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MCA In Touch – January 2019
MCA In Touch

President's Article

MCA President-Sara CuperusDear Colleagues:

I sincerely hope that you had a joyous holiday season. January is just about over, and we have hit the ground running! The legislative session is already a few weeks underway and things are starting to happen. The MCA legislative committee and our lobbyist have been super busy keeping their pulse on all the new bills introduced that affect chiropractors in our state. One big issue this session will most definitely be the repeal of Provider Tax. We are advocating in the best interest of chiropractors and will continue to fight on your behalf. For more information on what’s going on legislatively, see Dr Chuck Saywer’s article later in this newsletter. This is a very important legislative session for us and it's vitally important for us to have a loud voice at the Capital this year. Please mark your calendars for the 2019 Chiropractic Day at the Capital on March 14th. You’ll be able to join us for morning meetings with your legislators followed by the MCA Annual meeting and an afternoon of continuing education credits.

We have also undergone an audit of all our communications in the past few months. This was done by an independent firm. Our key areas of improvement are our website, social media presence and our newsletter. We have some serious work to do and we are committed to improving our communication with our members and non-members. Hopefully, you will see and feel this difference in the coming months.

We will be moving to a new CE platform, hopefully by the end of March. This move will be good for many reasons. It will be more user friendly than our current option. Also, this platform will allow us to share in a “marketplace” of webinars from other states who also use this same platform. This is very exciting as it will allow us to offer significantly more online webinar options. Remember, you also get 4 free online CEU’s with your membership, so be sure to take advantage of those!

We had a recent BIG WIN with Blue Cross Blue Shield of Minnesota through Secure Care. Just before the holidays, we were notified that 97140 (Manual Therapy) is finally a reimbursable code for chiropractors again! Some years ago, this was taken off the fee schedule for chiropractors. Through our partnership with Secure Care, we were able to open up dialogue regarding the code with BCBS and they have added it back onto our fee schedule. This is a big win for those who do any sort of manual therapy like myofascial release, Instrument Assisted Soft Tissue Manipulation and the like. This is effective immediately, so please feel free to start using this code today.

There are some interesting in-person opportunities coming up in the next few months as well. The Sports Council is busy putting together a Special Population and Nutrition Summit on March 2nd. This promises to be a day jammed packed with new information for you to use on Monday morning. We will also be holding our First Annual Awards Gala event on April 13th, celebrating each other and celebrating chiropractic. It will be a night to celebrate how far we’ve come this past year, honor some amazing doctors with awards and to fellowship with each other over some casino games. Mark your calendars to join us for a wonderful evening.

Your volunteer board continues to work hard to improve the practice climate for each chiropractor in the state of Minnesota. We strive to make a difference in the lives of each individual DC and their patients in the state of Minnesota. We are wholeheartedly committed to doing so.

What’s Happening (so far) in the Minnesota Legislature

Charles Sawyer, DC
MCA Professional Officer for Legislative Affairs

The Minnesota State Legislature convened on January 8, 2019 and the leadership of both the House and Senate have put forth their broad policy priorities. And, while they are likely to approach the topic from different perspectives, addressing health care costs, patient access and stability in the insurance market are front-burner issues. And, recent campaign promises from newly elected House members and the Governor will loom large in the conversation.

Replacing the 2% provider tax with an alternative source of funding for the MinnesotaCare program is one of our most important priorities – and we are not alone in that effort. The Minnesota Medical Association has recently endorsed a proposal that would lift the tax burden from the provider community – especially those practicing independently including dentists, psychologists, opticians and chiropractors – by imposing a 2% fee on claims processed by insurance companies and third-party administrators.

While no legislation has been introduced to date, Sen. Jim Abeler from Anoka expressed interest in the concept in a recent Minneapolis StarTribune article. However, now with a divided government following the 2018 election, we can all expect some sharp disagreement between the two parties over a solution for what is project to be a nearly $700 million funding shortfall for Minnesota’s public healthcare programs – Medicaid and MinnesotaCare – with a combined enrollment of approximately one-million Minnesotans. Simply stated, GOP members in both the House and Senate want the provider tax to sunset, as scheduled in 2020, while DFL members – and Governor Tim Walz – feel that the tax is essential.

Another Minnesota Chiropractic Association priority is the reintroduction of legislation in 2019 seeking to modify coverage for chiropractic services in the Medical Assistance Program and, now that DFL House members are in the majority, our lobbyists, Kevin Goodno and Anni Simons, have been meeting with previous and new prospective bill authors.

Other healthcare legislation that has received some media attention includes two identical bills (HF 3 and HF 27) that would enable the commissioners of human services and commerce to apply for federal waivers establishing a MinnesotaCare buy-in option for individuals and families. While that market-competition proposal will likely response a tepid response in the GOP-controlled Senate, there are two provisions in the Minnesota Comprehensive Health Act that are of interest; (1) direct contracting with healthcare providers and, (2) the establishment of reimbursement rates “which are adequate to ensure essential provider viability.”

