The American Chiropractic Association drops position paper on Surface EMG based upon review by Marcarian
The American Chiropractic Association's position paper on Surface EMG has had a major impact on both insurance reimbursement and even State Policy with regards to the adoption of Surface EMG. In June, in a response to a denial (you can access all denial responses in the "members only" section by registering and being approved. It is in the upper right of the website). When I received a recent denial referencing the ACA Position Paper denying payment, I took a look at their references. It turns out they were referencing the American Academy of Electrodiagnostic Medicine's Position Paper (written by Pullman, et. al. 2000) on Surface EMG. This Position Paper has been retired by the American Academy of Electrodiagnostic Medicine due to the fact that Pullman literally ignored 40 plus studies in his review. With the main scientific reference no longer valid, I wrote the ACA informing them that their position paper was not supported by their own references, threatening them with legal action if they did not respond. You can see (below) that within 10 minutes, the ACA removed their position paper from their website, placing "under review" where the position paper once was.
The ACA's removing it's negative position paper now opens the door for those receiving denials to be paid for their DynaROM evaluations, and further bolsters the American Medical Association's Position that Range of Motion without Dynamic EMG (DynaROM) lacks the sensitivity and specificity required to evaluate for true injury."
You can access the actual website by clicking HERE.
Watch short video showing a real clinical case of traditional endpoint Range of Motion vs. DynaROM on a real patient.
Paradimg shifts are difficult
It is so wonderful to see how many doctors have realized that each and every time they send a traditional ROM report vs. a DynaROM report they are hurting their cases. The paradigm shift to DynaROM has changed the outcomes for patients throughout North America, as muscle guarding is crucial in evaluating for soft tissue injury. Furthermore, it helps establish lack of injury was well as injury itself, and aids determining when the patient is at MMI. Congrats to all you doctors integrating this new mindset into your practices. Not that it matters, but the fact that it pays 5 times more than ROM in around the same testing time is definitely a benefit.
Patients always wonder if the instruments Chiropractors use are accurate and reproducible. This video shows a simple test that gives you instant credibility!
One of the greatest advantages of Static sEMG over Thermography is the fact that it measures muscle activity, something they can "feel" and you can "show." Watch this 10 second video!
Watch and Learn!
We've been indoctrinated into believing that the LOUDER and more PASSIONATE we are about our beliefs, the more likely patients will “buy in.” Watch this video and see if you can figure out what patients are trying to tell us when they say they "love this video."
So what is it that patients love? They can relate; it speaks their language. The bottom line: They don't care about your beliefs. They care about what you're going to do for them. People have become very data driven, which is why just TELLING them isn't enough anymore, you must SHOW them. MyoVision has produced the only research-based, reproducible Static sEMG on the market. It is the "Electronic Digital Palpation" tool, it's objective, shows patients what you feel and allows you to track progress over time. E-Scan data puts the patient in control of their healthcare. Give them this control and they will trust you.
By making Subluxation tangible, you no longer need to explain yourself or your value to your patients. Think of the E-Scan system as the "EKG for Spinal Health."
MyoVision's E-Scan has just received approval from one of the most prestigious hospitals in the world (yes, they are using the MyoVision Static sEMG in a hospital setting) as well as validation from the research department at a major University. So why wait? Capitalize on the "Evidence-Based Paradigm." A single test takes only 30 seconds - quick and painless!
You want your patients to understand you, so communicate in a way they can comprehend - using E-Scan; it's fast, easy and visual. Now, with the ability to send all your contact info directly to their smartphones, they'll PROUDLY show their friends and family how smart they are for not choosing just any regular Chiropractor, but a Chiropractor with a high tech vision - MyoVision to be exact!
Self-proclaimed expert, Andy Lewis, posted an attack on Chiropractors claiming the MyoVision was just another example of the "uneducated making false, unsupported claims." His distinct purpose was to attack the Chiropractic profession. Marcarian ensured his ineffectiveness.
I was asked by a doctor to respond to this Quackometer blog post, which states "It would appear that the device appeals to chiropractors as it gives a scientific veneer to an unvalidated diagnostic... The MyoVision device would not be the only type of questionable diagnostic procedure undertaken by chiropractors." I am still surprised at how few know about my victory against the State of Florida and all the insurers in the US. The win in this case put an end to the question "Is MyoVision valid?" In Merritt vs. DOH, it was myself and a very committed DC, Dr. Richard Merritt against the State of Florida (300 insurers and a slew of expert witnesses including an M.D.. Ph.D). After testimony from all expert witnesses, the Judge concluded that the tool was, in fact, valid as used by Chiropractors. Yet, blog sites like this continue to spread misinformation.
I have to give Mr. Lewis credit though; He did allow me to post my response to his unscientific claims. The basis of his claims, like all so-called experts, is they believe needle EMG is the only EMG (and the gold standard). Just do a quick PUBMED search and you'll see there are over 4 times more research studies published on the use of Surface EMG vs. Needle EMG, yet, like all pseudo-scientists, they prefer to spew their dogma vs. actually spending the 30 seconds it takes to do the PUBMED search.
