Friday Educational Sessions
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Screening for Red Flags and Contraindications in Cervical Spine Conditions (1 CE)

8:30 a.m. – 9:30 a.m.   
Meeting Room: Columbia 11

Presenter: William J. Lauretti, DC 

This presentation will prepare participants to recognize red flags and contraindications to care in patients with cervical spine complaints.  It will discuss the important issues doctors need to recognize in a patient's history, and cover  evidence-based physical examination tests that can help make a differential diagnosis. It will suggest appropriate action steps for a patient with suspicious findings. It will also offer ideas on how to have a useful informed-consent discussion with patients--particularly patients with challenging conditions. 

Learning Objectives:  

  1. Identify red flags and contraindications present in a patient's history and examination findings. 
  2. Improve the examination process for patients with cervical conditions by including evidence-based physical tests 
  3. Express the essential components of informed consent for patients 

Population Spine Health Management: Enhancing Clinical Outcomes and Increasing the Cultural Authority of Chiropractic for Spine Care (1 CE) 

8:30 a.m. – 9:30 a.m.  
Meeting Room: Columbia 12

Presenter: David J. BenEliyahu, DC 

The healthcare landscape in the U.S. is rapidly evolving with a shift to new payment models such as Pay for Performance and the Merit Based Incentive Payment System (MIPS), instituted by the Center for Medicare and Medicaid Services. Healthcare providers and health delivery systems must evolve as well to keep up with the changes in the way health care is delivered. This presentation will describe some contemporary practice principles being implemented by hospital systems and physicians nationwide. Chiropractors should become well versed in these contemporary practice principles and consider implementing them into their practices.  

The U.S. Bone and Joint Initiative, in its fourth edition of The Burden of Musculoskeletal Disease, reports that musculoskeletal conditions affect 50 percent of the U.S. population, of which 50 percent will have spine-related disorders. The chiropractic profession has a window of opportunity to take the lead in care coordination, and comprehensive management of this specific population of patients. This is referred to as Population Health.  

The presentation will review the principles of Triple Aim, Population Spine Health Management and Interprofessional Collaboration as it relates to spine care. Dr. BenEliyahu will present implementation steps, a risk stratification tool, sample care pathways and population spine health forms that can be customized by chiropractors to use in their practices. 

Learning Objectives:  

  1. Recognize practice principles of Triple Aim, Population Spine Health, and Population Spine Health Management, and how they apply to spine care, and specifically chiropractic practice. 
  2. Apply the importance of spine care pathways, risk identification/stratification and social determinants of health to enhance outcomes in chiropractic practice. 
  3. Express utility of interprofessional collaboration and integration to enhance outcomes and increase chiropractic's cultural authority for population spine health. 

Research Evidence: Finding it, Reading it and Knowing if it’s Good. Essential Knowledge and Skills for Evidence-based Clinical Practice (EBCP) (1 CE)

10:00 a.m. – 11:00 a.m.  
Meeting Room: Columbia 11 

Presenter: John Scott Stites, DC 

Being knowledgeable of the research status of the profession can be challenging and requires foundational understanding of the basic principles of evidence-based clinical practice (EBCP). In fact, modern healthcare requires adopting these principles. Although the skills required to practice EBCP are currently taught in many of our institutions, these skills were not part of the curriculum when the majority of today’s chiropractic practitioners were trained. The purpose of this session is to provide the doctor with the background and the tools to start to incorporate EBCP into their daily practice. This will be an interactive session starting with how to find the information you need. This involves developing answerable clinical questions and creating search strategies. Being able to effectively identify sound resources and understand the hierarchy of evidence are essential skills. Different clinical questions are answered by different study designs and these will be reviewed. Research papers are not novels and shouldn’t be read in that way; the presentation will review how to effectively read a research paper. To determine the quality of a paper it is necessary to do a critical appraisal assessing validity. This will be reviewed focusing on studies of therapy. Interpreting results will also be addressed. During the session, we will explore concepts of relative and absolute risk reduction and numbers needed to treat. At the conclusion of the session strategies to stay current in the literature will be examined.  

Learning Objectives:  

  1. Recognize the basic process of evidence-based clinical practice. 
  2. Identify the strengths and weaknesses of different study designs. 
  3. Review a scientific paper efficiently.  
  4. Critically appraise a paper on therapy. 
  5. Explain relative and absolute risk and numbers needed to treat. 

