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Hi, I’m Dr. Mark Studin, and together with ChiroSecure, we’re going to bring you some way cool information today on diagnosing, documentation, treatment planning, etc. We’re going to go to the slides right now, we’re going to share with you a whole bunch of really cool information. Now previously in a different segment, we did part one of this.
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Text randomization for soap notes and, and using pain scales and reporting pain. So I’d like to start pretty much where we left off. And by the way, if you ever want to get us, take your phone out, take a picture of this. This is for our consulting site, our x ray digitizing, or EMR Chiro and our academics.
So if you take a picture of this, you can get us anytime your heart desires. And that’s my cell number. You can reach me. Now, when we talk about When we get to the next slide, when we talk about reporting pain, we’ve already talked about using words and pain scales, such as using using the visual analog scale.
And when we talk about visual analog scale, you’ve got to show them a visual picture. And this was created by pediatric nurses way back when, and it’s usual and customary. And it’s not just for personal injury. It’s for everything. So take this picture, laminate it, put it on your wall. But when you report it, And you aren’t, say, in a personal injury paradigm.
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You should consider not just using words. That’s old school. And, and lawyers actually don’t like that. There was no pain in my neck before the crash. Since the crash, my neck and shoulders hurt in a scale of 6 out of 10. I’ve had numbness and tingling in my arms after the crash and weakness in the right side of my body.
So, you should have images. Images rule the day. And this is advanced reporting. And you should, and I use Snagit technology, and if you want to learn more about this, give me a jingle, I’ll share it with you. But this has been the reason for many attorneys to win cases. Look how I’m reporting pain before and after.
and after the crash with language. This is huge. This is called demonstrable. And this has been the reason for many, many, many attorneys prevailing in their cases. And judges seeing this in a snapshot, you get to see what’s there. This is way advanced stuff. And it just does. This took me about a minute to do.
Once you understand that it’s easy. But when we look at diagnosing, and I want to delve into a little bit of diagnosis. A diagnosis is what the carrier knows about the patient. It talks about necessity and level of care. All of that is determined by diagnoses. And if you’ve taken any of our seminars, and we do a lot of seminars on diagnosing, most of them are free.
If you want to jump on you can email me and I’ll or text me. You hopefully you took a picture. I’ll put another shot up. You can get my, my phone number later. I can give you the schedule of when we’re doing those. We have three, three hour, three CE credit courses that are free. It doesn’t cost anything.
So you’ll learn how to diagnose better and use it. But in order to maximize your care and reimbursement with correct coding and prevent lawsuits and spur referrals, you need to create a pick list. Now in EMR Chiro, which has been out for God about about a half a year already, which is unbelievable. One of the things I did when I crafted that, which you need to do is you need to create a pick list.
And in that pick list, you get to see just, it’s a cheat sheet. on what diagnosis to use and not use, and understanding your EMR system should actually guide you in the world of compliance. So here are the things you don’t do. You don’t put in V codes, external causes. Occupant location in the motor, in the automobile.
Or on the, on the ball field or whatever. You don’t put any of those things. It’s written in your report. You want, you never ever, ever, ever, ever, ever use a Roulette Diagnoses. I’m going to do an MRI. So I’m going to diagnose a herniated disc because I think it’s there. You only diagnose what it is.
There’s no such thing as a working diagnosis. Pain diagnoses, you know what those are? Throwaway codes. Low back pain, neck pain. You have to diagnose the tissue that’s injured. I want to know the tissue. I want to know is it a ligament issue, which could be a sprain. I don’t use strain. It could be laxity of ligament.
It could be biomechanical failure, a segmental dysfunction. I don’t like, I do like biomechanical pathology. So all of those are throwaway codes. I know I’m going fast, but I was only given 20 minutes today. So what you have to diagnose what’s wrong with your patient, what’s wrong equals length of care, allowable care, reimbursements.
The importance of a correct diagnosis. It’s, I mean, there’s a lot of things here. I’m not going to go through it. It guides treatment. It prevents complications. You have to be cost effective and don’t be afraid to change your diagnoses as the patient progresses, as you get diagnostics. And this morning, about three hours ago, Actually, three and a half hours ago, I had a lengthy conference call with the attorneys from State Farm, Liberty, and and and Geico.
And we talked and having the same diagnosis on every patient over and over and over and never changing. That’s a cause for what’s called a predetermined treatment plan. And they’re now doing RICO cases under the Organized Racketeering Act against individual chiropractors. And they don’t want the big doctors anymore.