Want to learn the truth? In the comments section of the "Myovision scans and chiropractic" blog post, I referenced 70 research papers that he claimed did not exist. If you would like a list of these papers, please email me: David@myovision.com. Read below for my response:
" It is important be educated when reviewing any device for its validity and credibility. I would gladly help you understand better the utilization and technology required for Surface EMG measurements. You state that “Surface EMG” usually uses “needles” which is patently false. If you do a literature review using the term “Surface EMG” via PUBMED you will find 7,560 references. Are all these published researchers using the term incorrectly and all the scientific journals published the word “Surface” when they meant “needle?” Obviously not.
Do you find the latest Gallup Poll on Chiropractic disturbing? Do you want to do something about it? I do.
The Answer? WWBJD!
Both the 2012 and 2014 Gallup Poll asked the public "how would you rate the honesty and ethical standards of people in these different fields?” In the category “very high,” MDs were rated at 70%, while DCs were rated at a paltry 38%.
Why is this when just 15 years ago MDs and DCs were rated more closely? What has changed? What are we doing wrong? What are they doing right? It seems unfair. We know as Chiropractors, we are the best at spinal healthcare, yet despite this, the public perception does not seem to agree.
We have spent a fortune on all different types of marketing campaigns, including endorsements from well-known sports figures, so why have we not broken beyond that 5-6% of the population? Perhaps we are asking the wrong question. Maybe we should be asking "what would B.J. do?"
How did B.J. Palmer take chiropractic from non-existent to the largest alternative healing profession in the US in 6 years?
In 1924 Chiropractic was relatively unknown. By 1935, Chiropractic became the top alternative healing art in the US. So, what did B.J. do to alter the course of Chiropractic forever? Although B.J. Palmer was probably one of the best at palpation to exist; he knew the importance of "show over tell" when it came to influencing the population. In addition to marketing campaigns - via radio - he knew that testing each and every patient with the Neurocalometer would have a major influence on how patients perceived Chiropractic. Science, at the time, was growing and the need for scientific tools was something he capitalized on.
Was B.J. the first to capitalize on the "Evidence-Based Model?"
There were those that did not like "how" it was presented, but all recognized conceptually, that it worked. It was significantly better than palpatory findings alone.
Though some did not like "how" it was presented, all recognized, conceptually, that it worked. It was significantly better than palpatory findings alone.
So what does this all have to do with the Gallup Poll? B.J. was ahead of his time: He listened. He heard that science was trumping belief systems and we needed to "tech up."
Surface EMG 2.0: Paraspinal Scanning sEMG now is reproducible, has solid control group research studies, and is "the EKG For Spinal Health."
The study below was published in an actual peer-reviewed, high quality journal. It found statistically significant differences between those with chronic low back pain and controls.
You're the experts on Soft Tissue Injury. You are a natural at not only diagnosis, but treatment as well. All you have to do is to prove it. DynaROM Motion sEMG provides the proof.
It is completely understandable that the average Chiropractor prefers to avoid PI in their practice. Why? Oh, so so many reasons.
Time for a wake up call!
I'll start with the last one first. Really? You're going to deny patients who need you more than ANY patients? Those injured in auto accidents, with the most serious of soft tissue injury..that thing you are absolutely best at treating your skilled hands? Forget about the fact that you have more latitude in how often and for how long you see PI patients, but the fact that you as a doctor are needed, and don't feel obligated to help is kind of a way of ignoring your most important oath.
Why is PI perceived as a "dirty game"? Because it has always required we do things which we know are unethical for the purpose of obtaining patients. Some pay for a list of DMV accident records. Some spend time and money taking attorneys to dinner. There are all kinds of "tricks". The best trick of all, is to have tools which prove your value to attorneys. This way you don't have to chase them down, but they chase you down.
Change the game from opinion vs opinion to data vs. opinion.
Attorneys tell me all the time, that they prefer to work with MD's over DCs. I started to ask. "Clearly the public perception is that the MD has more credibility over the DC" is what I heard. Is this the case for the DC armed with objective data? Not at all. As a matter of fact, doctors that used to fear being before a jury or even in a deposition now gladly accept such challenges, as they have their trusty DynaROM Data to protect them and their patients.
Focus on the data, and opinion means nothing. Literally.
By Allen Fraley, DC and David Marcarian, MA
In yet another attempt to limit patient access to chiropractors, The State of Florida’s Department of Health placed on a list of “invalid diagnostic devices” the technology underlying the MyoVision’s DynaROM System. This rule change was devastating to the profession, as this new tool had the power to prove not only the need for chiropractic care, but it’s effectiveness as a treatment. If the lobbyists for the insurers won, it would end this budding technologies impact on juries, limit insurance settlements, and ultimately negatively impact patient care nationwide. Chiropractors would have limited access to PI patients, as the evidence-based model's implementation requires that objective data be provided.