Employee Benefits for Chiropractic Services: Three Decades--Then and Now (1 CE)

10:00 a.m. – 11:00 a.m.   
Meeting Room: Columbia 12

Presenter: R. Douglas Metz, DC 

In 1991, Dr. Metz published two articles in The Journal of Chiropractic that addressed the state of chiropractic as viewed from within employee benefits payors and plan sponsors. Over the past 29 years (1991- 2020), the landscape has changed. In this presentation, Dr. Metz will revisit observations and recommendations made 29 years ago, providing insights, trends and ideas about how the chiropractic profession and the individual doctor can take advantage of those 21st century changes and opportunities, driven by an increased demand for lower cost and highly effective health care. 

The presentation will include historical observations regarding nearly three decades of changes and developments related to the following domains: coverage policy, guidelines and evidence, credentialing and training, quality management, utilization management, network management and adequacy, documentation, and inclusion and leadership.  The presentation will also address future trends such as developing cultural authority and integration, coverage policy and who pays the bill (the role of the plan sponsor), evidence applied to practice and policy, telerehabilitation, digital influence and AI, quality measurement, EHR, standardization and accreditation, integrated health systems, alternative payment models, and more.   

Learning Objectives:  

  1. Discuss the history, evolution and structure of employee health insurance benefits in the United States. 
  2. Analyze trends in employee benefits and how these trends may impact chiropractic doctors who participate with insurance networks and bill employee benefit carriers.   
  3. Explain the opportunities for chiropractic doctors to increase visibility and value of chiropractic services in the eyes of third-party purchasers and carriers. 

The Primary Spine Practitioner and Clinical Reasoning in Spine Pain® (1 CE)

11:15 a.m. – 12:15 p.m.  
Meeting Room: Columbia 11

Presenter: Donald R. Murphy, DC 

This presentation introduces a new, innovative role in the healthcare system, the Primary Spine Practitioner (PSP), and an evidence-informed, patient-centered approach to the application of the biopsychosocial model in the diagnosis and management of patients with spine-related disorders, also known as Clinical Reasoning in Spine Pain® (CRISP®). The evolution of the PSP role will be discussed as well as the knowledge and skill necessary to play this role. In addition, real-world examples of the PSP model will be presented. An overview will be provided of the development of CRISP® and the utilization of this process in developing a working diagnosis, considering the various potential biological, psychological and social contributing factors, and then embarking on a management strategy designed to address each factor in a busy clinical environment. 

Learning Objectives:  

  1. Recognize the role of the PSP in the healthcare system. 
  2. Apply an evidence-based clinical reasoning process in the diagnosis and management of spine-related disorders. 
  3. Explain how to function as a PSP utilizing CRISP®.  

Becoming a Genuine Resource on Chiropractic (1 CE)

11:15 a.m. – 12:15 p.m.  
Meeting Room: Columbia 12

Presenter: Morgan Young, DC 

This presentation will discuss the challenges of representing the profession to diverse groups of stakeholders--legislators, policymakers, patients and providers. Dr. Young currently works on several state-wide policies and evidence-based healthcare delivery committees that involve multiple types of stakeholders. There is often significant bias (or lack of knowledge) as well as political agendas to navigate. He will discuss strategies on how to engage each group through becoming a trusted resource with a less biased view of the evidence while avoiding pushing a special interest agenda. Being a non-confrontational resource can enable you to correct innocent (or not so) misconceptions that potentially impact policy. Dr. Young will discuss recent publication and work with the Bree Collaborative, where his involvement led to input from multiple chiropractic groups, including ACA, which had several positive effects for chiropractic and evidence-based care. 

Challenges with lobbying and legislation will be examined, and how pushing too hard before getting full buy-in and acceptance can be counter-productive, even when we "win."  

Dr. Young hopes to trigger some introspection into the professional chip many of us carry on our shoulders and whether we perpetuate our own struggle in some instances. He will propose that we shed the specter of advocating purely for chiropractic and shift to manual therapy as a whole with the patients’ best outcomes as the goal. 

Learning Objectives:  

  1. Differentiate between being a resource to provide information as opposed to the advocacy of special interests. 
  2. Engage meaningfully with public and private discussions on conservative musculoskeletal care. 
  3. Recognize opportunities to advance the profession through communication with other providers. 

Spine Pain as an Adaptive Challenge (1 CE)

1:45 p.m. – 2:45 p.m.  
Meeting Room: Columbia 11 

Presenter: John M. Ventura, DC 

R.A. Heifetz stated that the greatest failure of leadership has been attempting to solve adaptive problems as if they were technical problems. Historically, leadership has relied on authoritative expertise and technical knowledge, which will suffice when the challenge is technical: a specific answer is available to a specific question.  For example, the technical skill of the cardiologist to perform a coronary artery angioplasty procedure for a technical problem, a blocked coronary artery, is a technical solution to a technical problem. 

