Chiropractic incompetent economics?
Not long ago the MUA procedure was regarded as another therapeutic modality for the distinct purpose of increasing the revenue in a chiropractor’s office. Once learned and then certified, a chiropractor could use this technique to embellish every patient on whom he could lay his or her hands. In fact, in some MUA facilities, the more patients that were done, the more rewards the chiropractor received from the facility. Everything was working out well. The patients were happy because they were given medications that made them feel great. The chiropractor was making money hand over fist, the facilities where the procedures were being conducted were bringing in a lot of money, and the MUA procedure was lauded as the next great “money maker” of the times.
Then reality set in and the fact that this procedure was being abused became the battle cry of just about every insurance company in the country. The code 22505 was used to perform MUA, and therefore was the code everyone used to receive time honored “reimbursement.” We were slowly setting ourselves up to be taken down so hard, our collective professional heads would spin on our cervical spines wondering what happened, and where everything went.
Climbing out of the quagmire
Today with the advent of some very hard work, we are slowly climbing out of the quagmire that some of our colleagues built for us.
Recently, the American Academy of Pain Management (AAPM) asked the National Academy of MUA Physicians to join forces as affiliate members. One of the most important steps the National Academy of MUA Physicians (NAMUAP) can take is to become associated with a reputable organization; thus fostering a dialogue between professions. By becoming affiliated with the AAPM, is a major step in seeing that the MUA procedure will not become lost in the insurance shuffle.
MUA has begun a creditable resurgence. Several research papers are currently being completed that document not only the validity of the procedure, but the patient response with positive outcomes as high as 97%.8, 16 It is with the help of the AAPM and their national data bank that we will be able to begin scientifically and clinically justifying this wonderful procedure.
MUA’s new foundation
So, how do we survive the “reimbursement crunch” we are in right now until we can provide the “powers that be” with the information that makes it improbable and impractical to deny coverage for the MUA procedure?
We continue to do what we are setting as the new foundation for this procedure, mainly:
- Diligent documentation of cases.
- Specific records of patient selection.
- Complete documentation of patient outcomes and the assessment of prior treatments as a guide to patient recovery from using MUA.
- Assessable patient pain analogues with variants for psychological dependence.
- Never stop offering MUA as an alternative to prolonged conservative when manipulation is the therapy of choice; or when surgery is questionable.
Documentation has always been a problem in the chiropractic profession. However, one of the main reasons that we have made professional progress over the last several years is due to the diligent work of those who put the profession on the map by researching those time-honored “theories” that have been around for years.
Through continued work with many different types of physicians, the MUA procedure is finally starting to gain ground concerning validation. With the resurgence of MUA, only a few medical doctors wanted to get involved with the chiropractors who were performing the procedure. Now doctors from all factions of physical medicine are interested in the outcomes we are achieving. Documentation is one of the key reasons this is happening.
Specific Records of Patient Selection
Recording the findings and the outcome of patients receiving the MUA technique is one of the more effective tools that we have to make reimbursement of this procedure be more recognized. However, just as abuse happened in the past, this becomes one of the most important aspects of documentation.
The Debate Surrounding Serial MUA
One of the more common discrepancies has been the use of serial MUA and how the “serial” part of that portion of the procedure should be established. Basic guidelines for parameters in determining whether one MUA or multiple MUA treatments should be used have been established in the NAMUAP standards and protocols. Remember, as with all guidelines, these were established to give the doctor a “guide” to help determine the right choice, and as with any guideline they are evolutionary. Certain factors such as age, chronicity, repetitive injury etc., may be obvious for the certified MUA practitioner to know that the right choice in most of these cases is serial MUA.
National Data Banks: Key to OVERCOMING Third Party DENIALS
Finally, a mention of the importance of documenting everything that is taking place in the field of MUA. Since MUA’s early inception, Doctors of Osteopathy and Doctors of Chiropractic have been documenting case studies.5, 13, 15 This is very important to have in our history and the evolution of the MUA procedure.
However, what we need now is clinical documentation transferred into national data banks, which gives this procedure the credibility needed to overcome the third party payor denials. This will ultimately cause the insurance industry to refigure its mainstream attack of the MUA procedure being performed by chiropractors. When restraint of trade seems to be the focus these days, no matter what the procedures used in the chiropractic profession, it’s time to rethink our position. Documentation of positive patient response to this procedure is one of the strongest moves we can make. Clinical documentation of patient progress and concomitant rationale for performing the MUA procedure, as well as clinically justifiable progression of care is what will give us the needed tools to fight the seemingly unprofessional attack on MUA.
THE FUTURE of MUA
The MUA procedure is not experimental. It has been well documented for more than 60 years. However, now we need to have the support of all of the doctors and facilities that perform this procedure to join forces to fight the obviously vicious defamation of the character of a wonderfully successful procedure that is helping thousands of patients every year restore normal life functions.
After devoting almost ten years of life to this great procedure, this author has witnessed two things that have never changed: The faces of the patients who receive tremendous relief from their painful musculoskeletal conditions and the doctor’s faces when they see the change in their patients. Even after ten years, it makes all the aggravation, heartaches, blood, sweat and tears worth continuing the fight for MUA. Making Manipulation Under Anesthesia of the spine and extremities an acceptable scientifically valid procedure is the ultimate goal of all good practitioners of the MUA procedure. Just as our forefathers fought for the right to perform regular chiropractic adjustive procedures, we will fight for the right of the patients to receive this historically therapeutically successful procedure and our professional right to use it. s References available upon request.