchange in 2014, both companies have expressed interest to participate in 2015.
Although the expressed interest in participation by Wisconsin insurers is robust, the recent premium data released by OCI appears much grimmer. According to the OCI, insurance rates will vary based on a consumer’s age and where they live. The highest percent increase will be experienced by younger insured individuals in Madison. For example, a 21-year-old person in Madison will see a 124.85 percent increase in their premium from 2013 to 2014,
whereas a 63-year old person in Kenosha will only see a 9.72 percent increase in premium.
Critics of the OCI’s calculations are quick to point out that the percent increases do not account for the premium tax credits or cost sharing subsidies that will be available to consumers whose income ranges from 100 to 400 percent of the Federal Poverty Level, or roughly $11,490 to $45,960 for individuals and $23,550 to $94,200 for a family of four. The premium tax credit can be paid directly to the individual’s insurance company to help reduce the cost of health insurance for that person or family.
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(See “Obamacare” on page 20) (“Obamacare” continued from p. 17)
For example, according to a premium tax credit calculator available on the Kaiser Family Foundation website, a family of four—2 adults and 2 children— making $80,000 per year are at 340 percent of the Federal Poverty Level and could receive a tax credit of approximately $3,900, which would cover about 34 percent of the projected $11,547 unsubsidized annual premium for 2014.
In addition, consumers with incomes up to 250 percent of the Federal Poverty Level—$58,875 for a family of four in 2013—may be eligible for cost-sharing subsidies that can reduce the amount consumers pay in deductibles,
coinsurance and copayments. Thus, after one factors in premium tax credits and cost sharing
subsidies, the overall increase in premium may not be as high for some consumers as the OCI data initially suggests.
To help promote the Exchange and assist consumers in
determining their eligibility for public assistance, the Affordable Care Act also set aside funding for Navigators and Application Counselors and Assistors. These persons may not sell health insurance or provide advice to consumers about which health insurance plan best meets their needs, but they may guide
consumers through the Exchange
website and familiarize them with how the Exchange works. The interest level and participation by consumers in the Exchange depends upon the success of the Navigator and Application Counselor program, as well as efforts by health care providers, insurers, the State of Wisconsin and other interested groups. The more consumers that know about the Exchange and their obligations to purchase insurance coverage under the Affordable Care Act, the more likely they are to buy insurance coverage. For chiropractors, that may translate to more insured patients and reimbursement for services
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2013 Pricing Survey
1) What is your office’s ZIP code?
2) How many DCs in your office do these prices apply to?
3) Please fill in your price list for each service that was in effect on
June 1, 2013
. Your list
price is the undiscounted price that would usually be charged to a worker’s compensation
or insurance carrier with who you DO NOT have a managed care agreement.
*Please write an actual number. Do not write “all”.
Instructions:
Complete the survey and remove this page. Return (by fax, email or mail) to the WCA
Fax: 608.256.7123 Email to: [email protected] Mail: 521 E. Washington Ave, Madison, WI 53703
DUE BY FRIDAY, DECEMBER 13, 2013
This price survey is being conducted under Federal Trade Commission (FTC) guidelines. All responses are completely confidential. Results will be published in the Wisconsin Chiropractor.
Professional Care
98940 $ 98941 $ 98942 $ 98943 $New Patient Exam
99201 $ 99202 $ 99203 $ 99204 $ 99205 $
Radiology
72040 $ 72070 $ 72100 $Re-examinations
99211 $ 99212 $ 99213 $ 99214 $ 99215 $Procedures and Modalities
97012 (Traction/Mechanical) 97014/G0283 (Electrical Stimulation) 97035 (Ultrasound) 97110 (Therapeutic Exercises) 97112 (Neuromuscular Re-education) 97140 (Manual Therapy Techniques) S8948 (Cold Laser) $ $ $ $ $ $ $
Guest Column
Do you want to give your athletes that winning edge in the fourth quar-ter? Do they require an extra ingre-dient to make the difference between winning and losing?
Environmental toxins, one of the most serious culprits affecting an ath-lete’s ability to perform at an optimum level also happen to be one of the most elusive. This is their intrinsic nature. For instance, we often disregard things such as the packaging in which our food comes, the air that we breathe, or the shampoo that we use to wash our hair. But according to a report in the October 22, 2010 Science magazine, “70 to 90 percent of disease risks are probably due to the differences in the environments.”