They want the small ones because they only want one thing, your money. And if you’ve taken their money, they want it back and threefold. And they have no conscience. They’ll take your home. They’ll take your receivables. They’ll take everything. And one of the things that you’re giving them carte blanche to do is always use the same diagnosis over and over and over in every patient because they do an algorithm.
97 percent of the patients get the same diagnosis. You lose. You know how many cases they lose? Zero. And I’m not being sarcastic. And I’m not being inflammatory. They win every single case.
Some gurus tell you that, oh, you should use 40, 50 diagnoses. Guess what? You’re going to attract so much unwanted attention. You really should stick as a rule within the HCFA 12. If you have to go more, you can, but as a rule, stick within the HCFA 12. I picked, you pick two, pick two diagnoses per region. Two.
In a case where I was an expert on eight on a case, I had eight diagnoses. They settled for, actually, that’s not true. I had one, two, three, four diagnoses. They settled for 150, 000. You don’t need all those diagnoses, but don’t go more than two per region. And Sam Collins from H. J. Ross, I’ve communicated with, and we’re in lockstep with this.
You really shouldn’t need more than two per region. Or else you’re going to garner unwanted attention. Am I going fast enough? I hope not. I just want to segue out for a moment into evidence in the literature about chiropractic. It has nothing to do with diagnosing, has nothing to do with documenting. So I’m a little bit all over the place today, but check this out.
Current recommendations for initial treatment of acute low back pain starts with physical therapy. Starts with, Back to 1970, all the way through today, 76, 2012, 22. Initial presentation for acute low back pain is early physical therapy. That’s 2022. The McKenzie method, which is physical therapy for low back pain back in 76.
So it all starts and goes there, and when they look at that, they’re looking at nonspecific back pain. Physical therapy is the hallmark for pain. I looked at a study in 2023 with a cohort, meaning the number of people in a study, and usually see 100, 200 of a cohort. This had 4, 827. Doctor, look where it’s from, Defense Health Agency.
Naval Medical, Uniform Services, Henry Jackson, Advanced Military. This is all the VA with the exception of the University of Pittsburgh. Okay, all VA. Doctor of Physical Therapy, Doctor of Physical Therapy, PhD, Doctor of Physical Therapy. This is a chiropractor, Michael Schneider. He’s towards the end. That was University of Pittsburgh.
But all PhDs and doctors and PTs. What did they come up with? What did they find? The physical therapists found that opioid use increased by 80 percent. In 90% of the patients, if two or more modalities are used in pt, which means joint mob and exercise, rehab, and massage, and heat and stent, I don’t know any physical therapist that doesn’t use a minimum of two modalities.
So no opioid reduction is reduced if only manipulation is used. But if you add a modality to it. You’re going to increase it at 97, 90 percent of the patients, 89. 9. Spinal injections increased by 53 percent to a more. MD specialty, including surgeries, increased by 50%. Now, if we segue over to another study with a cohort of 1, 171 patients, and we look at chiropractic use and look at this, this is from the Cleveland Center, Case Western, Duke.
Butler, Virginia Health University, University of Pittsburgh. This is Duke again, and University, this is Cleveland Center. What do they find? That chiropractic versus medical care, in the same diagnosis, reduces, reduces Tramadol, which is a form of opiates, by 308 percent following a radicular event. 308%!
Let’s look at another cohort of 6, 868 patients. This is 2018. Chiropractic uses dec opioid uses decreased by 55% with chiropractic care, 56%. In an older population, the prescriptions decreased by 54% for a year. Prescription costs decreased by 74%. Pharmaceutical companies will not like us. Disability decreased by 313% chiropractic versus physical therapy for secondary disability, and 239% decreased.
versus chiropractic versus physical therapy. And look at this sucker right here. This is Nataydon, a cohort of 8, 023, 162 adult patients over four years. 96 percent of patients, 96%!
In medicine, upwards of 99 percent of the patients are diagnosed with non specific back pain. Upwards of 99 percent non specific back pain, which means they don’t know what’s wrong. So the other 1 2 percent or 4 percent fracture, tumor, infection, herniation. Where they could cut it out or they could throw drugs at it.
You cannot have a pharmacological solution for a mechanical issue. www. chirosecure. com Doesn’t exist, doesn’t exist, which is why they call it non specific back pain. Now, there’s a piece of technology called Simvrta, which will actually tell you where the primary lesion is. Maybe I’ll do that next time.
It’ll show you how to diagnose where the primary biomechanical pathology is, which we call subluxation. It’ll show you where it is. If you have a low back problem, due to central sensitization, which research has just recently in 2023 shows it shoots up to the brain, that in that biomechanical failure and the brain is going to sense there’s problems in the low back, but wants to create biomechanical homeostasis plum.
