parking permits - c.ymcdn.comc.ymcdn.com/sites/ · clinical study referrals pg. 12 ... john a....
TRANSCRIPT
eUpdateVolume 23, No. 7 July 2013
CONNECTING YOUto the Colorado chiropractic profession
Mission StatementThe mission of the
Colorado Chiropractic Association is to protect, promote, and expand the ethical and
professional practice of chiropractic in the state of Colorado.
INSIDE this issue...
Colorado Chiropractic Association The voice of Colorado chiropractic since 1917.
Handicap Parking Permits
The Department of Revenue has identified and are in the process of implementing duties and tasks for SB13 058 (effective January 1, 2014). Programming for the new legislation that was approved by Colorado State Title and Registration System (CSTARS) Committee on June 12th and will be completed this fall. The Department of Revenue works directly with the Colorado Advisory Council for Persons with Disabilities as they provide the training and resources/materials for law enforcement and the medical professionals. The updated forms, brochures, and applications will be revised and updated in collaboration with Colorado Advisory Council for Persons with Disabilities and the County Clerks.
The Department of Revenue will be updating their website and materials.
The CCA will have materials available for Doctors of Chiropractic, stay tuned for more information on this topic.
Handicap Parking Passes pg. 1
How to Succeed in Life pg. 2
Medicare Updates pg. 6
CCA Annual Convention pg. 8
Upcoming Events pg. 10
Clinical Study Referrals pg. 12
Prostate Cancer and Fish Oil Supplements pg. 14
Standing Meetings pg. 17
CGIA Damages Cap Increases pg. 18
Journal Of Neurotrauma pg. 22
Board/Staff Members & DORA pg. 26
Do you Dread New Medicare Patients? pg. 28
What is Functional Medicine? pg. 32
Membership Information pg. 38
P.I. Lawyers and Your Practice pg. 40
CC-Pac Donations pg. 42
Club CCA Vendors pg. 44
eUpdate July 2013
2
On a bulletin board in my office I have the following laws posted which I have reviewed daily for nearly 40 years. I am asked by patients or visitors a minimum of three to four times per week when they see these laws displayed if they can have a copy of what is to follow. To read and study the following rules of life on a daily and weekly basis will without question make an impact on all aspects of your life from your practice, to your professional, business, family and social life.
Post these laws in a conspicuous place and read just one or two of them each morning. Do not try to intently study and focus on all of these laws daily. Once you have reviewed each of these, take one law per day them and focus on that one law for the entire day and evening. Once per week read and review all the laws. Make these laws an integral part of your life and know them by memory. Doing this will be met with incredible rewards; to ignore this advice may be one of the most foolish things you will have ever done. What will become of your personal development, practice and life adventures will be forever positively altered by knowing and using these laws.
I first learned these rules by one of my early mentors a Master of the Mar-tial Arts and Master of Acupuncture in Kowloon China in 1972. I can say without hesitation each of these laws has made a major impact in my life and I sincerely do not believe my practice and personal success would have come as early as it did without this philosophy.
Lao Tzu has been credited with saying, "A journey of a thousand miles begins with a single step." Best wishes on your life journey, you've taken the first step.
THE LAW OF CREATION: Whatever we think about and focus on, grows into reality. We create the situations we think about throughout the day. Think you will succeed, you will. Think you will fail, you will do that too. Fo-cus on being sick we end up creating the illness, focus on being healthy and vibrant, we create that as well. Think you are old, others will perceive you that way. Feel and think you are young, we will create that as well.
THE LAW OF ATTRACTION: We attract people, places, things and circumstances into our lives in direct proportion to our wants, needs and desires. People and situations come into our lives not by accident, but by our attraction and creation of the need.
THE LAW OF CONTROLLING OUR OWN LIFE: If we are not specifically controlling our own life and cre-ating the circumstances which are necessary to meet our desires, we will become an instrument for others who do have control of their own life. We in essence will be used by others to meet their mission and destiny.
THE LAW OF RELAXATION: With physical laws, the harder we work, the more is accomplished. With mental laws, the more we relax, believe and expect to succeed with ease and confidence, the better the results.
THE LAW OF RECIPROCITY: Whatever we see in the universe sees us! Whatever attitudes, feelings, thoughts and desires we put out, regardless of if they are negative or positive, will always return to us.
THE LAW OF THE UNIVERSE (KARMA): Like the Law of Reciprocity, which deals with mental factors, the Law of Karma deals with physical manifestations. This law is what may affect our personal belongings, physical health and financial status. This law works both negatively or positively depending upon what we have put out to the universe.
THE LAW OF RETURN: Our rewards in life are in direct harmony with the value of our products, services or ideas. Very important !
THE LAW OF SUBSTITUTION: Consciously substitute all negative thoughts with positive ones immediately upon experiencing the negative thought. We can only experience one thought at any given time, therefore by substituting a positive for a negative, only positive will reach the subconscious.
THE LAW OF BELIEF: Whatever we believe with strong feelings becomes our reality. We are not limited by what we think we can do, but by what we think we can't. Self-limitations are not based upon reality; they are based on negative belief systems.
THE LAW OF PRESENT TIME CONSCIOUSNESS: It is imperative that we live in the present as opposed to "tomorrow," or in the past. Preparing for tomorrow with righteous living and positive thoughts prepare us for what we will manifest, however, it is what we do today, right now (present time consciousness) which is impor-tant to achieve the rewards of life.
THE LAW OF PERSONAL GROWTH: "To become, act and feel as if." To become a successful practitioner, businessperson, parent, sports player, etc. act and feel as if you are already successful. The human spirit will act upon what it is given.
THE LAW OF EXPECTATION: We must know what it is we want to accomplish or obtain before the uni-verse can manifest our desires. Most people don't know what they want due to unclear thinking and foggy mental vision.
THE LAW OF CLARITY: The clarity of our mind and thoughts are in direct proportion to the physical clutter in our lives. Take a look around you.
THE LAW OF CAUSE AND EFFECT: Within universal law, our thoughts are the cause; the conditions, ei-ther good or bad, are the effects. The outcome is totally dependent on our creation of thought. See the LAW OF CREATION
How to Succeed in Life Without Really Trying!“The Secrets of the Masters”
By: John A. Amaro L.Ac., DC, FIAMA, Dipl.Ac.(NCCAOM), Dipl.Med.Ac.
John A. Amaro L.Ac., DC, FIAMA, Dipl.Ac.(NCCAOM), Dipl.Med.Ac.
4
eUpdate July 2013
THE LAW OF BELIEF: Whatever we believe with strong feelings becomes our reality. We are not limited by what we think we can do, but by what we think we can't. Self-limitations are not based upon reality; they are based on negative belief systems. THE LAW OF PRESENT TIME CONSCIOUSNESS: It is imperative that we live in the present as opposed to "tomorrow," or in the past. Preparing for tomorrow with righteous living and positive thoughts prepare us for what we will manifest, however, it is what we do today, right now (present time consciousness) which is important to achieve the rewards of life. THE LAW OF PERSONAL GROWTH: "To become, act and feel as if." To become a successful practitioner, businessperson, parent, sports player, etc. act and feel as if you are already successful. The human spirit will act upon what it is given. THE LAW OF EXPECTATION: We must know what it is we want to accomplish or obtain before the universe can manifest our desires. Most people don't know what they want due to unclear thinking and foggy mental vision. THE LAW OF CLARITY: The clarity of our mind and thoughts are in di-rect proportion to the physical clutter in our lives. Take a look around you. THE LAW OF CAUSE AND EFFECT: Within universal law, our thoughts are the cause; the conditions, either good or bad, are the effects. The out-come is totally dependent on our creation of thought. See the LAW OF CREATIONTHE LAW OF PERSEVERENCE: People who succeed never stop trying. People who stop trying, never succeed. THE LAW OF FORGIVENESS: Forgiving all others is a necessary and ef-fective purgative for a successful life. The law doesn't demand that we like the other person or situation, just that we forgive them and let go of the mental chains which entrap us.
John A. Amaro L.Ac., DC., Dipl.Ac.(NCCAOM), Dipl.Med.Ac.Carefree, Arizona [email protected] This program meets all academic requirements of the NBCE and
individual States leading toward State Certification in Acupuncture15 hrs per Classroom and On Line.
International Academy of Medical Acupuncture
All registrations& inquiries
800-327-1113www.IAMA.edu
Earn 100-300 hrs CE through classroom and On-Line (distance) Fully approved and preparatory to include all distance learning modules for
the National Board of Chiropractic Examiners & ALL States. CE credit New York Chiropractic College Dept. Continuing Education
With an introduction to “intramuscular dry needling”
“AcuPoint Physical Medicine "tm This is the most popular Acupuncture
program in North America.
(Level One) 105 hrs. Modules #1—#7 “Fellowship” (FIAMA)Class #1 and #3 classroom seminar. Class #2, #4, #5, #6 and #7 Distance Learning Program
(Level Two) 100 hrs. Modules #8—#14 “Cyber” Distance Learning Fully Approved Leading toward Diplomate “Dipl.Med.Ac.” (15 hrs per module) Level Two individual modules may be taken during or following the Fellowship program for those doctors
requiring 150 or more hours or to attain Diplomate (Dipl.Med.Ac.) in the IAMA. (Level Three) 120 hrs. Case Study “Diplomate” (Dipl.Med.Ac.)