These environmental toxins come primarily from two categories—chemi-cals and metals. They accumulate in the body from taking medications or ingest-ing preservatives in foods. Exposure to pesticides, air pollutants and harmful/ hostile settings where toxic compounds are present can also allow toxins to become trapped in the fatty tissue of the human body. These toxins come from a variety of sources, but the initial exposure actually begins while a baby is still in the womb. And the threat is very
concentrations of one specific toxin, Bi-sphenol A, and the occurence of type-2 diabetes and reduced testosterone levels.
So what other toxins affecting the athletes? In its 2009 Fourth National
Report on Human Exposure to Envi-ronmental Chemicals, the Centers for
Disease Control and Prevention state that more than 212 chemicals have been found to be present in the blood and urine of most Americans.
According to the CDC, the six most widespread chemicals found are:
1) polybrominated diphenyl ethers
(PDEs), used as a flame retardant;
2) Bisphenol A (BPA) found in
plastic products;
3) PFOA, used on nonstick cookwares; 4) acrylamide, found in food cooked
at high temperatures;
5) mercury, found in seafood; 6) MTBE, second-hand smoke.
Fortunately, the liver serves as the body’s natural detoxification plant. It supports the physical process of excret-ing harmful toxins once they have been neutralized in the body, thus reducing the chance that they will recirculate and re-main in the body. In a healthy body, tox-ins, which are fat soluble, are transported from the intestine to the liver. Once in the liver, the they undergo Phase 1 detoxifi-cation, which begins the to neutralization process. Any unneutralized toxins then move into Phase 2 detoxification, which transforms the residuals into water solu-ble compounds.Finally, the newly trans-formed toxins are transported to either the kidneys or to the gall bladder, where they are excreted where they are excreted via urine or feces, respectively.
In a toxic body, though, these accumulated toxins are released back into the blood stream as an athlete starts to exercise and sweat. Both
In an unhealthy liver, toxins are unable to be detoxified at the speed that they are brought to the liver. In these cases, toxins build up and re-circulate in the blood, contributing to long-term poor health. These unneutralized, fat-soluble toxins can be stored in the body tissues such as fat, brain and nervous system, resulting in ongoing systemic symptoms and decreased athletic performance.
A number of symptoms indicate the presence of excessive toxins. These include, but are not limited to fatigue, lethargy, weakness, depression, head-aches, irritablility, cognitive difficulties and generalized muscle aches. All of these symptoms affect an athlete’s abil-ity to train and focus, not to mention play on game day.
As a solution, in my office I uniformly recommend a program utilizing the UltraClear Renew, and the effects on the athletes have been tremendously positive. This medical food has specific nutrients that are required to support all phases and organs of detoxification. Coupled with a proper detoxification dietary intake, athletes can safely remove toxins from their bodies and
im-By Dr. Robert Silverman
Detoxification for Athletes: The key to a winning performance
Robert Silverman, DC
In a toxic body
accumulated toxins are
released back into the
blood stream when an
athlete starts to exercise
and sweat. Both health
and performance are
impaired as these toxins
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FEBRUARY
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MARCH
Continuing Education
C.E. SPOTLIGHT:
Mastering ICD-10 w/ Jeff Wilder, DC
Effective Oct. 1, 2014, all health care providers must report diagnostic codes with the new ICD-10 system. Approxi-mately 140,000 ICD-10 codes will replace the existing 17,000 ICD-9 codes. In addition to this massive increase in code quantity—as well as an entirely new organization scheme— chiropractors must acquire such novel skills as recording the causation of diagnosis, laterality of extremity conditions and familiarity with European medical terms. Providers who fail to properly report with this new system may fall short on documentation requirements for insurers, as well as the state and federal governments.