Dr. Richard Merritt, a DC from Lakeland, FL decided to challenge the State. He contacted all the experts on the technology in the Chiropractic Profession, and the only to respond was David Marcarian, inventor of the MyoVision.
Insurers had seen the MyoVision technology's impact on settlements and were going to do everything in their power to invalidate it. In a major blow to the Chiropractors case, the State joined forces with over 300 insurers, 75 attorneys and the resources to put an end to this argument for good. A loss to the State and the insurers meant Chiropractors would lose the right to protect patients rights to chiropractic care due to the fact the evidence-based model was quickly becoming the norm.
The task was daunting: How would David Marcarian and Dr. Richard Merritt prevail against all odds? As is typical, everyone underestimated the knowledge of those from our profession:
Marcarian presented over 40 research studies, all supporting the use of the technology. Knowing the State of Florida and the insurers would most likely appeal the decision, the judge spent a year in producing the ruling that the technology was indeed valid, thus approving it as a diagnostic device.
According to Judge Cleavinger: "this technology has been shown to be useful in the evaluation of spine pain in much the same way EKG’s have become indispensable for chest pain evaluation”.
The insurers and the State of Florida failed to convince the Superior Court to overturn the decision, and apparently the Supreme Court rejected their appeal.
The impact this case has had on Chiropractic patients throughout the United States has been monumental, leading to a major win for the Dream Team.
Prior to this case, insurers could successfully argue that normal range of motion findings were justification to cut off care, even when the doctor placed in his or her notes that the patient experienced pain and muscle guarding.
With the patented DynaROM Motion sEMG technology, the ability to measure muscle guarding is a game changer, giving patients with normal ROM the right to maintain care.
The “legal game” of PI isn’t what it used to be, thanks to the dedicated efforts of a chiropractic “Dream Team” that fought the courtroom battles - and rewrote the rules.
Personal injury cases are a “love-it or leave-it” experience for many chiropractors. High on the list of objections is losing to the opposing side’s “medical experts,” whose opinions have historically held more weight in court.
But, it’s the facts that matter, says John K. Maltby, DC, FICA, FICAC(H), practicing in Blythe, CA. “When expert testimony relies primarily on the status of the expert, and is not based on solid data, it is purely opinion and nothing more,” says Dr. Maltby. “Data is indisputable and it easily wins over the status or rank of those offering medical opinions.”
In a recent $1MM soft tissue case, the patient was referred to Dr. Maltby for evaluation of her injuries using dynamic (active) range of motion analysis that simultaneously documents muscle guarding through the use of attached-electrode sEMG (DynaROM Motion sEMG). These two measures, when performed and graphed simultaneously, have been shown to be significantly more sensitive in proving soft tissue injury than endpoint ROM testing alone (Geisser, 2004). The exam results clearly indicated muscle guarding, validating the patient's injuries (Ambroz, 2000). And, according to the American Medical Association (AMA), muscle guarding is classified as a 5-8% functional impairment. (AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition)
This case, and others like it, have dramatically changed med-legal strategies and outcomes for DCs and their injured patients. Armed with new technology and objective data, chiropractors can now refute the most highly-credentialed medical expert’s opinion. “When evidence and technology are applied, and data are presented, it will always trump opinion,” says Dr. Jaeger. “And when you enter the med-legal arena, submitting the highest level of peer-reviewed evidence is what wins.” In the process, the value and status of chiropractic care is elevated in the eyes of the public, as well as in the medical and legal communities.
Dynamic range of motion testing, in combination with sEMG for measuring muscle guarding, has helped win a series of major PI cases for chiropractors and their patients.
The Merritt vs. DOH case lead to reimbursement for such testing under CPT Codes 96002 and 96004, and established admissibility of the DynaROM Motion sEMG instrument and data in all cases thus far. The reimbursement rate for these codes is five times higher than the reimbursement rate for endpoint ROM testing, without consuming additional time.
If you are still on the fence about handling PI cases, consider this: even “cash” patients are routine one day and injured the next. But the new ammunition provided by dynamic range of motion studies gives you the power to succeed.
Remember, when credibility and respect are high, so are referrals. Dr. Jaeger has this advice for DCs: “We now have the tools to make PI objective and evidence-based, so get on board and get it done! The rewards for your patients' health and your practice are invaluable."
Allen Fraley, DC
Dr. Fraley has more than 17 years experience working with personal injury and injured-worker cases, and has testified in court on behalf of these patients. He is a frequent guest speaker on chiropractic topics for the Washington State Association of Justice, and is a featured speaker for MyoVision.
firstname.lastname@example.org | 509-764-1836
Jason O. Jaeger, DC, fCBP
Dr. Jaeger holds adjunct faculty positions at four chiropractic colleges, and was awarded the 2014 Chiropractic Biophysics™ Researcher of the Year Award for the Advancement of Chiropractic Science. He also holds the 2015 CBP™ Chiropractor of the Year Award, and applies his extensive clinical experience to his treatment of injured patients.
email@example.com | 702-396-4993
John K. Maltby, DC, FICA, FICAC(H)
Dr. Maltby is a respected expert witness and two-term past-President of the International Chiropractors Association (ICA). He also served as ICA Chairman of the Board, and was ICA’s Chiropractor of the Year in 2007. Dr. Maltby has represented the ICA on the Board of Directors of the World Federation of Chiropractic.