Diplomate (Dipl.Med.Ac.) status with the International Academy of Medical Acupuncture is earned following completion of Level One and Level Two in addition to the submission of 30 clinical case studies (Level 3)
Class Size limited ……..take advantage of this opportunity Meets all DC, State, NBCE and NAET Acupuncture Requirements
International Academy of Medical Acupunctureand the
Colorado Chiropractic Association presents
John A. Amaro DC, L.Ac., FIAMA, Dipl.Ac.(NCCAOM, Dipl.Med.Ac.
Classroom #1....SEP 28-29 Class #2………....ON LINE
Classroom #3 ..OCT 19-20 Class #4………....ON LINE Class #5……....ON LINE Class #6………...ON LINE Class #7………...ON LINE
Special Fee per class
for CCA Members $275.
Non Members $320 per class
800-327-1113www.IAMA.edu
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eUpdateeUpdate July 2013July 2013
New 1500 Claim Form Receives Final Approval
Federal Agency Considers Further Chiropractic Coverage in Medicare
On June 17 , the National Uniform Claim Committee (NUCC) announced final approval of the Version 02/12 1500 Claim Form by the Office of Management and Budget. NUCC began revisions of the 1500 claim form in 2009 in order to accommodate reporting needs for ICD-10 and Version 5010. A detailed list of the differences between Version 08/05 (the current form) and the new form, Version 02/12, can be found here.## CMS implementation dates are as follows, but please note that these dates are subject to change (check with commercial payers to verify whether they will adhere to the same timeline):
• Jan. 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
• Jan. 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
• April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12).
Providers should also review NUCC's Reference Instruction Manual ### for Form Version 02/12 to familiarize themselves with the new format prior to implementation. ACA will have further updates for members as information becomes available.
http://www.nucc.org/images/stories/PDF/1500_claim_form_announcement_2012_02.pdf
http://www.nucc.org/images/stories/PDF/1500_claim_form_change_log_2012_02.pdf
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02.pdf
For the first time in more than 40 years, the Centers for Medicare and Medicaid Services (CMS) has taken a positive step toward expanding coverage for patients to include Evaluation and Management (E&M) services provided by doctors of chiropractic. The agency's call for further information on this issue, included in the recently proposed 2014 Physician Fee Schedule Update (CMS-1600-P), is a welcome opportunity to provide pertinent research and data to demonstrate that establishing such coverage is appropriate.
Since the chiropractic demonstration program was included in the 2003 Medicare Modernization Act, national chiropractic associations have been working with CMS and the U.S. Department of Health and Human Services (HHS) to secure coverage of the essential services provided by doctors of chiropractic. The profession has long believed that Medicare beneficiaries deserve this level of access. The ability to provide Evaluation and Management services as a covered Medicare benefit is an important first step in this direction.
As CMS has posed specific questions within the proposed rule, the Chiropractic Summit (which included representatives from the ACA and ICA), senior citizens' organizations and other allies will work together to ensure a coordinated message is prepared in support of this key patient benefit. For further information, please contact John Falardeau, ACA's senior vice president of government relations, at (703) 812-0214 or [email protected]
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eUpdateeUpdate July 2013July 2013
Documentation Kathy Mills Chang, MCS-P Friday, Sept. 13 9 am-1 pm 4 CE
Auto Injuries Unplugged Melissa Winthers & Panel Friday, Sept. 13 2:30-6 pm 3 CE
Annual Business Meeting Friday, Sept. 13 7 pm N/A
Complex Spine Conditions Nicole Ingrando, DC Saturday, Sept. 14 8 am-12:30 pm 4 CEChiropractic Clinic Certification for the Massage Therapist Various Speakers Saturday, Sept. 14 8 am-6 pm CE for MTs only
EHR and Health Care Reporting Requirements(NO CE involved in this session) Robert Moberg Saturday, Sept. 14 8-10 am N/A
Secrets of Core Relationship ManagementsFor Chiropractic Assistants Kathy Mills Chang, MCS-P Saturday, Sept. 14 10:30 am-6 pm N/A
The Role of the Sports Chiropractor Locally and Globally Philip Santiago, DC Saturday, Sept. 14 1:30-6 pm 4 CE
Awards Banquet Special Guest: Peter Lemon Saturday, Sept. 14 7-10 pm N/A
Advanced Functional Taping, Theory and Practice Tim Ray, DC Sunday, Sept. 15 8 am-12:30 pm 4 CE
C.P.R. Mark Wolff, DC Sunday, Sept. 15 1:30-4:30 pm 3 CE
Hyatt Regency DTC 7800 East Tufts Ave Denver, Co 80237
Room Block ends Aug. 30 - Book NOWresweb.passkey.com/go/ColoChiro2013
Colorado Chiropractic Association Annual Convention September 13-14-15, 2013
P E T E R C. L E M O NPeter C. Lemon is one the youngest surviving Vietnam War recipients of the Congressional Medal of Honor.
Outnumbered twenty to one during an enemy attack in Vietnam, Mr. Lemon responded by repulsing the charging adversaries using machine gun fire, grenades and hand-to-hand combat assisting in saving the lives of his comrades. Although wounded numerous times, Lemon refused to be evacuated until the enemy had retreated and all his injured comrades were airlifted to safety. The award was presented by President Nixon.
Mr. Lemon is an inductee in the elite ‘Ranger Hall of Fame’.
He is the author of Beyond the Medal, A Journey from Their Hears to Yours and Executive Producer of the Emmy winning documentary Beyond the Medal Of Honor. He donated his book to the 32,000 secondary schools in the United States and the documentary, with curriculum, to over 17,000 public and private high schools to inspire our youth to become wor-thy citizens.
On May 1st 2009, Mr. Lemon was presented the coveted ‘Outstanding American by Choice’ award by President Obama at The White House, recognizing his life of professional achievement and civic contribution.
CCA
Hyatt
Hyatt Regency Denver Tech Center
7800 East Tufts Avenue - Denver, CO - 80237Phone: 303-779-1234 Sales Fax: 303-714-4671
$99CCA Convention Rate
includes garage parking
Best CCA Convention 2013 booking option is on-line at:https://resweb.passkey.com/go/ColoChiro2013
or call 888-421-1442
Room block cut off is August
30, 2013
Take a virtual tour at techcenter.hyatt.com
HOTEL AMENTITES-The Café Restaurant - breakfast, lunch and dinner-Garrity's Sports Bar and Grill-Root25 Taphouse and Kitchen-Fitness Center-Indoor swimming pool, Sauna and Jacuzzi-Airport transportation with Super Shuttle $19 one-way-Complimentary hotel shuttle within 5 miles
ROOM AMENTITES-32" flat panel HDTV-Refrigerators-iHome alarm/clock radio-Cable/satellite TV channels-Upgraded bathrooms-Hyatt Grand Bed
-2 miles from the CCA Office-5 Miles from Park Meadows Mall-10 Miles from Downtown Denver-25 Miles to Dener Intl. Airport
July 2013
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eUpdate
CE Hour requirements for 2011-2013 Colorado relicensing period:
15 CE hours between November 1, 2011 and October 31, 2012
AND 15 CE hours between November 1, 2012 and
October 31, 2013Must have valid health care provider level CPR card AND at least four hours total
of documentation/record keeping every two years.▲
“There is a scam going round recently where various forms of doctors get slammed on yelp and other review sites. Turns out, there is an outfit that posts the bad reviews, then approaches the doctors promising to “fix” the problem for a fee. Several local doctors got hit about four months ago. As with anything on the Internet that is anonymous, be careful.”
2013 Upcoming EventsRegister for any of our events on-line at
www.coloradochiropractic.org/registration/events.cfmTo take online classes (including four hours of documentation) visit
cca.peachnewmedia.com
Sports Physical and CPR Combo ClassesCertify to perform Junior High and High School Sports Physicals.
Denver Thurs. Oct. 17
Documentation and CPR Combo ClassesKathy Mills Chang fulfills the four required hours of Documentation.Dr. Mark Wolff provides professional level CPR training Denver Sat. Aug. 17 l Thurs. Oct. 31**
CCA Annual Convention
Fri. Sept. 13 **CPR on Sunday Sept. 15(Bundle Packages available with convention registration)
ColoradoSprings Sat. Sept. 28
Fort Collins Sat. Oct. 12
**Featured**More
Seminars Listed
Online!
Chiropractic Clinical Nutrition - Sponsored by Anabolic LabsSaturday, August 10 Saturday, October 12
Dr. David Seaman presents the first of a three part series regarding clinical nutrition.
X-Files Basic Training - Basic X-Ray Certification for Chiropractic Assistants.November 16-17
Colorado law requires that unlicensed personnel taking any type of x-rays (including digital) in chiropractic clinics receive at least 24 hours of training. This course provides 12 hours of training with instructions on how to complete the remaining 12 hours at your clinic.
Yochum and Yochum Comprehensive MRI of the SpineSaturday, July 27, 1:00- 7:00 p.m. Sunday, July 28, 8:00 a.m. - 2:00 p.m. 12 Hours of PACE approved CE
The apple doesn’t fall far from the tree and in this case, it is the Yochum family tree. Join Dr. Terry R. Yochum, author of Essentials of Skeletal Radiology, and his daughter, Dr. Alicia M. Yochum for this 1st time ever, intergenerational education event.