In contrast, adaptive challenges include a change in beliefs, a shift in values and often competing perspectives. To follow the technical problem noted in the previous paragraph, the adaptive challenge would be that faced by the patient suffering from the blocked coronary artery: quit smoking, change their diet, practice relaxation and exercise. The technical solution solved the technical problem (balloon angioplasty), but for any sustained benefit the patient will need to address the adaptive challenges: their beliefs, values and motivations about smoking, diet, exercise and relaxation.  

Low back pain presents as both a technical and adaptive challenge. Modern science has shown great advances in addressing many of the technical aspects of low back pain. But low back pain also presents several adaptive challenges, to both those patients suffering from low back pain and those providers rendering care. 

Guidelines, algorithms and research help us to solve the technical challenges of spine pain, but the adaptive challenges require adaptive solutions. Dr. Ventura proposes utilizing Relationship-centered Care, Relational Coordination and the Self-determination Theory as pragmatic steps to foster change.    

Learning Objectives:  

  1. Differentiate a technical problem from an adaptive problem. 
  2. Recognize both the technical and adaptive challenges associated with spine pain. 
  3. Identify and implement three strategies to help solve the adaptive challenges using Relationship-centered Care, Relational Coordination and the Self-determination Theory. 

The American College of Physicians Guideline for Low Back Pain--Building an Evidence-Based Case for Chiropractic (1 CE)

1:45 p.m. – 2:45 p.m.   
Meeting Room: Columbia 12 

Presenter: Christine Goertz, DC, PhD 

Low back pain is ranked as the No. 1 cause of worldwide physical disability morbidity, with an estimated global point prevalence of 9.4% in 2010 and lifetime prevalence estimated to be as high as 80%. It is estimated that that low back pain and arthritis impact 100 million people in the U.S. per year, at an annual cost of $200 billion. The public health impact of back pain is exacerbated by the fact that the benefits of many widely used treatments for back pain, such as spinal fusions, epidurals and prescription medications, are outweighed by the risks. In growing recognition of this problem, largely as a result of the opioid crisis, numerous public and private organizations over the past two to three years have adopted new guidelines for the treatment of back pain, including the Centers for Disease Control, the Food and Drug Administration, the Joint Commission and the American College of Physicians. All call for the increased use of non-drug therapies. However, the American College of Physician’s (ACP) 2017 Guideline on Low Back Pain takes it one step further by calling for the use of non-pharmacological treatments prior to the use of any prescription medications for patients suffering from acute, subacute and chronic low back pain. Many of the evidence-based treatments recommended in the ACP guideline are commonly either delivered or recommended by doctors of chiropractic. For example, current literature shows that chiropractic management for low back pain leads to lower levels of pain intensity and pain-related disability that are similar to other forms of recommended conservative treatment, results in a low risk of serious adverse events, leads to high levels of patient satisfaction and costs no more than other conservative treatments for back and neck pain. 

Learning Objectives:  

  1. Describe the prevalence, cost, public health impact, and common treatment approaches for low back pain in the United States.  
  2. Describe the American College of Physician’s 2017 Guideline on Low Back Pain, including at least three examples of recommended non-drug treatments for low back pain.  
  3. Discuss the current evidence base for chiropractic care. 

Dynamic and Structural Evaluation of Sports Injuries (1 CE) 

3:15 p.m. – 4:15 p.m.  
Meeting Room: Columbia 11

Presenter: Christine Foss, DC  

This presentation will evaluate and interpret dynamic and static patterns of athletic injuries.  The attendees will be taken on a journey that will change the way they evaluate and treat a multitude of common injuries sustained in sport.  This lecture begins with the review of common sport injuries, clinical findings and research as to injury predisposition. Reviewing research in athletic injury treatment paradigms and the projected success of conventional rehabilitation of athletic injuries. The lecture continues by examining the mechanisms of injury for athletic injuries and how we can look to current research in injury prevention and early recognition. Future trends of athletic injury are reviewed as well as applicable treatment regimens that set the stage for optimal performance. 

Learning Objectives:  

  1.   Analyze athletic injuries and define kinetic patterns that may be the cause of injury.  
  2.   Define mechanisms of injury, globally evaluate the patient for faults that may be the predisposing factor and apply treatment regimens that move towards optimal performance. 
  3.   Recognize that structural faults of athletic injuries may or may not be correctable. 