David Marcarian, MA
NASA-Trained Researcher and inventor of high-tech biometric instrumentation, including the patented Wireless DynaROM Motion sEMG System which graphs muscle guarding and ROM simultaneously. This technology has established chiropractors as the leading experts in soft tissue injury. Upcoming CE Seminars can be viewed at www.myovision.com or by emailing firstname.lastname@example.org.
We want to ensure your test are as accurate as possible - one way is to make sure your electrodes are in good condition. Below are examples for both the E-Scan static electrodes and the DynaROM electrodes.
For your DynaROM tests, you are using the Dynamic Electrodes (item# pb-50). The image to the right shows both good and bad electrodes. To get the best connectivity and results, you want to make sure the gel in the middle of the electrodes are dark and moist (as shown by the 3 right-most electrodes). When they become dry (as shown by the 2 electrodes on the left) your test results will suffer.
Dynamic electrodes are good for one-time use only and must be thrown away after each use. So make sure you have plenty in stock - visit www.store.myovision.com to purchase.
To learn more about how to get the most accurate results from your tests, click the button below.
OK, so now that Windows 8 has gotten pretty stable, the only thing which annoys pretty much everyone is the fact that it takes SO much longer to do everything without a Start button. Having worked in several Ergonomics labs, including at NASA and IBM’s Santa Teresa Lab, I know for a fact Windows 8 violates all the basic tenets of “sound ergonomic design”. Why? The psychology of it has to do with our ability recall vs. recognize. For example, to use Windows 8’s search function to access the Control Panel, you have to remember “Control panel." With a start button, you click the button and see "Control Panel” as one of your choices. That means that there are significantly less errors and less inputs to find it. Now, how do we add it back when Microsoft says it is impossible? The easy way, using a feature called “Classic Shell,” a freeware program which adds the start button back in Windows 8./8.1.
To get this, go to www.classicshell.net then download and install. I would deselect all the check boxes and hit “decline” on the offers. Then voila, you’ve got your start button back!
Watch how simple it is to interpret and generate a report using the new tools in Feature Pack C:
Dr. Josh Wagner has created easy to follow communication for any DC to convert new patients’ mentality from: “Can this chiropractor help me?” to "When Can I Begin?” All without heavy education or force. On the webinar he shows you how to easily frame yourself and your care as “The Prize” in your new patient’s mind. All while making your patients feel completely listened to. And it’s easier than memorizing long scripts.
By Nancy Miggins, DC & David Marcarian, MA
The current healthcare ecosystem mandates efficiency and objectivism. The requirements to document, bill third party payors and actually get paid are becoming increasingly more rigorous and laborious. It is no longer enough to properly document and code what you do in your examination and treatment of a patient, it is essential that you can prove medical necessity and substantiate your clinical decisions with objective data.
Chiropractors believe they are immune and can fly under the radar of insurance audits and fraud investigations. Unfortunately, you can’t avoid the radar. Insurance companies have been establishing utilization profiles for years and they know your every move.
Emphasis and focus should be placed on strict compliance, meeting normative standards and employing proper testing and technology to generate objective, clinically relevant data. Even well-intentioned outliers get audited.
Today’s successful Chiropractors are empowered with real data, not dogma, and are embracing evidence-based practice. Evidence-based practice incorporates objective data; data that is factual, unbiased, and unchanged by personal feelings or interpretations, to help determine the best course of treatment.
Unlike previous paradigms which relied heavily upon patients’ blind faith in their doctor, evidence-based practice seamlessly blends the doctor’s clinical expertise with research proven diagnostic technology. Evidence provides peace of mind for the patient and the third party payer.
Objective data bolsters your clinical opinion and provides a means to monitor patient progress and effectiveness of treatment. Adjustments to the patient’s program of care can be made efficiently, resulting in improved outcomes and more cost-effective treatment.
Technology is the answer to cover your assets. One size does not fit all, however, so it is important to use the right tool for the job.
Static sEMG provides information about muscle firing while in the neutral posture. Taking only a minute or two to perform, this is the ideal quick screening tool. It shows the effect of subluxation on the muscles of the spine, along with postural influence, short leg, and head forward position. At minimum, Static sEMG is a form of electronic palpation yet unlike palpation, has great inter-examiner reliability. It displays an easy to interpret graphic to enhance patient awareness and education.
New University research has validated Standing Static sEMG studies as clinically valuable.1 Even more important, the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress (2).