CCA Annual ConventionSeptember 13-14-15, 2013 Up to 22 Hours of CE Early Bird Pricing now available
Functional Medicine Series -with Brandon Lundell, DC, DABCI, Dipl Ac, ME, APCSaturday and Sunday, August 10 and August 11 - Continues for 4 more modules - sponsored by Nutri West and CCA
Validating Chiropractic with Malik Slosberg, DCSaturday and Sunday, October 12 and 13 -- Review of the latest in chiropractic research - 12 CE hours
FINAL WEEKEND SPECIAL!!! 15 hours of CE including Documentation and CPRSaturday and Sunday, October 26 and 27 -- Flexible to fit your needs - take 1 to 15 hours of CE! - More info soon.
Acupuncture with John Amaro, DCSaturday, September 28 - Sunday, September 29 Saturday, October 19 - Sunday, October 20
Join acupuncture legend Dr. John Amaro for an acupuncture certification series OR take one of the live seminars. In this series, TWO seminars are LIVE and FIVE are completed on-line. You will be certified to take the National Acupuncture Test offered by NBCE - after passing this, you will be able to apply for acupuncture certification under your chiropractic license.
Online DOT-CME Pysical Training- multiple dates please see online
US Department of Transportation’s Federal Motor Carriers Safety Adminis-tration’s National Registry of Certified Medical Examiners Training Program.
Take advantage of this opportunity to provide additional services in your practice and become certified and registered by the National Registry of Com-mercial Medical Examiners (NRCME) and the Federal Motor Carrier Safety Administration (FMCSA) to perform DOT exams.
YOU MUST BE ON THE NATIONAL REGISTER to perform DOT-CME exami-nations in MAY 2014. Simply complete this Webinar series which allows you to sit for the exam.
Sponsored by New York Chiropractic College AND CCA. Take LIVE on-line webinars OR recorded webinars at any time 24/7.
New Doc Lunch SeriesWednesday, July 31 - Tort SystemJoin new Colorado DCs for lunch and learning from 11 a.m.-1 p.m.Lunches will continually be held on the 4th Wednesday of the month at the CCA Conference Room
Whiplash and Beyond - Dr. Art CroftAugust 16-17 2013 - Call Dr. Brad Gulla to register - 719-380-0138
10
eUpdate July 2013
ADVISORY!
eUpdate July 2013
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eUpdate July 2013
Denver area chiropractors are being invited to refer patients to a groundbreaking clinical study validating the mind/body connection in relation to certain internalized illnesses, defined as illnesses that have no identifiable physical organic cause. Examples include: Chronic Fatigue, Fibromyalgia, Allergies, Asthma, Migraine, Anxiety, Sleep Disorders, IBS and more. The study is designed to test this hypothesis: If the mind internalizes one’s reality and the body responds with internalized illness --and one’s reality is a construct created by context -- then a new context that creates a transcendent reality will allow the body to outgrow the internalized illness. Eight years of preliminary research bear out this hypothesis, which is now being documented in a clinical study conducted by the Littleton-based, nonprofit Institute for the Research and Study of Expanding Consciousness (IRSEC). Candidates for the study include open-minded men and women over age 21 who accept the mind/body connection and understand that the mind can create certain conditions. Patients with life-threatening illnesses or in mid to late stages of degenerative diseases are not eligible. Ideal candidates for the clinical study are primarily women of 40 years of age or older with chronic internalized illnesses. Chiropractors may continue to see their patients during the course of the study.
For more information, call Maury Cohen, IRSEC Outreach Coordinator at 303-871-0460 or visit www.irsec.org and click on the Clinical Study link. [email protected]
Refer your Patients to a Groundbreaking
Clinical Study
eUpdate July 2013 July 2013
1514
eUpdate
Prostate Cancer and Fish Oil Supplementation –
ABSOLUTELY No Association Demonstrated!
There has recently been a surge in media coverage regarding a study that allegedly examined the effects of fish oil supplementation on prostate can-cer expression (1). Quite to the contrary, the subjects in this study were not supplemented with fish oil or put on a fish-rich diet, which means that it is completely inappropriate to suggest that such would cause prostate cancer.
The authors explain that they did a blood test on 834 subjects who de-veloped prostate cancer in the SELECT Trial and measured fatty acids in plasma phospholipids (1). The SELECT Trial examined how supplemental selenium and vitamin E would impact the expression of prostate cancer (2). Table 1 outlines the outcome of this study.
Table 1 SELECT TRIAL Outcomes (2)Supplement # of subjects % who developed cancerPlacebo 8,696 6.08Vitamin E/selenium 8,707 6.37Selenium 8,752 6.56Vitamin E 8,737 7.09
At most there is a 1% great risk of developing prostate cancer if one supplements with vitamin E. However, news reports that came out after SELECT was published implied that vitamin E and selenium supplements are a cause of prostate cancer. The appropriate conclusion is that these supplements as a monotherapy for prostate cancer prevention are ineffective.
A look at the details of the new prostate cancer-fatty acid study reveals that a more appropriate conclusion is needed. As stated above, the subjects were 834 individuals who developed prostate cancer in the SELECT Trial. After a blood draw, the fatty acids were measured as a % of total fatty acids in plasma phospholipids and included omega-3, omega-6 and trans-fatty acids. Table 2 outlines the average omega-3 fatty acid levels, which includ-ed eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Table 2. Omega-3 fatty acids and prostate cancer?Fatty acid No cancer Prostate cancerEPA .61% .65%DHA 2.91% 3.01%While the .04% increase in EPA and the .1% increase may be statisti-
cally significant, the clinical relevance of such small differences remains unknown and was NOT discussed in the paper. Despite this unknown, news reports irresponsibly suggest that consuming fish and fish oil supplements may be a cause of prostate cancer and that men should be careful not to eat too much fish.
The more appropriate conclusion would be that since controls and prostate cancer patients have nearly identical plasma phospholipid levels of omega-3 fatty acids, it is not likely that an association between fatty acids and prostate cancer can be identified in this study. Other dietary and lifestyle factors are likely to be involved. Consider that pros-tate cancer is rare in Inuit Eskimos consuming a traditional diet that includes extremely large amounts of omega-3 fatty acids (3).
Unfortunately, the media scare about eating fish and taking fish oil has been pervasive. Why would the media be so irresponsible? Either it is due to ignorance and/or perhaps a new prostate cancer treating/preventing medication may be in the works. This notion may not be so far-fetched. Consider that statins are now often recommended as a preventive strategy for people with total cholesterol below 200 mg/dl.
References
1. Brasky TM, Darke AK, Song X et al. Plasma phosopholipid fatty acids and prostate cancer risk in the SELECT Trial. J Natl Cancer Inst. 2013; Jul 10. [Epub ahead of print]
2. Klein EA, Thompson IM, Tangen CM, et al. Vitamin E and the risk of prostate cancer. The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011;306(14):1549-56.
3. Dewailly E, Mulvad G, Pedersen HS et al. Inuit are protected against prostate cancer. Cancer Epidemiol Bio Prev. 2003;12:926-27.
David Seaman, DC, MS, DABCNProfessor, Clinical SciencesNational University of Health Sciences Pinellas Park, FL
Register now for Chiropractic Clinical Nutrition presented by Dr. David Seaman DC, MS, DABCN and sponsored by Anabolic Labs.
Class is August 10, 2013
Click Here to Register
By: David Seaman, DC, MS, DABCN
17
eUpdate
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eUpdate July 2013 July 2013
The CCA eUpdate is published monthly. Its purpose is to provide news about activities of the various committees and information concerning current developments of interest to the membership. Articles, reports, letters, opinions, advertisements, statements, and editorial comments do not necessarily represent the position of the CCA. No endorsement of any item should be inferred unless specifically identified as the official policy of the CCA. All material may be ed-ited for clarity or space, and publishing decisions are based on quality of writing, timeliness, and potential interest to the readers. The CCA eUpdate reserves the right to edit or reject all materials. The CCA eUp-date accepts advertisements and inserts from a variety of sources, but makes no independent investigation or verification of any claim or statement contained in the advertisements. Inclusion of advertisements should not be interpreted as an endorsement by the CCA of any product or service offered through the advertise-ment program.
Colorado Chiropractic Association The voice of Colorado chiropractic since 1917.www.coloradochiropractic.org - [email protected] E. Hampden Avenue #B-7 Denver, CO 80231-4929 - 303-755-9011 OR 800-829-0339
Standing Meetings2013
Mesa County Chiropractic Association Meeting First Wednesday each monthAugust 7September 4
12:30 to 1:30 p.m. at UTEC Culinary Restaurant at 2508 Blichman Ave in Grand Junction. You may order ahead by calling 970-255-2641. Please contact Dr. Wes Sheader for more information at [email protected] or 970-254-2954.
Colorado Chiropractic Association Board of Directors MeetingNext Meeting: Annual MeetingSeptember 13 @ 7:00 p.m. Loacation- Hyatt Regency DTC
Colorado Women’s Chiropractic AssociationSecond Tuesday of every odd numbered month
September 10thNovember 12th
7-9 p.m. CCA Conference Center. Each meeting features a guest speaker and an open forum for ideas and discussion. Contact Dr. Rebecca Noren for more info (303) 984-1111 or [email protected]
Colorado State Board of Chiropractic ExaminersUsually 4th Thursday every other month
Colorado State Board of Chiropractic Examiners (CSBCE). Meetings generally start at 9 a.m. Location is 1560 Broadway, Denver. Check the board’s web site for room and agenda: www.dora.state.co.us/chiropractic/boardmeetings.htm
July 25thSeptember 26thNovember 14th
We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc. ∗ Based on a NCMIC policyholder survey conducted by Ward Group,the leading provider of benchmarking and best practices research studies for insurance companies. For more information about Ward Group, visit www.wardinc.com.
