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A series of articles emphasizing practical
knowledge you can't find in practice guides
and interviews with experts who share
their techniques for effective and efficient
case management
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Articles emphasizing practical knowledge you
can't find in practice guides
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Profiles of people who changed workers’
compensation law.
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• Warren
Schneider
• Marjory Harris
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HARRIS:
Chiropractic treatment has often been used to treat work-related
injuries. The recent “reforms” have threatened
the scope of such treatment and greatly limited the rights
of workers to choose this non-invasive healing modality.
What do you see as chiropractic’s present and future
role in the comp system?
AUERBACH:
In my opinion, it isn’t so much that the “reforms”
have threatened the scope of chiropractic practice, but
rather have reduced the monetary compensation rate for
certain services, and eliminated certain services overall
from any payment for these services. The scope of chiropractic
remains an issue before the Board of Chiropractic Examiners
of the State of California. There is no doubt that the
“reforms” have greatly limited injured workers’
rights to access non-invasive treatment modalities. Perhaps
there are some who would say that there is still access,
although it is extremely limited. It remains my belief
that the chiropractor’s role in the present and
future comp system should be that of the primary gatekeeper,
along with administering care that is necessary to cure
and/or relieve from the effects of the industrial exposure.
This does not imply that this is an open ended unlimited
opportunity for maintenance or lifetime chiropractic care.
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“Chiropractic is a health care profession that focuses
on disorders of the musculoskeletal system and the nervous
system, and the effects of these disorders on general
health. Chiropractic care is used most often to treat
neuromusculoskeletal complaints, including but not limited
to back pain, neck pain, pain in the joints of the arms
or legs, and headaches.
Doctors of Chiropractic – often referred to as chiropractors
or chiropractic physicians – practice a drug-free,
hands-on approach to health care that includes patient
examination, diagnosis and treatment. Chiropractors have
broad diagnostic skills and are also trained to recommend
therapeutic and rehabilitative exercises, as well as to
provide nutritional, dietary and lifestyle counseling.”
The
American Chiropractic Association (AC)
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HARRIS:
In view of the restrictions on chiropractic treatments,
is there still a role for the chiropractor as a Primary
Treating Physician?
AUERBACH: I believe that there will always
be a role for a doctor of chiropractic as the primary
treating physician. Those DCs who are well trained and
continue to educate themselves on the ever-changing work
comp system, provide an alternative to patients other
than medication, injections, and surgical intervention,
in the appropriate clinical scenarios.
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For
a summary of the workers’ compensation law relating
to chiropractic treatment,
click
here |
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HARRIS: What is
your philosophy of treatment?
AUERBACH:
I am conservative in my philosophy regarding treatment.
An accurate diagnosis is at the basis for treatment of
any condition, be it industrial or not. If a patient seeks
chiropractic care and there has not been demonstrable
change in their condition both symptomatically and objectively
within a four week period of time, something else should
be done by way of a diagnostic test, referral to an allied
professional, or changing the course of treatment to assist
that patient in achieving their goals for treatment.
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HARRIS:
How are you dealing with the restrictions imposed by the
statutory requirement in Labor Code §4600(b) that
your treatment be based on the ACOEM guidelines?
AUERBACH: It is my opinion that the entire
scenario with ACOEM was brought about because of the abuses
within the system. The abuses manifested in all areas
of the work comp system, not just chiropractic. It is
my understanding that ACOEM guidelines or other nationally
recognized guidelines can suffice as a basis for obtaining
authorization for treatment. It is my understanding that
the second edition of the ACOEM guidelines involved consulting
with one doctor of chiropractic, which certainly would
not be considered a fair representation of the profession
as a whole. In my opinion, the second edition of the ACOEM
guidelines are limited and don’t take into account
an individual’s condition on a case-by-case basis.
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HARRIS:
Letting the legislators or government bureaucrats decide
on what treatments are appropriate, or how many of each
will be allowed, scares me. "Cookie cutter"
medical treatment can be disastrous in the individual
case. Have you had any experiences where a patient has
really been harmed by the limits on treatment imposed
by the 2003-2004 legislation?
AUERBACH:
I have not personally been involved in cases where a patient
has been harmed by the limits on treatment imposed by
the 2003-2004 legislation. However, it continues to be
my opinion that a patient should have the option not to
take medication to manage their musculoskeletal injuries,
if this is their choice. The reforms definitely limit
this option for patients.
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HARRIS:
I have received many calls from chiropractors wanting
to "do lunch" and talk about how they can function
as "gatekeeper" PTPs and refer my clients out
for sleep studies, psychiatric evaluations, erectile dysfunction,
etc. and then write AMA Guide reports that will get high
overall ratings. I suspect they have been to seminars
on practice preservation. What do you think of this post-reform
development?
AUERBACH: I
cannot personally tell you that there are seminars promoting
this, since I have not attended those types of seminars.
However, it would not surprise me. The concept behind
the AMA Guides is that you have to take into account the
“whole person”. As such, one has to be careful
about how they address the other issues such as sleep
deprivation, internal complaints, etc., and be prudent
in recommending that the patient be referred out to the
appropriate specialists for assessment of these conditions.
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HARRIS:
You serve regularly as an AME or QME. How have the "reforms"
changed your forensic practice? Do you find it is taking
much longer to do reports under the new system?
AUERBACH: There is no doubt that the “reforms”
have changed forensic practice. It takes a much longer
time face to face with the patient to do the history and
questionnaires, much longer than it did pre-reform. The
medical-legal reporting requirements are also more entailed
and do require a greater amount of time commitment on
the part of the physician so that their report constitutes
substantial medical evidence.
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Tami S. Auerbach,
D.C. practices in San Diego.
She received her license to practice chiropractic in 1985
and has been certified as a Qualified Medical Evaluator
since 1994. For more information
click
here.
Tami Auerbach, D.C.
2903 4th Avenue
San Diego, CA 92103-5901
Phone: (619) 542-1534
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