Presented by Barbara Zabawa For DCs & CTs Eau Claire Presented by Robert Silverman, DC 12 CE HRSfor DCs Milwaukee Module 4 Presented by Jeff Wilder, DC 8 CE HRS for DCs & CTs Brookfield Presented by Barbara Zabawa For DCs & CTs Eau Claire Presented by Jeff Wilder, DC 8 CE HRS for DCs & CTs Green Bay Presented by Stevie Martin for DCs & staff Brookfield Presented by Steve Fridinger, DC 12 CE HRSfor CRTs Eau Claire Session 4 Multiple Presenters 4 CE HRS for DCs Green Bay Presented by Brenda Holland, DC for CTs Brookfield Presented by Jeff King, DC 4 CE HRS for DCs & CTs Brookfield Presented by Jeff Wilder, DC 8 CE HRS for DCs & CTs Eau Claire Presented by Christoper Murray, DC 14 CE HRS for DCs Madison Presented by Christoper Murray, DC 14 CE HRS for DCs Brookfield Presented by Brenda Holland, DC for CTs Brookfield Presented by Wendy Varish, DC 6 CE HRS for DCs & CTs Brookfield Presented by Jeff Wilder, DC 8 CE HRS for DCs & CTs Wausau
Stay tuned for more information on the
2014 WCA SPRING CONVENTION
For the complete WCA Continuing
Education calendar, additional
information on programming, and
registration materials, visit www.
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WCA Classifieds
Practice For SaleLooking to take control of your business future? Make it happen with this chiropractic opportunity in Madison. This fully furnished chiropractic clinic has all you need to start practicing tomorrow: Two adjusting rooms with tables, X-ray room (machine included), exam room and space for rehab or nutritional counseling. Past-patient files included. Owner relocating to pursue other business opportunities. Price is negotiable. Madison is a progressive city receptive to alternative healthcare. A DC can make a good living there. Email practice.for.sale.madison@ gmail.com to seize this chance.
Practice For Sale
Schermerhorn Chiropractic, an established practice on South Avenue in La Crosse is for sale. Doctor practiced activator, acupuncture, diversified and physiotherapy techniques. 1500 active cases. Stand-alone structure, with half of building rented out. Five car off-street parking.
Relief Coverage
Practice relief and coverage available. This includes but is not limited to vacations, maternity/medical leave, etc. Northwestern Graduate. Currently studying for a Diplomat in Chiropractic Neurology. Contact for availability and rates. Currently licensed in MN, WI, MI, OH, IN and PA.
Practice For Sale
Located in the Hudson area. Part-time cash practice. Open 12 days per month. $94,209 gross revenues with approximately $60,000 net income. $70,000 total price. Contact Loren or Eric Martin: 952-953-9444.
Practice For Sale
SE Wisconsin—Doctor retiring in prosperous city. Practice open 3 days/week. $138,107 gross. Very low overhead, $454/month rent. Call Loren Martin for information: 952-953-9444.
Practice For Sale
Well established practice for sale in Central Wis. Same location for 25 years. Office designed for DC practice. Includes two treatment rooms, examination room, X-ray room, private office, office manager space and reception room. Well-equipped with Zenith Vertilift tables, examination table, two Dynatron 850 electrotheraphy units, Summit 300/125 X-ray and a Konica SRX 101A processor. Ample storage and additional office space. EHR compliant. Patient records and billing systems all electronic. Daily notes using voice recognition software. Practice compensation in form of cash, Medicare, and various third party payers. Collection rate over 90 percent. Doctor will stay for an orderly transition. Email lysnecare@wi-net. com or call 715-824-2347 for details.
MORE CLASSIFIEDS ON P. 26
•La Crosse area. DC retiring. Building Included.
•North central. 23-year old Gonstead practice.
•Eau Claire/Chippewa Falls. •Hudson. Cash practice. 18 hours/wk. •SE Oconomowoc area. Solid practice. •SE. DC retiring. Very low overhead.
3 days/wk.
•Wausau area. Family referral. $215,786 gross.
Loren or Eric Martin,
Practice Op Inc.
Ph. 952-953-9444
[email protected]
PRACTICES
FOR SALE
In Wisconsin
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Associate Wanted
Immediate opening in our beautiful Milwaukee facility. State-of-the-art equipment. Responsibilities include: treating patients, conducting evaluations, taking digital X-rays, working collaboratively with neuro- and orthopedic surgeons, and being in contact with patient’s nurse case managers and lawyers. Excellent people skills required. Must be professional and enjoy working with a wide range of patients. Qualifications: Female doctor with 5 years of experience—Wisconsin licensed and in good standing—Previous experience with Worker’s Compensation and PI highly recommended—Bilingual is a plus. Please email a Resume or CV to [email protected].