©2013 NCMIC NFL 3520
WeBack in 1946, NCMIC was formed by a group ofchiropractors with the express purpose of offeringmalpractice insurance to D.C.s at a time when noone else would.
More than 40,000 D.C.s know they cancount on NCMIC—a company created bychiropractors and for chiropractors.
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It has always been our mission to protect doctors’ practice and reputation. Butdon’t just take our word for it. In a recent survey, 95 percent of ourpolicyholders were extremely or very likely to recommendNCMIC to a friend.*
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WTCOO_CCAUpdate_7.5x9_Layout 1 3/24/13 2:22 PM Page 1
eUpdate July 2013
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eUpdate July 2013
Colorado Increases Caps on Damages Recoverable Under the Colorado Governmental
Immunity Act
Articles, reports, letters, opinions, advertisements, state-ments, and editorial comments in this publication do not necessarily represent the position of the CCA.
Melissa Winthers is an attorney at Fleishman & Shapiro P.C. She represents people who have been injured in collisions and can be reached at 303-861-1000 or [email protected].
By: Attorney Melissa Winthers
On July 1, 2013, Senate Bill 13-023 which raises the damages recov-erable under the Colorado Governmental Immunity Act [CGIA] will become effective. The bill was a reaction to the deadly and costly after-math of the Lower North Fork Wildfire which was believed to have been started by a prescribed burn.
As background, generally speaking, the local government is im-mune from liability for its own negligence. As shocking as that may sound, that is the law. Due to the Lower North Fork wildfire, the CGIA was amended to waive sovereign immunity in legal actions against the state arising from a prescribed fire started by the state on or after Janu-ary 1, 2012. In addition to citizens now being allowed to bring a claim for damages caused by a prescribed burn, the major exceptions to gov-ernmental immunity include: automobile accidents; negligent operation of hospitals and jails; dangerous conditions of public buildings; negli-gent construction, operation or maintenance of public roads; dangerous conditions of parks or recreational facilities; negligent operation of public water, sewer, gas, electric, power or swimming facilities; and failure to perform an education employment required background check.
In those instances described above where the government is respon-sible for its own negligence, prior to the recent enactment of Senate Bill 13-023 recovery against a public entity was limited to a maximum of $150,000. For example, if an individual was rendered a quadriplegic in a motorcycle accident caused by a government worker, the injured indi-vidual could recover no more than $150,000, regardless of whether the individual required life-time medical care. Even if the public entity had insurance coverage far exceeding $150,000, the injured person’s recovery was capped at $150,000. Governmental immunity and damages caps on recovery have been an extremely harsh reality for catastrophically injured people with extensive life-care needs and wage loss.
Senate Bill 13-023 now raises the cap on damages from $150,000 to $350,000 for an individual claim and raises the cap for multiple claims
arising from a single incident from $600,000 to $990,000. The new dam-ages limitations will be adjusted to account for cost of living increases based on the consumer price index.
It is also very important to understand that when an injured person’s claim against the government falls under an immunity exception, the in-jured person MUST file written notice of the claim within 180 days of the date of discovery of the injury. If the written notice is not given within 180 days, the claim is forever barred. If the written notice is sent to the wrong person or entity, the claim can be forever barred. For example, while the statute of limitations for an automobile accident is 3 years from the date of the injury, when a governmental vehicle caused the crash, the Colorado Governmental Immunity Act creates another much shorter time-frame of 180 days to file written notice to preserve the claim. Often, people who are injured do not retain legal help until 180 days has passed. Those injured people who are unaware of, and have not complied with the notice requirements, are left with no remedy.
In sum, Colorado took a much needed step forward in increasing compensation for injury victims by enacting Senate Bill 13-023. How-ever, there are still many pitfalls associated with governmental immunity. Should you have any questions about these claims, please feel free to contact me.
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You can have a one page simple financial policy as a member of ChiroHealthUSA. Request a sample copy today! Send an email to [email protected] with FORM in the subject line.
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and keep more money.
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Facts You Shouldn’t Ignore:
1 of every 3 chiropractors will be audited in 201375% of chiropractors graded their documentation as “poor” An average chiropractic practice leaves $31,000 in missed reimbursement on the table every yearInadequately trained staff costs a typical chiropractic office thousands of dollars annuallyWhen surveyed, 4 out of 5 chiropractors incorrectly thought they were able to provide first-visit “freebies”
Are you one of these doctors? Let us help you find out if compliance risks are placing you in danger or your hard earned money is slipping through the cracks. Take our FREE Reimbursement Analysis Survey and schedule your complimentary consultation to see how you can practice with more joy and peace of mind. We’re only one click or phone call away, ready to help you.
1
The salutary effects of DHA dietary supplementation on cognition,
neuroplasticity, and membrane homeostasis after brain trauma
Journal of Neurotrauma
October 2011; Vol. 28; No. 10; pp. 2133-2122
Aiguo Wu, Zhe Ying, Fernando Gomez-Pinilla
Department of Integrative Biology and Physiology, University of California at Los
Angeles
KEY POINTS FROM THIS ARTICLE:
1) “Traumatic brain injury (TBI) is one of the most common causes of death and
disability in United States: 220,000 hospitalizations, 52,000 deaths from head trauma, and 80,000-90,000 patients suffering from permanent disability each
year.”
2) “Even though over 30 major clinical trials have been made, no efficient
treatment for TBI has been found to date.”
3) TBI results in long lasting consequences on the cognitive ability of patients.
4) The pathology of traumatic brain injury is characterized by membrane damage, oxidative stress, failure in the capacity of neurons to metabolize energy,
sustain synaptic function, and likely resulting in cognitive and emotional disorders.
5) These authors assessed the potential of the omega-3 fatty acid docosahexaenoic acid (DHA) to counteract the effects of concussive injury on
important aspects of neuronal function and cognition.
6) Fluid percussion injury (FPI) or sham injury was performed on rats which
were then maintained on a diet high in DHA (1.2% DHA) for 12 days.
7) DHA supplementation improves learning ability in FPI rats.
8) Given the involvement of SOD [superoxide dismutase endogenous antioxidant] and Sir2 [a longevity gene] in promoting metabolic homeostasis, DHA
may help the TBI brain by providing resistance to oxidative stress.
9) The overall results emphasize the potential of dietary DHA to counteract broad and fundamental aspects of the TBI pathology that can translate in preserved
cognitive capacity.
10) Dietary supplementation of fish oil before brain injury can protect the brain from the deleterious effects of TBI on cognition and plasticity.
2
11) DHA is a crucial omega-3 fatty acid abundant in the brain, is important for
brain development and plasticity, and has been shown to support learning and memory neurodegerative disorders such as Alzheimer’s.
12) This study investigated the healing capacity of DHA dietary supplementation
when provided immediately after a concussive injury in rats.
13) There is a homeostatic effect of DHA dietary supplementation when provided
immediately after TBI.
14) A short period of DHA supplementation “significantly counteracted the
negative effects of the injury on cognitive function, neuronal signaling, and
membrane homeostasis.”
15) “These results indicate that DHA supplementation can provide the type of
broad protection important for counteracting the effects of TBI.”
16) “Given the role of DHA in membrane homeostasis and neuronal signaling,
these findings implicate dietary DHA as a potential candidate for counteracting the adverse effects of TBI on synaptic plasticity and cognition.”
17) “Short time feeding of DHA significantly unregulated molecules with
recognized antioxidant capacity such as SOD and Sir2.” “DHA upregulates SOD and Sir2, which may contribute to counteracting oxidative damage to plasma membrane
after TBI.”
18) “The increase in DHA content may help maintain membrane fluidity, thereby preserving cognitive function in TBI animals.”
19) It is known that TBI causes degradation of membrane phospholipids. Synaptic
membranes phospholipids are preferentially enriched in omega-3 fatty acid DHA.
Increased DHA content helps prevent the loss of DHA from membrane lipids.
20) “Our findings suggest that supplementation of DHA may help the TBI brain
preserve synaptic membrane integrity and fluidity, thereby enhancing membrane
related cellular function and subsequent cognitive improvement.”
21) “Our results demonstrate that DHA dietary supplementation applied
immediately after TBI counteracts the related cognitive decay.”
COMMENTS FROM DAN MURPHY
As noted, traumatic brain injury often leaves the patient with serious long-tern
cognitive and functional consequences. This article suggests that an important therapeutic intervention to markedly improve the clinical outcome is to immediately
supplement the patient with fish oil (as it is high is DHA).
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eUpdateeUpdate July 2013July 2013
El Paso County ChiroPraCtiC assoCiation
Presents:
Whiplash and BeyondWhat are We Missing?
This seminar is specifically designed to thoroughly dissect the personal injury case, with particular focus on whiplash and
concussive injury, from a legal and clinical perspective.