The Global Spine Care Initiative: Delivering Community-Based, Sustainable Models of Care (1 CE)

3:15 p.m. – 4:15 p.m.  
Meeting Room: Columbia 12

Presenter: Deborah Kopansky-Giles, DC 

World Spine Care was conceived in 2008 to address the massively underserved issue of musculoskeletal care-related disability in low- and middle-income communities around the world. Today, World Spine Care operates six clinics in four countries: Botswana, the Dominican Republic, India and Ghana. Each of these countries has different levels of resources, cultures and expectations. These clinics are supported by government agencies, other NGOs or university volunteer clinical services. 

These clinical programs provide evidence-based care in their communities; however, by themselves, they do not meet the WSC vision of “a world in which everyone has access to the highest quality spine care possible.” To work toward this vision, World Spine Care convened the Global Spine Care Initiative (GSCI) with a goal to develop an evidence-based, practical and sustainable model of care for spinal disorders that can be implemented internationally. GSCI aims to transform the delivery of spine care in underserviced communities. Many of the principles of GSCI, however, can easily be implemented by clinicians in high-income communities.  In the last quarter of 2018, the European Spine Journal published a series of 15 articles from GSCI as a special supplement. There were contributions from 68 clinicians and scientists from 24 countries. These papers present a consensus-based model of care, which can be used to establish and scale spine programs in low- and middle-income communities around the world.  

This 60-minute evidence-based presentation will provide an overview of the background, history and the outcomes from the GSCI publications. It will focus on translating research into practice and on how the results of GSCI can be incorporated into the clinical practice of chiropractors in North America. 

Learning Objectives:  

  1. List the six GSCI classifications of spine conditions. 
  2. Describe the GSCI care pathway. 
  3. Describe the basic principles necessary to apply the GSCI care pathway within their practices. 

Quality Payment Program in Year 4 (2020) and CMS Engagement (1 CE)

4:30 p.m. – 5:30 p.m.  
Meeting Room: Columbia 11 

Presenters: Barbara Connors, DO, MPH, CMS & Troy A. Sturgill, DC 

Dr. Connors, chief medical officer, and Dr.  Sturgill, ACA member and QPP clinician champion, will provide a comprehensive overview of the CMS Quality Payment Program (QPP) in an interactive, peer-learning presentation format. 

The presentation will review the Quality Payment Program and give an introductory explanation of its two participatory tracks: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). CMS recognizes that clinicians within chiropractic medicine are newly eligible to report MIPS data, so Dr. Connors will outline MIPS eligibility, reporting options and data submission, performance categories, and payment adjustments. She will also touch on Advanced APM criteria and models currently being tested by the CMS Innovation Center.  

Dr. Sturgill will then share his personal experience engaging with CMS as a QPP clinician champion. He will detail how he became involved in QPP, what he’s learned through participating, the importance of connecting with CMS to provide feedback, and what participation in QPP means both to himself and his practice. An open Q&A session will follow.  

Learning Objectives:  

  1. List the updates for Year 4 (2020) of the Quality Payment Program. 
  2. Describe QPP quality measures applicable to chiropractors. 
  3. Engage with the Centers for Medicare and Medicaid (CMS) and provide feedback. 

Enhancing Cultural Competence in Practice to Effectively Deliver Chiropractic's Value to Diverse Populations (1 CE)

4:30 p.m. – 5:30 p.m.  

Meeting Room: Columbia 12
Presenter: Gerald L. Stevens, DC, MS 

This presentation aims to educate chiropractors on the nuances of interacting with various cultures. Enhancing a chiropractor’s cultural awareness and knowledge of customs is key in building practices in ethnically diverse areas.  Increasing the doctor’s cultural intelligence should help them to accommodate the needs and desires of various cultures. Once these needs are met, chiropractors can communicate what they can do to help patients’ neuromusculosketal systems.  

Tips will be provided to enhance communication in a way not to offend various cultures. Barriers will be identified, along with advice to overcome them, paving the way for doctors to communicate the value of chiropractic. The presentation will help doctors, students and chiropractic assistants to avoid problems with patient management. Proper communication is the key to chiropractors’ ability to deliver valuable treatments to these populations and grow their practices.  

Learning Objectives:  

  1. Identify cultural barriers and explain how to overcome them in practice. 
  2. Describe tips to enhance the chiropractor's ability to communicate and manage patients from diverse cultures in practice. 
  3. Relate cultural knowledge and cultural awareness to chiropractors to expand the types of patients we see in practice.