Dynamic sEMG uses EKG electrodes attached to the skin, measuring muscle response continuously as the patient moves. This technology boasts over 7500 research papers published to date. It’s ability to determine presence or absence of soft tissue injury was established in a major Superior Court decision in the State of Florida (3). The AMA has recently provided a specific CPT code for billing.
Dynamic sEMG has recently evolved into a more effective and efficient technology known as DynaROM sEMG, in part due to a meta-analytic review from The University of Michigan. Researchers found the clinical value of Range of Motion was significantly enhanced by incorporating Dynamic sEMG. By measuring and graphing ROM and Dynamic sEMG simultaneously, one can see if muscle guarding and bracing accompanies limited range of motion. If it does not, the patient is most likely magnifying symptoms.
Dynamic sEMG coupled with simultaneous computerized ROM is the only truly objective testing available to Chiropractors for determining the presence or absence of soft tissue injury (1,4).
Brandon Casey, partner at Casey Law Offices, states “Attorneys like evidence, and by that I mean actual evidence-based treatment, not opinion.” He goes on to say “sEMG studies are the best proof of soft tissue injuries. In this day and age of skepticism, they are essential in a litigation case.”
With the latest in evidence-based technology, the process of providing insurers and attorneys with objective, physiologic data is simple and quick, requiring only a small time investment by the practitioner or trained assistant. Objective data leads to an objective Doctor, creating clinical competence. The doctor who embraces and integrates such technology will sleep better, knowing the burden of proof lies in the insurer’s hands in an audit, as data wins over opinion 99% of the time.
1. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
2. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain. Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg,WV Zucker, Robert MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV Caruso, Marianne RN,VA Medical Center, Martinsburg, WV. PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
3. Richard W. Merritt vs. Florida Dept. of Health et al (Case No. 04-1149RX)
4. Gerhardt, John. “Utilizing sEMG in the medical-legal arena to prove presence or absence of soft tissue injury”, White paper: 2011.
Written by David Marcarian, MA and Nancy Miggins, DC
As the original Chiropractic “Technogeek”, I feel obligated to make the lives of Chiropractors easier and more productive through the use of technology. One age-old issue screaming out for a technological solution has piqued my interest. It is well known that patients retain only 5-20% of what the doctor communicates; even less at a screening. Without being able to reinforce the message we convey, and do so quickly and effectively we lose our patients’ attention. Traditional solutions have relied upon everything from general pamphlets and videos espousing the value of Chiropractic, to expensive celebrity endorsements. We have struggled for decades attempting to “sell the invisible” and still only appeal to 8% of the population.
The emergence of Static sEMG in the early 90’s attempted to provide a user-friendly technology that produced patient-friendly graphics, but was limited by technological and reliability issues. This technology not only forged the way for evidence-based practice, providing objective data that Chiropractors need and patients want, but also provided an effective tool for internal marketing and spinal screenings, a mainstay for generating new patients. Yet the problem still persists.
What does a NASA researcher do? Seek out data, and observe. So that is what I did. Instead of interviewing doctors, I spent four months interviewing patients.
In the process of interviewing patients, an issue with significantly greater impact on the profession was exposed: Those in pain easily garnered the support of friends and family members in choosing Chiropractic as the treatment of choice. Those not in pain seeking Chiropractic care for general health and wellness, clearly expressed one common challenge: Each and every one admitted they found it extremely difficult to justify their Chiropractic visits to family and friends.
More important than this was the emotional response I received from patients who had taken home their Static sEMG test as it validated their complaints to cynical family members. One patient actually cried saying “My husband didn’t believe me until I showed him my print out”. You go to the doctor when you’re sick. You see the Chiropractor in pain. Why would you possibly go if not in pain?
We’ve been attempting to implement the dental model of “preventive care” for years with little success. But to a Technogeek, this is just another fun problem to solve.
In reviewing the literature on patient communication, I found some clear trends (1, 2, 3, 4).
In the days prior to objective data, we would pleasantly say “thank you”, and go off to get several opinions potentially putting off fixing the problem for months or even years! Sound familiar?
We in the Chiropractic Profession share the mechanics dilemma, and may learn a lesson from their approach. We live in a data driven society. Show them why with “instant” indisputable, objective data and we overcome not only their objections and reinforce the need for care, but overcome family members objections. In a data driven world, objective data rules, and those with it have the power to convince. Whether it be mass airflow sensors or wellness care. The key is finding a way to transmit this data in an electronic, instantaneous form which is visual in nature for maximum effectiveness.
I realized that it would be most intelligent to meet the patient where they lived… on their smartphone! Nielsen reports that more than 50% of mobile consumers are using smartphones. According to Nielsen’s monthly analysis of cell phone bills for 65,000+ lines, smartphone owners – especially those with iPhones and Android devices — are consuming more data than ever before on a per-user basis. This is an enormous captive audience waiting to be engaged.