KEynotE sPEaKErDr. art Croft – Whiplash and Brain traumatology
(Live Video Conference from San Diego)
Whiplash and Beyond
DatE: August 16 - 17, 2013
tiME: Registration 7:00 am - 8:00 am Conference 8:00 am - 5:30 pm
loCation: Antlers Hilton 4 South Cascade Avenue Colorado Springs, Colorado 80903
rsVP: Please RSVP by August 2nd to Dr. Brad Gulla at (719) 380-0138 or [email protected]
Co-sponsored by:
Name of Attendee: _______________________________________________________________________ Business Name: _________________________________________________________________________Business Address: ________________________________________________________________________Phone: _____________________________________ Email: ______________________________________
REgistRAtioN FEEs:sign me up for the following courses: Register by August 1st Register after August 1st Healthcare Provider Level CPR Re-Certification $40.00 $55.00 Clinical Documentation $80.00 $95.00 Whiplash and Beyond 2013 $120.00 $155.00 Total $________ Total $________PAymENt: Please accept my check: Check # __________ Amount $ __________ Please bill my credit card: Amount $ __________ Name on Card: __________________________________________ Billing Address: _________________________________________ Card #: _____________________________________ Expiration Date: ____________ CSV#: __________
Please send your completed registration form via one of the methods below: • mail: El Paso County Chiropractic Association, 3510 Galley Road, Suite 104, Colorado Springs, CO 80909 • Fax: (719) 380-8055 • Email: [email protected]
REgistRAtioN FoRmWhiplash and Beyond 2013Whiplash and Beyond 2013
DAtE: August 16-17, 2013ANtlERs HiltoN 4 soutH CAsCADE AvENuE ColoRADo sPRiNgs, Co 80903
(Conference notes will be sent to this email address the week prior to the event.)
CouRsE DAtE timE Cost FooD/BEvERAgE PRoviDED
Healthcare Provider Level CPRRecertification
Clinical Documentation(Drs. Koontz, Anderson, & Gulla)
Direct and Indirect Signs of CervicalSpine Trauma (Dr. Anderson)
Mechanism of Injury and Making Appropriate Referrals (Dr. Koontz)Whiplash and Brain Traumatology
(Dr. Croft)Practical Neurological Examination
in Concussion Cases (Dr. Gulla)Litigating Personal Injury Cases
(Attorneys Shapiro & Greer)
Friday, 8/16
Friday, 8/16
Friday, 8/16
Saturday, 8/17
Saturday, 8/17
Saturday, 8/17
Saturday, 8/17
2
4
2
1.75
1.5
2.25
1.5
$40.00
$80.00
$120.00
Included
Included
Included
Included
8:00am - 10:00pm
10:15am - 12:15pm &1:15pm - 3:15pm
3:30pm - 5:30pm
8:00am - 9:45am
10:00am - 11:30am
12:30pm - 2:45pm
3:00pm - 4:30pm
CE HouRs
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eUpdate eUpdateJuly 2013 July 2013
Executive CommitteeChairman of the Board
Nelson Vetanze, DC, CCEP
President Mike Masteller, D.C. DABCO
1st Vice PresidentRobert Bridge, DC
2nd Vice PresidentKelvin Washington, DC, DACBSP, Dipl., Ac.
Secretary-TreasurerSteve Schuster, DC, LCP
Board of DirectorsDistrict 1 Director/Alternate
Rhonda Jackson, DC/Gary Rademacher, DC
District 2 Director/AlternateRobert Nelson, DC, DACBSP, FICC /
James Farrell, DC
District 3 Director/AlternateCraig Warhurst, DC/Craig Pearson, DC
District 4 Director/AlternateGreg Crawford, DC, DABCO/
Aaron Koepp, DC, DABCO,CCSP,CCST
District 5 Director/AlternateRobert Palmer, DC/
Brian Polvi, DC
CBCE Meeting DatesTHURSDAYS
July 25th Sept. 26th Nov. 14th
The Michael Skolnik Medical Transparency Act of 2010
Senate Bill 10-124 enacts the "Michael Skolnik Medical Transparency Act of 2010" to extend reporting requirements to many health care professionals who apply for or renew a license, certification, or registration, on or after July 1, 2011. The Division of Registrations is in the implementation process at this time. Please refer back to www.dora.state.co.us/chiropractic/statutesrulespolicies.htm for additional information as it becomes available.
It is YOUR responsibility as a Colorado doctor of chiropractic to know, understand and adhere to the Practice Act under which you are licensed. To view the Statutes, Rules, and Board Policies for Colorado doctors of chiropractic, visit:
Colorado State Board of Chiropractic Examiners (CBCE)
Program DirectorMarschall [email protected]
Staff AssistantLisa [email protected]
1560 Broadway, Suite 1350 Denver, CO 80202 MAIN (303) 894-7800(303) 894-7764 - Fax
www.dora.state.co.us/chiropractic/statuterulespolicies.htm
Licensing [email protected] of practice [email protected]
Board Members and Staff
Colorado Chiropractic Association
The voice of Colorado chiropractic since 1917.8751 East Hampden Avenue #B-7
Denver, CO 80231-4929(303) 755-9011
or (800) 829-0339 Fax (303) 755-1010
e-mail [email protected]
Reprinting of materials is granted, except for materials indicated as copyrighted or reserved, but only upon giving credit to the CCA eUpdate in the reproduction. Reproduction of any other material without credit is prohibited, and if you want to quote or reproduce from any item, call or write for information and permission. Copyright(C) 1989 to present Colorado Chiropractic Association
District 6 Director/AlternateWilliam “Bill” Thomas, DC
District 7 Director/AlternateRandy Roman, DC/Michael Treinen, DC
District 8 Director/AlternateDavid Dickerson, DC
District 9 Director/AlternateShandy Grady, DC/
Lea Yoder, DC
Directors at LargeJill Hutter, DC
Chad Kesner, DC, DACBSP, CCCN, CEDPDavid McClain, DC
Rebecca Heidelberger, DC (alternate)Patrick Ray, DC (alternate)
Staff
Executive DirectorVineta Campau
Membership Development Director
Becci McCormack
Media and Events CoordinatorAmanda Segebart
www.coloradochiropractic.org
Board Meeting Dates
*
for locations please contact the CCA
Find your CCA District
Thurs. Jan. 17, 2013Thurs. Mar. 14, 2013Thurs. May 16, 2013Thurs. July 18, 2013Fri. Sept. 13, 2013(annual business meeting)
Click for CCA
By-laws
(revised September 2011)
eUpdate July 2013
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eUpdate July 2013
an initial visit; it depends on what the doctor decides needs to be done," try this, "We offer a program that limits your first visit to only $100." You’ll see the difference the first day!Find out more about how ChiroHealthUSA can, not only keep you compliant, but also make practice easier, profitable and more fun.
Dr. Foxworth is a certified Medical Compliance Specialist and President of Chi¬roHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. Dr. Foxworth is a 1984 Honors Graduate, (Cum Laude), of Cleveland Chiropractic College in Kansas City, MO. He served as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center 4 years and is a member of the American Chiropractic Association and a 3 term past-president of the Mississippi Chiropractic Association. He was voted by his peers as Chiropractor of the Year for several years and is currently a Fellow of the International College of Chiropractic. He was appointed to the Mississippi State Board of Health by Governor Kirk Fordice and again by Governor Ronnie Musgrove and served 12 years, two of them as Chairman. You can contact Dr. Foxworth at 1-888-719-9990, [email protected] or visiting the ChiroHealthUSA website at www.chirohealthusa.com
Do You Dread New Medicare Patients?
By Dr. R. A. Foxworth, FICC, MCS-P
Dr. R. A. Foxworth, FICC, MCS-PPresident, ChiroHealthUSA
Certified Medical Compliance Specialist
Phone: 1-888-719-9990Fax: 1-888-685-2220
www.chirohealthusa.com
I don't know about you, but I LOVE new patients! Sure, there's more work involved with starting a new relationship: going through initial intake, examination process, clinical decision-making, formulating diagnoses and written treatment plans, explaining findings and clinical conclusions to the patient (including their financial responsibility), then finally getting agreement to begin care. We know new patients are the life-blood of practice; especially if patients’ focus, and their man-aged care insurance companies’ focus, is on pain relief and not wellness.It’s challenging. Now compound that by seeing how this di-rectly affects new Medicare patients! Generally, Medicare pa-tients are on some type of fixed income. Medicare only covers three CMT codes reimbursable for medically necessary care rendered by chiropractor. So the new patient visit is 100% the patient's financial responsibility when Medicare is the primary insurance.When a new patient calls, have a clear answer to the question, "How much does it cost to see the doctor?" especially when Medicare is the primary insurance. Being unclear about fees or giving a broad or vague range of fees makes it difficult for a Medicare patient to commit and schedule that appointment.Here's a simple solution: become a provider with ChiroHeal-thUSA, a Discount Medical Plan Organization (DMPO). As a provider you can set a capped Initial Visit Fee that is all-inclu-sive for the initial visit services provided. Your scripting be-comes simpler. When asked, "How much will it cost?" instead of answering, "Our regular fees may range from $175-$350 on
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eUpdateeUpdate July 2013July 2013
and the present:
FUNCTIONAL MEDICINE A 5 Module SERIES
(Modules I and II in 2013) TAKE ONE OR ALL FIVE!
Recognize patterns of dysfunction before disease manifests.
12 CEs available for CO, CT, DE, GA, IA, ID, IL, IN, KS, MI, MN, MO, MS, MT, ND, NE, NM, NV, OR, RI, SC, TX, UT, VA, VT, WA,
WY. (If you don’t see your state, ask if it can be added.)
Implement INDIVIDUALLY TAILORED protocols incorporating blood/lab tests and diet, lifestyle and supplement recommendations.
