AMERICAN COLLEGE OF
CHIROPRACTIC CONSULTANTS

OFFICIAL NEWSLETTER
Volume 3 Issue 1 - Fall/Winter 2002

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Executive Board: Dan Bowerman, DC President Jeffrey Cates, DC - VP Gerald Cicero, DC - Secretary Scott Becker, DC - Treasurer Tom Snyder, DC - Past Pres. This newsletter is a service of the American College of Chiropractic Consultants and is designed to provide readers with pertinent information concerning the College, its examining board (ABCC) and utilization management activities. Readers may save and use information contained therein only for personal use. No other use, including reproduction, transmission or editing, of the newsletter information may be made without the prior written permission of the ACCC, which may be requested by contacting the ACCC headquarters. ACCC makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information printed within, and the ACCC assumes no responsibility or liability regarding the use or misuse of such information.The opinions expressed in the ACCC newsletter are not necessarily those of the College. Advertisements appearing in the ACCC newsletter do not imply approval nor endorsement. Providers should consult their respective state licensing boards concerning the use of advertised products or services.

FALL CONVENTION The 2002 convention was held in Charlotte NC and was a well attended, rousing success. The topic was honing the skills of an expert and focused on understanding current concepts in evidence based practice.   Study Finds CCP Guidelines  Unsuitable for Use in Chiropractic Practice Jeffrey Cates, DC lead a team of respected doctors, all with research backgrounds, on a search for a usable guideline evaluation tool. The "Appraisal Instrument for Clinical Guidelines" (also known as the Cluzeau instrument) was identified as a reliable and valid method of guideline evaluation. Application of this appraisal tool in the assessment of the CCP and Mercy guideline documents revealed the CCP guidelines score to be notably lower than the Mercy Guidelines. On the basis of the results of the guideline appraisals, the CCP document was not recommended for use in clinical practice. The Mercy guidelines were recommended with the proviso that new scientific data be considered.  The CCP Guidelines scored poorly as compared to the Mercy Guidelines  The study has been published in the JMPT and can be access at the link below. Evaluating the quality of  clinical practice guidelines. Cates JR, Young DN, Guerriero DJ, Jahn WT, Armine JP,  Korbett AB, Bowerman DS, Porter RC, Sandman TD, King RA.

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Man Loses Leg and Suit Against HMO

A man lost part of his leg after his health maintenance organization refused to let his doctor treat him. He has posthumously lost his bid to sue the plan.

The 5th U.S. Circuit Court of Appeals held on Dec. 9 that determining whether a doctor is a primary-care physician or not is an administrative, not medical, decision, and any suit challenging such determination is pre-empted by the Employee Retirement Income Security Act (ERISA). Haynes v. Prudential Health Care, No. 01-60801. 

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HIPAA Has Drs. Groping in the Dark

On Dec. 4, OCR released its first significant guidance on the rule since the Bush administration gutted the privacy regulation in August.  Most insurance company regulations were stripped from the program leaving only a bureaucratic mess for doctors and hospitals. Many doctors and administrators are confused as to the requirements. 
                     For information on HIPPA compliance please go to http://www.hhs.gov/ocr/hipaa/privacy.html

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 More on Guidelines!

Clinical practice guideline on the use of manipulation or mobilization 
in the treatment of adults with mechanical neck disorders
Gross AR, et al.  Manual Therapy.  November 2002; Vol. 7, No. 4, pp. 193-205.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12419654&dopt=Abstract

Purpose:  An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cervicogenic headache.  Pain, function, patient satisfaction and adverse events were appraised.

Methods:  The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used.

Results:  Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief.  While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect.  Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone.  Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest.  Based on weak evidence, estimates for serious complications for manipulation ranged from one in 20,000 to five in 10,000,000.

Recommendations:  Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain.  Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise.  The risk rate is uncertain. 

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Life University loses CCE Accreditation
Fails to Measure up to CCE Standards

  Life University lost its chiropractic accreditation on June 10, and on Oct. 20, a three-member panel from the CCE refused Life ' s appeal to lift the revocation.

Following the school ' s loss, Life founder Dr. Sid Williams accused the CCE of trying to steer the chiropractic profession into the larger realm of medicine by limiting the types of philosophies being taught in America ' s chiropractic institutions.

Near the end of the letter, the CCE maintains that it acted properly in its decision to strip Life of its chiropractic accreditation. "What sometimes seems lost in all of the consternation and political rhetoric is that the Commission on Accreditation was doing the proper work of an effective accrediting body," the letter reads. "The COA had been addressing concerns with (Life) for over seven years; that despite intense COA efforts to assist the program toward compliance, a lack of improvement led to eventual public sanction; that further stern communication and progressive COA action did not result in compliance with the Standards."  (Source Marietta Daily Journal)

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