It was crucial that this process maximized the use of technology to remove the need for human interaction and labor. Unnecessary labor is proof of a poorly designed system. This tool had to be fast, allow for instant communication, and provide indisputable, objective data which could be easily presented to skeptical family members and friends. Due to the fact everyone has smartphones, it has to be easily viewable on the tiny screen. Allowing the texting of the image via SMS would improve its effectiveness.
With major technological improvements that have tripled the speed of muscle tension measurements, the tool of choice for this objective data would be Static sEMG. Although Thermography was considered, it is too finicky due to sensitivity to environmental heat and cold, making screenings difficult. Additionally, patients can’t feel temperature differences between left and right sides of their spines, making the results less “believable”. Modern, Wireless Static sEMG can be performed in virtually any environment. More importantly, everyone knows the ache of muscle tension, making instant credibility the doctor’s reward when the graphed results reflect what the patient feels. New University research has validated Standing Static sEMG studies as clinically valuable (6). Even more important, a major study by the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress (7, 8).
Impersonal is ineffective. If the patient’s personal Static sEMG results, graphical in nature could be instantly transferred to the patient’s smartphone, that crucial communication between doctor and patient would be reinforced within seconds. Unlike a generic pamphlet on the value of Chiropractic, the patient needing to prove the necessity for care can instantly forward from their smartphone the test results to skeptical family members. Another requirement is for the graphical image to act as an “E-Business Card”, presenting both specific information on the doctor’s office, and an easily customized special offer. The impact on those who’ve received the forwarded, visually appealing graphic would provide powerful advertising for the clinic.
So I built this thing, filed patents and tested it. And guess what else happened. In Beta Testing all of the above conditions were met, and more. The big surprise was how many patients posted this graphic image on Facebook, and did so while still in the doctor’s office! Imagine the impact of your office information marketed by your patients at no cost to you? With the average person having 120 Facebook friends (5, 9), the value in terms of marketing alone is quite significant.
The tool proved invaluable at screenings where not only did the patient walk away with an instant personalized message, but also knew exactly how to reach you to take advantage of the special offer embedded in the graphic. Even better, the doctor stored the prospective patient’s email address for instant follow-up and future email marketing.
The term “Viral Growth” is an understatement when it comes to the impact of these visual images flying around the internet. The biggest surprise of all is that each and every patient tested said, and without exception (after saying “Cool”, that is): “Now I can show my _______ why I need my Chiropractor.” It is unknown if this can get us beyond that 8% of the population we’re seeking. Considering the massive proliferation of Smartphones, it at least takes advantage of a new form of high-tech, low cost marketing with potentially powerful consequences.
Technology can be your best friend or worst enemy. By finding the best product and support for your needs, you will have a great partner in building your practice. Follow the simple guidelines above, and you will enjoy all, the advantages of technology without the stress.
1. Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.
2. Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953-5.
3. Osborne H. In Other Words…Actions Can Speak as Clearly as Words. Boston Globe’s On Call Magazine. Jan/Feb 2006. www.healthliteracy.com/article.asp?PageID=3763 (accessed Mar 3, 2006).
4. Osborne H. In Other Words…Teaching with Pictures. Boston Globe’s On Call Magazine. Nov 1999. www.healthliteracy.com/ article.asp?PageID=3822 (accessed Mar 3, 2006).
5. Dunbar, R.I.M. (June 1992). “Neocortex size as a constraint on group size in primates”. Journal of Human Evolution 22 (6): 469–493. doi:10.1016/0047-2484(92)90081-J
6. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
7. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain. Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg,WV Zucker, Robert MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV
8. Caruso, Marianne RN,VA Medical Center, Martinsburg, WV. PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
9. Marlow, Cameron: “Maintained relationships on Facebook” 2009, March 9, www.facebook.com
Many Chiropractors find their way into the profession because they have had a positive, life-changing experience with Chiropractic. It is a profession where miracles, great and small, happen on a daily basis. Few Chiropractors, however, take the time to identify, plan and build their niche practice and instead accept what comes their way.
Most Chiropractors have dabbled with accident recovery, but only a small fraction of the Chiropractic profession has chosen to become experts in the personal injury arena. Personal Injury practices flourish regardless of the economy. In 2011 alone, an estimated 2.22 million people were injured in motor vehicle traffic crashes.1 This astounding number does not include those people who do not report injuries at the time of filing an accident report. Those who reported a traffic accident experienced an 84% increase in the likelihood of new onset chronic widespread pain (2).
Furthermore, according to the Bureau of Labor Statistics (BLS), more than one million workers suffer back injuries each year, and back injuries account for one of every five workplace injuries or illnesses. In addition BLS states that one-fourth of all compensation indemnity claims involve back injuries, costing industry billions of dollars on top of the pain and suffering borne by employees.
Personal Injury provides Chiropractic with an abundance of injured patients in need of treatment and guidance. The complexity and diversity of injuries sustained as a result of a motor vehicle or work-related accident can be intimidating to the victim. While these types of accidents are a common occurrence, few people understand the importance of seeking qualified expertise in both the medical and legal aspects of the case. Getting proper care from a qualified professional in a timely manner and, as important, following through with that care to full recovery is essential.