Receive a Certification for completing a course in Functional Medicine (Lab Interpretation, including serum, saliva and stool tests) and Comprehensive Lifestyle, Dietary, Nutritional, and Holistic Protocols. The demand for this training is being met! Take one or all five of the series (Modules III, IV and V will be offered in 2014). Certificates of achievement are awarded after each class. Training materials included in the registration fee! Includes: a Comprehensive, Holistic Blood Chemistry Lab Reference Manual compiled by Dr. Lundell; thorough notes, outlines, slides etc.; a complimentary month of bloodwork analysis software; all the tools you need to guide through the process and ensure future success in Functional Health!
Foundations in Functional Medicine Certificate: First two completed class modules Intermediate Functional Medicine Certificate: Four completed class modules Advanced Functional Medicine Certificate: All five completed class modules in the series.
Module I and Module II will be repeated in 2014 to allow more flexibility in completing the groundwork!
Brandon M. Lundell, DC, DABCI, Dipl Ac, NE, APC
Dr. Brandon Lundell is more than a certified DABCI, he instructs DABCI students! He has also practiced Functional Health and lab testing for many years; there is a
reason for the six month+ waiting list at his clinic!
Functional Medicine Series Module I – Introduction to Functional Medicine
August 10 & 11, 2013 (Saturday 9:00 am – 6:00 pm; Sunday 8:00 am – 12:00 pm) “Functional Medicine Series Part I – Introduction to Functional Medicine”; Embassy Suites., Airport, Denver, Colorado; $250.00 for Professionals (only 200.00 for CCA members); Students/Assistants 125.00 (only 100.00 for CCA member assistants and spouses); 12 CE’s (we will apply for your state CEs if you give us enough notice): Brandon Lundell, DC, DABCI. Making Functional Medicine practical, Dr. Brandon Lundell shows you the ropes and introduces the Functional Health paradigm; starting with labwork, case studies, using functional medicine resources, manuals, devising treatments individually tailored to your patients. If you’ve wanted to learn about blood chemistry, the opportunity is here! Road maps are provided to individually tailor programs for each patient, including health protocols, with diet, lifestyle and supplement recommendations. Presented to all levels of expertise. From novice to seasoned practitioner, you will receive information that you can use immediately. If you are not a beginner to Functional Health, you can skip the intro from 9 am to 11 am Saturday morning. Includes basic blood chemistry, optimal vs. pathological ranges, metabolic syndrome and insulin resistance, immune dysfunction, CBC abnormalities, anemias, forms/symptom questionnaires, case studies, etc. NW is going green. We will provide flash drives containing the notes for every seminar. Please request written notes for an additional charge.
Functional Medicine Series Module II – Intro to Functional Medicine (cont’d)
October 5 & 6, 2013 (Same time & place) Dr. Brandon Lundell presents “Functional Medicine Series Part II”; Embassy Suites, Airport, Denver, Colorado; $250.00 for Professionals (only 200.00 for CCA members); Students/Assistants $125.00 (only 100.00 for CCA member assistants and spouses); 12 CE’s (we will apply for your state CEs if you give us enough notice): A powerhouse two-day weekend and the second in a series! Dig deeper into the realm Functional Health. Dr. Brandon Lundell presents Module II of the Functional Health series, with timely topics (metabolic disorders, methylation, inflammation, metabolism, thyroid/liver/kidney dysfunction, urinary tract disorders, lipid markers, CVD, intro to GI disorders, advanced testing, etc.) and the importance of incorporating blood/lab test information. More labs and case studies included. NW is going green. We will provide flash drives containing the notes for every seminar. Please request written notes for an additional charge
2014 continuation of the series (dates TBA) will include: Module III (April 5 & 6, 2014): GI Dysfunction and Protocols; Module IV (May 17 & 18, 2014): Endocrine disorders: Adrenals, Male, Female, Preconception and Infertility etc.; Module V (June 28 & 29, 2014) – Endocrine Disorders (cont’d) and multiple case studies to put it all together.
Please Contact Dr. Lynn Toohey of Nutri-West for More Information 866-271-8888 0r 303-662-9997 (Denver area)
E MAIL: [email protected]
eUpdate July 2013
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eUpdate July 2013
However, jumping in with drugs, surgery, and other acute care treatments often does not succeed in helping those with chronic, debilitating ailments, such as diabetes, heart disease, or arthritis. Another approach is needed
The Two-Pronged Healing Approach of Functional Medicine
To battle chronic health conditions, Functional Medicine uses two scientifically grounded principles:
1. Add what's lacking in the body to nudge its physiology back to a state of optimal functioning.
2. Remove anything that impedes the body from moving toward this optimal state of physiology.
Plainly put, your body naturally wants to be healthy. However, the body may be missing things needed to function at its best, or something might be standing in the way of its optimal function-ing. Functional Medicine first identifies the factors responsible for the malfunctioning. Then it deals with those factors in a way appropriate to the patient's particular situation.
Functional Medicine practitioners often use advanced labora-tory testing to identify the root cause or causes of the patient's health problem. Old-fashioned medical diagnosis helps too, in the form of listening carefully to the patient's history of symptoms and asking questions about his or her activities and lifestyle.
For treatment, Functional Medicine practitioners use a com-bination of natural agents (supplements, herbs, nutraceuticals, and homeopathies), nutritional a~1d lifestyle changes, spiritual/ emotional counseling, and pharmaceuticals, if necessary to prod a patient's physiology back to an optimal state. In addition, edu-cating patients about their conditions empowers them to take charge of their own health, ultimately leading to greater success in treatment.
Treating Symptoms Versus Treating the Person
In the dominant health care model today, medication is used to get rid of people's symptoms. If the patient stops taking the medication, symptoms generally return.
Functional Medicine approaches health problems differently. Instead of masking the problem, it aims at restoring the body's natural functioning. Although Functional Medicine practitioners may prescribe pharmaceuticals, they use medications to gently nudge the patient's physiology in a positive direction so the patient will no longer need them.
For example, conventional doctors would normally prescribe pharmaceuticals like Prilosec, Prevacid, or Aciphex to treat acid reflux or heartburn. When the patient stops taking such drugs, the heartburn symptoms come back. In contrast, a Functional Medicine practitioner might find that a patient's ac id reflux is caused by Helicobacter pylori bacteria. Eradicating the Helicobacter pylori might very well lead to the end of heartburn symptoms, permanently.
It's also important to note that in Functional Medicine treatment for similar symptoms might vary tremendously
Functional Medicine is patient-centered medical healing at its best. Instead of looking at and treating health problems as isolated diseases, it treats individuals who may have bodily symptoms, imbalances, and dys-functions.
As the following graphic of an iceberg shows, a named disease such as diabetes, cancer, or fibromyalgia might be visible above the surface, but according to Functional Medicine, the cause lies in the altered physiology below the surface. Usually, the cause of the disease and its symptoms is an underlying dysfunction or an imbalance of bodily systems.
Named diseases are just the tip of the iceberg. Below the surface, accord-ing to Functional Medicine, are the real causes of a patient's health prob-lems.
If health care treats just the tip of the iceberg, it rarely leads to long-term relief and vibrancy. Idei1tifying and treating the underlying root cause or causes, as functional Medicine does, has a much better chance to success-fully resolve a patient's health challenge.
Using scientific principles, advanced diagnostic testing, and treatments other than drugs or surgery, Functional Medicine restores balance in the body's primary physiological processes. The goal is the patient's lifelong optimal health.
How Functional Medicine Heals a Key Health Care Gap
Today's health care system is in trouble because it applies a medical man-agement model that works well for acute health problems to chronic health problems, where it is much less successful.
If you have a heart attack, accident, or sudden lung infection such as pneumonia, you certainly want a quick-thinking doctor to use all the quick-acting resources of modern medicine, such as life-saving technology, surgery, and antibiotics. We are all grateful for such interventions.
What isFunctional Medicine?
By: Ronald Grisanti, DC, DABCO, DACBN, MS
Dr. Grisanti is medical director of Functional Medicine University. If interested in improving your diagnostic skills and increasing your community reputation and recognition, we strongly recommend subscribing to our Free Clinical Rounds Series. These challenging case studies will give you the unique opportunity to test your clinical skills and, at the same time, improve your ability to handle many of the most difficult cases. Go to the following link to get your free access: www.ClinicalRounds.com.
Ronald Grisanti, DC, DABCO, DACBN, MS
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for different patients, according to their medical histories and results of laboratory tests. Factors that can come into play in producing the same symptoms include toxic chemicals, pathogenic bacteria, parasites, chronic viral pathogens, emotional poisons like anger, greed or envy, and structural factors such as tumors or cysts.
The Roots of Functional Medicine
You may be surprised to learn that the concept of Functional Medicine isn't new. It actually represents a return to the roots of modern scientific medicine, captured in this statement by Sir William Osler, one of the first professors at Johns Hopkins University School of Medicine and later its Physician-in-Chief: "The good physician treats the disease; the great physi-cian treats the patient who has the disease."
Another important saying by Osler is: "If you listen carefully to the patient, they will tell you the diagnosis." This encapsulates the importance that Functional Medicine places on taking a thorough history from the patient.
Your Experience of Functional Medicine
When you consult a Functional Medicine practitioner, the first step is always your history. Practitioners are trained on how to unravel and make sense of a complicated story. Often clues in the story lead to the identifica-tion of key imbalances.