Associate Wanted
Oak Creek Relief & Wellness seeks a D.C. to assist with evaluations, X-rays taking and line marking. The perfect situation to collect a weekly paycheck while also looking for work or waiting to take a board exam. Interested individuals should email [email protected].
Associate Wanted
Two doctors with more than 50 years of combined experience seek an associate for the office in South Central Wisconsin. Clinic has established patients, staff and EHR-compliant equipment in place. We offer a base salary/percentage of collection for excellent income potential. Experience is preferred, but not necessary. We will train the right candidate for this once-in-a-lifetime opportunity. Please send your resume and cover letter to [email protected].
Associate Wanted
Looking for an energetic team player to perform X-rays, examinations and ancillary procedures. Some front desk responsibilities. Compensation based on experience. Send cover letter and resume to [email protected] or fax to 608-826-0996.
Associate Wanted
The Wellness Center at Gress Chiropractic in Merrill is adding an associate to busy subluxation-based, family-focused practice. The right DC will be licensed, outgoing and caring. Excellent communication skills a must. Good salary, generous bonuses based on production and benefits. Visit ChiroKidsWi.com for more info. Email resume to kategress@ gmail.com or fax to 715-539-9098.
Associate Wanted
Downtown Milwaukee Clinic seeks an independent contractor or associate chiropractor. Interested individuals should email a cover letter and resume to [email protected].
Associate Wanted
Modern, busy clinic in NE Wis. seeks an associate state of the art, multi-doctor practice. Located in Oshkosh. Barely an hour to Milwaukee, Madison and Green Bay. Excellent income potential. For information, contact [email protected].
Associate Wanted
Duties to include: examinations, digital X-ray studies, overflow adjustments and vacation coverage. Volume 325-350 pv/wk, M to Th. No regular screenings or long weekends. Learn to be run a quality practice. Current associate will train. Interested applicants send resume and cover letter to [email protected]; Please do not contact office.
Seeking CT or CRT
Kettle Moraine Health Center seeks a Chiropractic Technician to assist for 10-16 hours per week, afternoons and early evenings. X-ray certification preferred. New hire will participate in administering therapies, preliminary examinations and case histories, as well as other responsibilities as they arise. The practice is located in Delafield, Wis. To apply, send an email rv309@ centurytel.net or call 262-646-2123.
Billing/Office Manager Wanted
Billing/Office Manager needed for Madison Westside office. Must be friendly, outgoing and detail-oriented. Familiarity with Medicare and Medicaid billing procedures a must. Resumes and a cover letter should be sent to: Office Manager, PO Box 46012, Madison, WI. 53744.
Business Opportunity
Tired of doing it all? Want to sell or merge your clinic to our group? CHIROPRACTIC COMPANY is looking to expand in the Milwaukee-Waukesha-New Berlin area. Be a part of the future. If interested email us at [email protected] and let’s start the conversation.
Business Opportunity
Join the fastest growing subluxation-based chiropractic group. AlignLife is a national chiropractic organization providing comprehensive wellness systems, marketing campaigns, business management and national branding. Gain the benefits of a group while maintaining full ownership. Turnkey Clinic Conversions & Start-Up Opportunities. Visit TheDreamPractice. com or dial 877-254-4654. Don’t Wait! Call Today—Gain Prosperity Tomorrow.
Equipment for Sale
X-Ray machine, processor and X-ray Cassettes—$1500 obo. High-voltage Pulsed Galvanic Stimulator. Two Gonstad tables. Gonstad Cervical Chair. Stainless steel rolling cart. Heel Anatometer traction table (with attachments). All equipment in good condition. Seeking best offers.
Office Share
Established practice in Kenosha has an office sharing opportunity available for the right licensed chiropractor. Call 262-945-1106 for more information.
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Please call Account Executive Jason Dumke with any questions. He can be reached by phone at 262.945.4400 or email [email protected].
We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc. ∗ Based on a NCMIC policyholder survey conducted by Ward Group, the leading provider of benchmarking and best practices research studies for insurance companies. For more information about Ward Group, visit www.wardinc.com. ©2013 NCMIC NFL 3520
We
Back in 1946, NCMIC was formed by a group of chiropractors with the express purpose of offering malpractice insurance to D.C.s at a time when no one else would.
More than 40,000 D.C.s know they can count on NCMIC—a company created by chiropractors and for chiropractors.
Our Own
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don’t just take our word for it. In a recent survey, 95 percent of our
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