Chiropractic In The News

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From Reuters Health Information

Nationwide Database to Help Set Insurance Reimbursement Rates

By Jonathan Stempel
NEW YORK (Reuters) Oct 27 - New York Attorney General Andrew Cuomo announced on Tuesday the creation of a nationwide database to help set health care reimbursement rates, benefiting patients who use doctors outside their insurers' networks and capping an industry-wide probe.
 
A new nonprofit, Fair Health Inc. will develop a database for consumer reimbursement, as well as a website where consumers will be able to compare prices before they choose doctors.
 
Calling prior reimbursement practices an "injustice" and "fraud," Cuomo said at a Syracuse, New York, press conference that Fair Health will "ensure transparency, accountability and fairness" for Americans who use out-of-network doctors.
 
The attorney general said the changes will stop insurers from "under-reimbursing consumers for the very product they pay for," a practice he said has cost patients hundreds of millions of dollars.
 
About 70% of insured working families have out-of-network plans that let them choose their own doctors, a system that affects more than 110 million people, Cuomo said.
Cuomo obtained nearly $100 million from insurers such as Aetna Inc, UnitedHealth Group Inc and WellPoint Inc to fund Fair Health.
 
He said Fair Health will be fully implemented within one year, and developed by five upstate New York universities.
 
A probe by Cuomo's office had found that UnitedHealth's Ingenix unit operated a "defective" database that major insurers used to determine the "usual and customary rates" for reimbursing out-of-network medical expenses.
 
Insurers often promise to cover up to 80% of customary expenses when a patient goes out of network.
 
But should reimbursement rates be set at artificially low levels, patients would be forced to pay more money or doctors would be forced to accept less for their services. Insurers, on the other hand, would benefit from reduced costs.
 
Calling Ingenix a "black box," Cuomo said it created a conflict of interest because insurers were both providing and using the same data in calculating reimbursement rates.
 
The American Medical Association had criticized the old reimbursement system for shortchanging doctors and patients.
 
Dr. William Dolan, an AMA board member, in a statement said the changes should allow doctors and patients to "look forward to getting the straight deal."
Without admitting wrongdoing, UnitedHealth in January agreed to pay $350 million to settle class-action lawsuits brought on behalf of the AMA, doctors, patients and others over reimbursement rates.
 
Dr. Reed Tuckson, chief medical officer of Minnetonka, Minnesota-based UnitedHealth, said the company will work with Fair Health to launch the database "as soon as practicable."
Cuomo's announcement was monitored by webcast.

Reuters Health Information © 2009 

 Respectfully,
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
CMCS Management, Inc.

One of the most important studies was performed by Ronald Pero, Ph.D., chief of cancer prevention research at New York's Preventive Medicine Institute and professor of medicine at New York University. It showed the positive effect that chiropractic care can have on the immune system and general health.

 

Dr. Pero measured the immune systems of people under chiropractic care as compared to those in the general population and those with cancer and other serious diseases. His initial three-year study was of 107 individuals who had been under chiropractic care for five years or more. The chiropractic patients were found to have a 200% greater immune competence than those people who had not received chiropractic care, and they had 400% greater immune competence than those people with cancer and other serious diseases. The immune system superiority of those under chiropractic care did not appear to diminish with age. Dr. Pero stated:

 

When applied in a clinical framework, I have never seen a group other than this chiropractic group to experience a 200% increase over the normal patients. This is why it is so dramatically important. We have never seen such a positive improvement in a group. [3]

 

Another study from Patricia Brennan, Ph.D., leading a team of researchers, conducted a study that found improved immune response in her test subjects following chiropractic treatment. The study specifically demonstrated the "phagocytic respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes were enhanced in adults that had been adjusted by chiropractors." [4]

 

Life Chiropractic University, produced an incredible study from the Sid Williams Research Center in 1994. The researchers took a group of HIV positive patients and adjusted them over a six-month period. What they found was that the "patients that were adjusted had a forty-eight percent (48%) increase in the number CD4 cells (an important immune system component)." These measurements were taken at the patients' independent medical center, where they were under medical supervision for the condition. The control group (the patients that were not adjusted) did not demonstrate this dramatic increase in immune function, but actually experienced a 7.96% decrease in CD4 cell counts over the same period. [5]

 

The immune system is affected by the nerve system through the connections with the endocrine and the autonomic nervous system. And chiropractic care improves the function of the nerve system through improving the movement of the spinal bones that encase and protect the spinal cord.

 

Stressful conditions lead to altered measures of immune function, and altered susceptibility to a variety of diseases. Many stimuli, which primarily act on the central nervous system, can profoundly alter immune responses. The two routes available to the central nervous system are neuro-endocrine channels and autonomic nerve channels. [6]

 

Dr. Wegmann is the co-founder of TheNewWellness.com one of the fastest growing health websites in the world.

 

[1]. Deadly new flu virus in US and Mexico may go pandemic". New Scientist. 24 April 2009.

 

[2]. U.S. Institute of Medicine; Stacey L. Knobler, Alison Mack, Adel Mahmoud, Stanley M. Lemon (editors) (2005). The Threat of Pandemic Influenza:

 

[3]. Pero R. "Medical Researcher Excited By CBSRF Project Results." The Chiropractic Journal, August 1989; 32.

 

[4]. [4] Brennan P, Graham M, Triano J, Hondras M. "Enhanced phagocytic cell respiratory bursts induced by spinal manipulation: Potential Role of Substance P." J Manip Physiolog Ther 1991; (14)7:399-400.

 

[5]. [5] Selano JL, Hightower BC, Pfleger B, Feeley-Collins K, Grostic JD. "The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients." The Chiro Research Journal; 3(1); 1994.

 

[6] Felton DL, Felton SY, Belonged DL, et al. "Noradrenergic sympathetic neural interactions with the immune system: structure and function." Immunol Rev. 1987 Dec;100:225-60.