The next set of clues comes from a comprehensive physical examination, which includes many nearly forgotten examination procedures used by famous diagnosticians (both living and long gone), such as chapman reflex points, ankle brachial reflex, and nail inspection.
The final set of clues comes from advanced laboratory testing. Innova-tive, cutting-edge lab tests help the practitioner look deeply into a patient's physiology to identify how it has been compromised and how physiological balance can be restored.
After diagnosis and treatment, a Functional Medicine patient can expect his or her symptoms to diminish in severity, along I with a renewed sense of well-being and significant increase in health and vitality.
A Functional Medicine Sampler of Case Studies
~ CASE 1: Sinus Infections and Allergies
Traditional Medical Approach:
The patient was an adult male with a chief complaint of sinus infections and allergies for a period of six years. He had previously consulted with three medical physicians. Medical testing included a CT scan of the sinus-es, which was negative for any pathology. Treatment consisted of the fol-lowing prescriptions: Sudafed, Claritin-D, and Allegra. Results were poor.
Functional Medical Approach:
Based on an extensive history and review of his medical records, Dr. Gri-santi ordered an Airborne Allergy test and food sensitivity test. The results revealed that the patient was highly allergic to Aspergillus fumigatus and Alternaria alternata molds. Dr. Grisanti instructed the patient in how to identify molds in his residence and at work and what steps to take to elimi-nate them. The patient was prescribed a natural pharmaceutical that in-creases his immune system's defense against molds and fungi . After three weeks, the patient was completely free of symptoms and has remained that way for the past two years.
~ CASE 2: Irritable Bowel Syndrome and Fatigue
Traditional Medical Approach:
The patient was a 27-year-old female with an I I-year hi story of irritable bowel syndrome and fatigue. She had previously consulted with four medi-cal physicians before scheduling an appointment with Dr. Grisanti.
Medical testing included an upper and lower GI study and colonoscopy, all of which were fo und to be negative for any pathologies. Treatment con-sisted of the prescription Hyoscyamine. Results were poor.
Functional Medical Approach:
Based on an extensive hi story and review of her medical records, Dr. Grisanti ordered a Digestive Stool Test and Allergy Blood Test. Two bac-terial pathogens were found to be infecting her intestines: Pseudomonas aeruginosa and Citrobacter freundii . The medical literature clearly linked these two pathogens to diarrhea disease. In addition, her allergy test revealed a significant sensitivity to gluten and rice. The patient was pre-scribed a natural pharmaceutical that helped eradicate the two bacterial pathogens and was placed on an elimination diet addressing the rice and gluten.
After one month, she was symptom-free.
~ CASE 3: Menopausal Symptoms
Traditional Medical Approach:
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The patient was a 61-year-old female with menopausal symptoms, in-cluding hot flashes, decreased libido, and weight gain over a period of five years. The patient had previously consulted with one medical physician, who performed no medical testing. Treatment consisted of the prescrip-tion Estrace. Results were fair, but the patient was concerned about the drug's potential side effects
Functional Medical Approach:
Based on an extensive history and review of the patient's medical records, Dr. Grisanti ordered a Women's Hormonal Panel. The results were quite revealing. Her estrogen/progesterone balance was significantly compromised, with too much estrogen and not enough progesterone. This imbalance was the main cause of the patient's roller-coaster emo-tional challenges. After presenting this information to her physician, she was prescribed the proper balance of estrogen and progesterone. The patient eventually went to a compounding pharmacy and had a special formula of estrogen/progesterone made. She became symptom-free and experienced an increase in energy. In addition , she lost 54 pounds in eight months.
This article is a reprint from the May, 2013 Issue of The American Chiropractor Magazine.
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Name & Title(s):
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By submitting this application I am committing to a minimum of 1 year membership, at said level, with the Colorado Chiropractic Association (CCA): I agree to uphold the code of ethics and bylaws of the Association and to abide by the rules and regulations set forth, including timely pay-ment of dues. If I wish to cancel membership I will do so in writing. I understand that by providing my fax number, e-mail address, and other business/personal information; I hereby consent to receive faxes, e-mails, texts and other electronic communication sent by, or on behalf of, the Colorado Chiropractic Association unless I notify the CCA to remove my info from the communication list.
Dues Schedule - Please check one: ENHANCED membership DC (4 years or more in practice) $65.72 Monthly $744.57 Annually $1,500 Annually BRONZE
DC Spouse $17 Monthly $200 Annually Contact the CCA for MORE info on enhanced options.
DC (3 years in practice) $40 Monthly $456 Annually
DC (2 years in practice) $20 Monthly $228 Annually
DC New Graduate $10 Monthly $114 Annually
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Join the Colorado Chiropractic AssociationThe voice of Colorado chiropractic since 1917.
Please return this completed form with payment to:CCA 8751 E. Hampden Ave #B-7
Denver, CO 80231-4929 or FAX to (303) 755-1010
Dues are deductible as an ordinary business expense. Contributions or gifts to the Colorado Chiropractic Association are not tax deductible as charitable contributions for income tax purposes. However, they may be deductible as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities. The CCA estimates that the non-deductible portion of your annual dues - the portion which is allocated to lobbying - is 21%.
April 2013
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rado
ChiropraCtiC assoCiation
Protect your right to Practice
Protect your Patient's right to receieve care
EASY PAY monthly
deductions from your credit card or
bank account.^gGet to know the new
CCA members in your area!Please contact the doctors in your area and
welcome them to Colorado and the CCA.
It’s EASY - Contact information available at needchiro.com
or call the CCA 303.755.9011 or 800.829.0339
EnhancedMembership
A SPECIAL Thank You to the following generousCCA Enhanced Members
Fred Blesch, DCRobert Borman, DCJennifer Crismon, DCElizabeth Decker, DCGlynn Hopkins, II, DCLarry Low, DCCraig Warhurst, DC
The Colorado Chiropractic Association offers enhanced
membership opportunities to help support YOU, your patients, and the chiropractic profession in Colorado. Your enhanced
membership will be used to fund legislative activity at the state level AND the care and maintenance of the CCA office – the headquarters
for chiropractic in Colorado!
Thank Youto ALL CCA Members
for your support of the CCA and the Colorado chiropractic profession
to the WELCOME!
NEW Colorado Members
Jon Blaha Ryan ScottingFruita Grand Junction
Bruce Lee Tracy O’NealWestminster Scottsbluff, NE
Danny SmithEvergreen
Robin WaterburyLongmont
eUpdate July 2013
eUpdate July 2013
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If you treat people who have sustained injuries as a result of an auto collision, working with a reputable personal injury attorney is essential to your practice. Attor-neys who specialize in personal injury law can assist you in identifying and obtain-ing the insurance information you will need in order to process medical bills. They will work with you to identify and access bodily injury and uninsured/underinsured motorist coverage, help you coordinate and establish relationships with other medi-cal specialists that will work with you and your patient, and will fight to ensure that you are adequately and fairly compensated for services performed. Personal injury attorneys understand the complexity of insurance law and the coordination of insur-ance benefits. They can assist you in identifying primary and secondary sources from which your patient can seek benefits. Looking for insurance benefits to pay a patient’s bill sometimes means looking outside the box and may include the coordination of worker’s compensation, Med Pay, private health insurance and Medicare benefits.
How Experienced Personal Injury Attorneys Can Assist your Patients and Practice:
I. Understanding Med Pay Coverage
• Medical Payments ( “Med Pay”) Coverage is defined by Colorado statute as coverage which provides benefits for “bodily injury, sickness or disease resulting from the ownership, maintenance, or use of the motor vehicle” (C.R.S. §10-4-635 (1)(a)). Every policy of auto insurance issued in the state is required to offer a minimum of Five Thousand Dollars ($5,000.00) of coverage unless such coverage was waived by the insured in writing. Med Pay benefits may be used for several purposes. For a pa-tient who has private health insurance, Med Pay can be utilized to help pay a patient’s health insurance deductible and/or their co-payments. If a patient does not have health insurance, Med Pay is even more vital as the patient will rely on this coverage to help them pay for treatment following an accident. Med Pay benefits are required to first be paid to licensed ambulances, physicians and hospitals that provide trauma services. (C.R.S. §10-4-635 (2)(b)(I) and (II)). As of January 1, 2005, C.R.S. §10-4-635(5)(d) after the passage of thirty days, insurers are to pay for the care that was provided by a “licensed health care provider.” The statutory definition of a licensed health care provider includes chiropractic physicians and physical therapists.
• Med Pay covers not only the person insured by the automobile policy, but also may extend coverage to resident relatives . Passengers who have Med Pay cover-age under their own automobile policies may also be covered by the Med Pay that accompanies the vehicle in which they were riding. At times, it is possible to use both the insured driver’s and the insured passenger’s Med Pay benefits. If your patient
How a Relationship with a Personal Injury Attorney Can Benefit Your Practice
has multiple insurance policies, it may be possible to access the Med Pay coverage from all of those polices. This is called “stacking coverage.” Stacking coverage may give the patient more funds to pay for their medical care. Knowing how to stack coverage is advantageous for the physician as they are able to tap into various payment sources and are able to receive timely payment for services rendered.