With the latest in evidence-based technology, the process of providing insurers and attorneys with objective, physiologic data is simple and quick, requiring only a small time investment by the practitioner or trained assistant. Dynamic sEMG coupled with simultaneous computerized ROM is the only truly objective testing available to Chiropractors for determining the presence or absence of soft tissue injury.3,4 Objective data leads to an objective Doctor, creating clinical competence.
There are no shortcuts to success in the personal injury industry. The skills developed by mastering this evidence-based, patient-centered field create a solid foundation for a sustainable, financially lucrative practice.
It takes more than clinical competence to thrive in the personal injury industry. As a Chiropractor, you can’t just rely on injured patients to find you. You need to validate and align yourself with attorneys who also specialize in personal injury and who can partner with you to achieve the best results for your patients.
In the past this endeavor has been daunting, however, when armed with indisputable objective data that will solidify an injury claim, attorneys will seek to work with you. Previously, attorneys had reservations about working with DCs, as most cases come down to credibility of a DC’s vs. MD’s opinion. Objective data levels the playing field, as data trumps opinion 99% of the time. Brandon Casey, partner at Casey Law Offices, states “Attorneys like evidence, and by that I mean actual evidence-based treatment, not opinion.” He goes on to say “sEMG studies are the best proof of soft tissue injuries. In this day and age of skepticism, they are essential in a litigation case.”
The rules of personal injury case management may be simple, but they are not necessarily easy. There is a definite process to follow to maximize your reimbursement potential. These simple guidelines will help streamline the legal process, leading to prompt and consistent payment for your Dynamic sEMG testing.
Adhere To Testing Protocol: It is essential to learn proper testing technique, as good data is crucial to your success. Proper technique insures accurate data. Without this your credibly may be in jeopardy, and your clinical conclusions open for dispute.
Practice makes perfect and mastering proper test protocol requires actually performing tests. Testing theory will not provide you with the skills required to flourish in this industry.
Clinical Interpretation: Unfortunately, accurate data is not enough to win cases and get paid. You must make clinical sense of the data, presenting it in a clear, concise manner. Receiving a bill without the required report is a red flag for insurers. Not only does it lead to claim denial, but possible disciplinary action.
It is imperative that you get proper training regarding accurate and thorough interpretation of the test findings. Relaying these findings, combined with the test graphics and your clinical recommendations is mandatory if you wish to gain professional respect and receive consistent payment for your services.
Prepare For Deposition: There is nothing worse than having solid data, and not being able to defend your work. Both patient and attorney are relying upon you as the Expert Witness. Take this responsibility and obligation seriously, and garner the respect you deserve as a doctor. Ultimately your income will abound.
Doing your research and educating yourself on the pertinent sEMG studies is a key component to deposition mastery. Take the time to learn from each attorney encounter to bolster your confidence and become the Expert Witness that you are.
Follow Up: It is imperative that proper follow-up and follow through is made with insurance carriers and attorneys. Most payment delays or denials occur from incomplete information or lack of documentation. Initially it might require diligence and tenacity, however as you persevere the process becomes streamlined.
Be proactive and utilize the power of FEDEX and Certified Mail. Insurers will claim they did not receive bills and reports, a common first attempt at denial. Insurers “learn” quickly who perseveres and who does not. Those who persevere get paid.
Retesting: Initial testing should be performed 4-6 weeks after a motor vehicle accident or workplace injury. The test and interpretation with written report must be included in insurance and attorney billing. Do not take this lightly. An important part of being paid for this service depends on the presentation and interpretation of the data.
Dr. Gregg Friedman, Chiropractor and personal injury expert, recommends performing Dynamic Surface EMG with simultaneous computerized ROM testing every 30 days of care to document progress and establish necessity for continued treatment. The additional test and written report, including a comparison of results should be included in the billing.
The key here is to practice, practice, practice. The more you do , the more confidence you will develop. And, as is true with any competent case management, refer out if necessary. A second opinion from a medical doctor or specialist helps to build your case, and your reputation. Working with a network of diversified practitioners solidifies results and strengthens the claim.
Attorneys want to see consistency in your testing and interpretations, case management, and ability to discriminate between those truly injured and symptom magnifiers. Objective data is the key element in being able to defend your diagnosis and justify your treatment recommendations.
Being a victim of an auto accident or workplace injury is both inconvenient and intimidating. Navigating the medical and legal aspects can be daunting. Dr. Allen Fraley, Chiropractor and personal injury expert, strongly urges other Chiropractors that are interested in becoming personal injury experts to acquire the proper technology, seek education to master the unique aspects of a personal injury practice, and gain confidence and expertise in the interpretation of sEMG. This mastery and confidence will be conveyed with patients, attorneys and judges. When combined with indisputable, objective sEMG data, you can’t lose.