It’ll put spasms in the cervical thoracic area. So your regional adjusting has been really debunked. You should look for the primary lesion and there’s tools to show you where that primary lesion is. There are tools. We’re going to show you that next time how to do it and understand it. It’s really, really, really cool stuff.
So we’re getting people, well, 96 percent of the time we’re 96 percent of the time in medicine, cannot even figure it out. And they call it nonspecific back pain. Then they send them to physical therapy, which increases opiates by 90 percent in 90 percent of the people by 80%. And then they have greater disability.
It doesn’t work. It just isn’t appropriate. And it’s all based on outcomes. And I am a numbers guy. I am a research guy. Yeah. I read research. I am a voracious reader of research. All of this is critically important. We get 96 percent of our patients better. It’s simple. So folks, Alan, you’ll be happy. I know I’m not supposed to mention your name too bad.
I finished well within the allotted time. I am so excited to do this stuff. I mean, I can’t begin to tell you where I want to go, how much I want to share with you. There’s so much more research coming out. I just read another article that I wrote up about chiropractic and the positive outcomes for migraines and headaches and just every day so much is coming out.
I’m going to be, I’m going to be 69 years old shortly. And in the formative days, we had nothing. In the seventies and the eighties, we had nothing but philosophy. You can’t be mired in philosophy anymore. Well, you can, and the late Frank Zolli, who was the former dean and founding dean of the University of Bridgeport College of Chiropractic, Frank used to tell me, and he’s, he’s passed since, and I miss him dearly, he used to say, Mark, philosophy is the study of truth.
Start looking at truth. Do not ignore the evidence in the scientific literature. You know what hasn’t changed? The chiropractic spinal adjustment. What has changed is what it does. Why do I call it a biomechanical pathology? And not subluxation. I don’t anymore. Because as of now, let me just get my stat out.
I’m going to look at a different computer screen. We’ve gotten 2, 049, 110 referrals in all 50 states over the last 12 years. Why? Because years ago when I spoke to medical doctors and I said, oh, there’s a subluxation here. And I’m going to adjust that person. They’re going to say, there’s a subluxation, meaning a bone is displaced, not quite a dislocation, but it’s like way out there.
And you’re going to, what they say, manipulate the neck. Are you crazy? You’re going to cause it to be paralyzed. And I look at them. They don’t tell me that that’s what they’re thinking, because they told me that. Because I teach, I’m a professor at the State University of New York at Buffalo School of Medicine.
I teach thousands of medical doctors. So when they tell me that, They say, they’ve said in their mind, they say, this guy’s a frigging moron. I’m not ever going to work with this quack. They’ve told me that by the way, not after the fact, when I told them that we don’t, well, let me just get to the rest of the story.
As soon as I changed my language to, we’re treating biomechanical pathology. You know what they all say? Oh, wow. We know that’s real. And there’s an ICD code to it. We know that’s real. We just don’t know anything about it. Now that you understand that we have someone to send it to, what are your credentials?
And then all of a sudden, that referral counter started spinning nationally, and that number goes up and up and up and up, all by, you know, when I talk subluxation, which is a chiropractic term, and there is very little in the literature about the chiropractic subluxation, and the subluxation complex and the five components, subluxation, That was created by Len Faye in the 1960s in a library in London, and I spoke to Len many times.
A lot actually. But the point is, is that it’s like me speaking English and them speaking Swahili. There is a disconnect. Why would they ever want to work with us? So once I started changing my language, and something they could understand, I still do a chiropractic spinal adjustment that hasn’t changed.
I don’t negate my roots of subluxation or what I’m treating, but it’s the same thing as a biomechanical failure and it reduces the barriers. We as a profession treat seven to 10 percent of the profession. Sometimes they say 11 or 12. I think that’s inflammatory. Don’t care. Medicine treats 99 percent of the population.
I would rather you treat, I’d rather you have a closed practice where people have to beg to get an appointment in your office cause you have too many patients. And one of the ways to do that is break down the barriers and be part of the healthcare team. You are not selling out chiropractic. You’re not giving drugs.
You’re not doing any of those. You’re not giving up a chiropractic, anything. You’re just communicating a language people can understand. To me, philosophy is the study of truth. And I look at those truths and I look at the evidence in the literature and it all backs up. Listen, I could go on forever, but right now I’d like to thank From the bottom of my heart, ChiroSecure for giving me this forum, for being able to share information with you, and we’ll see you next time.
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