II. Avoiding Insurance Industry Red Flags
• Experienced personal injury attorneys are familiar with the insurance industry and common practices utilized in the processing of personal injury claims. When you work with an attorney who specializes in this area they are able to ad-vise you of potential problems and pitfalls that are commonly encountered in Med Pay and personal injury claims and sug-gest ways to avoid them. They can show you how a claims adjuster evaluates a case and what items/phrases/notations in a patient’s records help make the processing of your patient’s claim easier or more difficult. It is important to understand what type of things will be seen as red flags, and what might be detrimental to the patient’s recovery for damages, and ultimately, your bottom line.
• An attorney with expertise in personal injury works hand in hand with the Med Pay and bodily injury adjusters assigned to a claims file. They ensure that they have all relevant medical records and bills so that payment can be timely processed. Attorneys who have expertise in this area can help you address common concerns raised by adjusters such as those associated with gaps in treatment and preexisting conditions. They can provide suggestions and advice regarding the sharing of information that will help the adjuster process claims faster.
III. Understanding Colorado Law
• Periodically, there are rulings on legal cases that can affect chiropractic patients’ rights to obtain payments for their treatment. By way of example, on April 30, 2012, three cases were decided by the Colorado Supreme Court impacting the ability of an injured person to obtain compensation for accident-related care. These decisions made it easier for chiropractic providers to obtain payment for the care they provide to an injured person.
• Personal injury attorneys can help you with claims involving governmental immunity issues (when a person is injury as a result of a city, county or state actor). These cases are unique in that notice must be provided to the government entity within a certain time frame or the claim may be forever barred. A lawyer can help you identify such cases and ensure that the statutory notice is properly and timely provided so that your patient’s claims can be processed.
IV. Liens, Assignments and Authorization
• If you are treating personal injury patients, you are probably well aware of these forms. It is important that that you, your patient and the attorney representing your patient are aware of any liens or assignments that exist between doctor and patient. If a lien has been accepted by the physician against personal injury proceeds, it is critical that the physician communicate this information to the attorney. An experienced personal injury attorney will work to see that the injured patient obtains maximum compensation for his or her injuries and losses. They will work hand-in-hand with the treating physician on behalf of the patient.
• The attorney also monitors the treatment from the various medical providers to determine if sufficient coverage exists and to see that information is carefully presented at the settlement and/or jury stage. For example, the attorney will work with the physician to be certain that issues regarding permanency have been rendered, that all the necessary radiology studies (MRI/CT scans) have been performed, and that all past and future medical costs been determined.
Conclusion
Attorneys who specialize in personal injury law assist patients and physicians in identifying and obtaining critical insur-ance information to process medical bills. Personal injury attorneys understand the complexity of insurance law and the coordination of insurance benefits. They assist in identifying primary and secondary sources of coverage, navigating the claims process and understanding the Colorado legal system. Experienced and reputable personal injury attorneys over-see all of the matters necessary in order to maximize recovery for their clients and in doing so, ensure that the chiropractic physician is fairly paid for their services. Working with a lawyer who specializes in this area of law benefits both the chiro-practic patient and the physician treating them.
Why Working with a PI Attorney is so Important
Jerry Malman is an attorney at Malman Law Firm, LLC. He represents individuals who have been injured in automobile, truck, motorcycle, and bicycle collisions. Jerry can be reached at 303-733-7900 or [email protected].
By: Jerry Malman
Jerry Malman will be speaking at the next New Doc Lunch on August 28th. Check our calendar of events for registration information.
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eUpdate
Sharon Anable, DCJoseph Arvay, DCPaul Austin, DCAndreas Ballard, DCJason Barnes, DCDavid Barton, DCChristine Bender, DCRichard Bergeron, DCBonnie Borman, DCWilliam Borman, DCDavid Boyd, DCTimothy Brady, DCBob Bridge, DCDouglas Chapman, DCMartin Claus, DCJack Cody, DC Greg Crawford, DCTim Cummings, DCLee Dimick, DCJoe Dziezgowski, DCEric Dzwonkowski, DCAlfred Euhus, DCJim Farrell, DCDoug Forsstrom, DCBrian Foster, DCRoger Franz, DCDonna Frendt, DCDon Gibson, DCKelly GradyShandy Grady, DCEric Graves, DCKeith Graves, DCBrad Gulla, DCJay Hafner, DCGreg Haitz, DCPamela Hart, DCTed Hasty, DCRebecca Heidelberger, DCJulie Henderson, DCBruce Hextel, DC
THANK YOUPAC contributors!
James Hoffman, DCCandice Huffman, DCGlen Hultgren, DCJill Hutter, DCRhonda Jackson, DCRob Jackson, DCDouglas Jones, DCJack Kimura, DCAaron Koepp, DCMandy Kreager, DCTodd Kreager, DCHal Lease, DCCarrie Linn, DCVincent Loparco, DCKeith Lundburg, DCJeffery Maen, DCLuis Marquez, DCRobert Masteller, DCCharles McDonald, DCHeather Meinke, DCIsaac Mooberry, DCSteve Mooring, DCTim Murphy, DCBob Nelson, DCRebecca Noren, DCGlen Pinto, DCPhillip Pollock, DCPaola Porrone, DCDean Raffelock, DCPatrick Ray, DCTim Rinn, DCCheryl Rodebaugh, DC
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Members 2010-2012Jeremy Rodgers, DCRandy Roman, DCWilliam Salsman, DCJay Sanders, DCSue Schappert, DCSteve Schuster, DCBrock Schwartz, DCTrenton Scott, DCP.A. Skoviak, DCRandy Snyder, DCMike Springfield, DCCraig Stimson, DCMatt Storey, DCCraig Smith, DCScott Smith, DCWilliam Strempel, DCBrian Stutz, DCSteve Sussex, DCMichael Sutter, DCShad Sutton, DCBill Thomas, DCHung Tran, DCMichael Treinen, DCWally Unruh, DCNelson Vetanze, DCKeith Wagner, DCCraig Warhurst, DCGail and John Warner, DCJames Whidden, DCMonty Wilburn, DCMark Wolff, DCJohn Wyatt, DC
Charge my credit card $_____ (up to $550) as a one time donation to the current CC-PAC fund
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PLEASE scan and email to [email protected] OR fax to 303-755-1010Questions? Call 800.829.0339 or 303.755.9011
Why join the club? Donating to the CC-PAC, Colorado Chiropractic Political Action Committee, is the best way to protect your patients rights and patient access to chiropractic treatment in Colorado. Your contribution will be used to support positive, pro-chiropratic contacts with state legislators. Each Colorado legislative session fosters issues that impact doctors of chiropractic and their patients. The Colorado Chiropractic Association, CCA, keeps updated on these issues and together with our lobbyists push for a pro-chiropractic agenda. There is always a need for a well-funded PAC. Please contribute today. Thank you! (Staff, spouse, family, friends and patients can contribute too.)
The Campaign Finance Reform Act establishes rules on contributions to PACs (Political Action Committees) in Colorado. The maximum contribution an individual can make to a PAC is $550 per election cycle (every two years). For example, an election cycle is from December 2012 to December 2014. Corporate/business checks are allowed as well as checks from individual accounts. A husband and wife may make a single $800 contribution if the contribution is done from a joint checking account. Each family member may contribute with their own personal account, but only one contribution can be made from a joint account. In addition, contributions can be made directly to candidate campaigns by individuals up to $400 each two-year election cycle ($200 for the primary election and $200 for the general election). Please include your current address, profession/employer with your contributions to make it easier for the candidates to properly report.
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July 2013
Please direct INSURANCE questions toCCA Insurance Chair
Dr. Greg Crawfordemail to:
or FAX to 970-493-2105
Medicare Questions - contact Dr. Crawford or
Kathy Mills Chang - [email protected] 1-855- TEAM-KMC
Susan McClelland - [email protected]
ResourcesJoin the Novitas JH MAC Transition email list at
https://www.novitas-solutions.com/transition/jh/lists.html
Join Medicare (CMS) email list:http://www.cms.gov/Medicare/Medicare.html
You will be required to receive claim payments via electronic fund transfer Electronic Funds Transfer form:
http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS588.pdfNovitas will acknowledge receipt of your EFT form with a letter.
Provider inquires: 1-855-252-8782
Index for contact info Novitas Solutions:https://www.novitas-solutions.com/contact/index.html
Check Local Coverage Determinations (LCD) with Novitas:https://www.novitas-solutions.com/policy/jh/l32718-r4.html
Navigating Novitas Solutions website start here:https://www.novitas-solutions.com/site-map.html
PLEASE NOTE: Kathy Mills Chang and Susan McClelland are consultants in this arena and may require a fee for extensive questions.
Insurance Assistance
Part B Claims for COLORADONovitas SolutionsAttn: Part B ClaimsPO Box 890107 Camp Hill, PA 17089-0107
Send Claims to:Noviats Payer ID: 04112
Club membersClub CCA members provide on-going support for the CCA and
the chiropractic profession through advertising, donations, and the excellent products and services they provide to Colorado DCs.
PLEASE consider a club CCA member for your chiropractic product and service needs.
Vendors: Find out how YOU can become a club
CCA member at http://www.
coloradochiropractic.org/headlines/files/ClubCCA2.pdf
www.ncmic.com800.769.2000, x 4200
www.anaboliclabs.com
800.344.4592nutritional supplements
www.nutriwest.comLynn Toohey, PHD - 866.271.8888
nutritional supplements and education
www.cbrcolorado.comCandice Seigel 720.431.0049
insurance billing
www.chirohealthusa.com888.719.9990
cash discount program
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eUpdate July 2013