1. National Highway Traffic Safety Administration. “2011 motor vehicle crashes: Overview” NHTSA’s National Center for Statistics and Analysis, 9313-120612-v3, December 2012
2. Jones GT, et al. “Road traffic accidents, but not other physically traumatic events, predict the onset of chronic widespread pain: Results from the EpiFunD Study” Arthritis Care and Research 2011.
3. Geisser M E, Ranavaya M, Haig A J, Roth R S, Zucker R, Ambroz C, Caruso M. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. Journal of Pain 2005; 6(11): 711-726.
4. Gerhardt, John. “Utilizing sEMG in the medical-legal arena to prove presence or absence of soft tissue injury”, White paper: 2011.
Businesses across the board are changing their marketing strategies to focus on utilizing technology and social media platforms. The apparent benefit is that they can read the minds of their customers and study the specifics of consumer behavior, this leads them to provide high-class products and customer services. In essence, with the help of advanced social media tools, it has become easier to access data and make better, smarter decisions. Business optimizations can be made more quickly and accurately.
Traditional marketing concepts have been completely outshined by these more advanced and effective channels of marketing. The business card is dying, as are other print materials used for self promotion. If someone wants to know who you are or locate your phone number or your address, they will Google you. In addition, direct mail is being used less and less. The associated cost is higher, the return on investment is lower, and it is difficult to track the results accurately.
From Facebook to Twitter, social media platforms have truly transformed the landscape of marketing. Innovations in technology are driving powerful changes in the way individuals engage in health care delivery.1 These marketing mediums, combined with industry innovations, provide the Chiropractor with the ultimate power of engaging patients, which deliberately involves them in their health recovery process and builds a stronger, long-lasting relationship with the Doctor.
Social media has placed the patient at the center of the Chiropractor’s business objectives. This has enabled Chiropractors to cater to the needs of their patients rather than trying to mold patients to fit the practice.
A patient-centered care environment inspires causal motivation that results in patients that WANT to comply with treatment programs and be the best they can be. People will work their hardest for something or someone they believe in. Patients who are causally motivated tend to be advocates for their Chiropractor and are great referral sources.
According to Constant Contact, attracting new customers, engaging existing customers, and getting referrals are the top concerns for small businesses surveyed. Respondents were asked to identify which strategies they find most effective. Here’s a quick recap:
Email marketing – 83%
Website (content and SEO) – 71%
In-person interactions – 68%
Social media – 49%
Outbound calling – 33%
PR – 22%
Direct mail – 21%
Traditional advertising (TV, radio, print, etc.) – 17%
Pay-per-click – 17%
Of those using social media, Facebook is far and away the most effective.2 Given this information, it is extremely important for the Chiropractor wanting to keep pace in this new healthcare environment to embrace this change and embark on this new marketing strategy.
Not all social media channels are created equal. They all have their primary focus and functionality. While YouTube and a Blog are great at delivering patient information, Facebook is the premiere choice to provide patient reminders, support for wellness and recovery and responding to patient questions. With limited time and budget, it’s important to spend resources on activities that will yield the greatest return – it’s important to select the ideal social media channels for the job.3
One of the positive outcomes of an economic slowdown is the innovation that can come out of it. Many of our industry leaders are responding to this social media marketing trend by creating products and services that mainstream Chiropractic into our high-tech, smart phone, connectivity-dependent society.
These products and services are geared toward Chiropractors and patients alike. John Cox, CEO of Visible Health, notes that “somewhere around the order of 80 percent of all information communicated between a physician and a patient is lost when a patient walks out of the room.” Social media venues allow the Chiropractor a more effective means to manage the doctor-patient relationship by providing a strategy for communicating pertinent and appropriate information, consistently.
Patients benefit greatly from this communication technology, whether focused on general patient education, sEMG findings, specific condition information or health and wellness topics. These tools reinforce the “why” of seeking Chiropractic care and put this information in the hands of your advocates so they can easily share the information with others. Mobile devices present a tremendous opportunity to provide patients with even greater access to these powerful tools that support the current dynamic in healthcare delivery.1
To dominate your digital space invest the time and resources to implement the following:
The good news it that you don’t need a big bank account to go viral or create an outstanding promotion. You just need a unique and different idea. Tell a simple, bold, forward thinking creative story that is brief and memorable. People respond well to freshness and new ideas. A solid social media strategy should not be driven by social media itself, but rather your Chiropractic business objectives – social media is a tool to help you achieve your goals.
1. O’rourke, K., Heckman, J., Elwood, D. Development and Exploration of a Multifaceted Social Platform to Improve Patient Education, Communication, and Activity, Medicine 2.0 ‘12:Boston, USA, September, 2012.
2. Dornaus, Erika The Health and Wellness of Small Business, Constant Contact White Paper, May 2012.
3. Berg, Dean. Healthcare Social Media: How to Choose the Best Tools for the Job. Annica Media, September 2012.
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