We will keep you informed during the 2019 session of the Minnesota Legislature and you will have an important opportunity to influence the healthcare policy conversation on Thursday, March 14, 2019 at MCA Day at the Capitol so I strongly encourage you to register now so we can get appointments scheduled with your House and Senate members scheduled!

As always, if you have any questions or want additional information, please contact me at or (612) 719-1079.

MIPS Changes for 2019 Create Potential Opportunity

Lyle Coleman, DC

The world of electronic medical records and what used to be called meaningful use continues to evolve. 2019 will be year three of the Quality Payment System and MIPS (Merit based Incentive Payment System). And there are some changes this year that potentially create an opportunity for a lot of DC’s. An Overview Fact Sheet and link to the QPP website are included in this article.

Part of MIPS is the low volume exclusion. And in year 2 that exclusion meant that about 90% of DC’s were shut out of the system. The bad part of that was that those shut out had no chance to earn bonuses to the fee schedule. A blessing was being excluded from complying with what used to be called meaningful use.

This year there is a significant change involving low volume exclusion.

The existing thresholds from year two remain, having more than $90,000 in approved charges and over 200 different patients with episodes during the measurement period. Added this year is a third criterion: providing over 200 approved procedures. Exceeding all three measurements meant you will be required to participate in MIPS program.

The new rule that is truly significant for us is this: If you exceed only 1 or 2 of the threshold measures but not all three of them, you can voluntarily opt into the MIPS system. Being able to opt in is brand new this year. Figures from Pro Publica Treatment Tracker showed that over 500 Minnesota DC’s did over 200 approved procedures in the latest year they measured.

The reward for good scores in the MIPS system this year is an additional 7% bonus over the Medicare fee schedule for pure Medicare patients. Advantage Plans are not included. A fair score in MIPS would equal no bonus, and a poor score could mean up to 7% reduction in payments. So there is risk as well as reward. Based on 200 procedures (98940, 98941, 98942) @ 7% of 2019 fee schedule would equal a bonus of about $580 for all 98941’s. That is hypothetical for example only. In practice having all 98941’s is suspicious to Medicare and invites audit. The risk of penalty is that same hypothetical $580.

So if you are in the group that is already doing over 200 approved Medicare procedures annually, please do some investigating. What work and time would it take to comply with the MIPS requirements to generate a good score? What is your personal risk of generating an average or poor score? Do you have to make a capital investment in software capability in order to become compliant? At what cost? What is your personal potential bonus amount? Is that amount worth the time, work, and investment needed to make it happen? And the risk? Can you tolerate the penalty if you don’t actually do as well as you thought you could?

Remember that CMS calculates your patients, dollars, and procedures. They notify each provider of their status on their own timetable.

You are not alone in the process of figuring all of this out. View the official summary document for the details on this year’s final rule.

If you have questions, here are the experts to answer them:

In the end, remember that this is voluntary only and the decision is up to you. The only people who have to do this are those meeting all 3 low volume exclusion thresholds.

As always I am happy to help you as I am able. Just address a question thru the MCA listserv so everyone can learn.

CLEAR Scoliosis Screening

Dennis Woggon, BSc, DC

The Adams Test is considered the gold standard in scoliosis screening. The patient bends forwards at 90 degrees and the individual looks for the manifestation of the rib hump. Unfortunately by the time that the rib hump is observed, the scoliosis is usually above 30 degrees. Adam’s test should be called the Too Late Test for scoliosis.

When combined with the Scoliometer, it is more effective. Many school nurses are recommended to use the Scoliometer with Adam’s Test. The rolling ball on the Scoliometer at 7 degrees equals a 20 degree scoliosis on x-ray. The CLEAR Scoliosis Institute recommends a referral for evaluation at 4 degrees.

The question must be asked, why does the Adam’s Test show a rib hump when the patient bends over at 90 degrees? What does this bending do to make a pronounced effect?

Alf Breig, in “Adverse Mechanical Tension on the Spinal Cord” addressed this as well as the article “Can a Short Unforgiving Spinal Cord Cause Scoliosis”?

The normal cervical lordotic, thoracic kyphosis and lumbar lordosis give the spine flexibility and strength. Engineers state that the Number of Curves squared plus one equals resistance.

The atlas lines behind the center mass of skull, which is superior and anterior to the sellae turcica. This creates and inherent anterior lever arm to the cervical lordosis, thoracic kyphosis, lumbar lordosis and sacral kyphosis.

If # Curves squared plus one equals resistance, the 5 curves times 5 equals 25 plus one equals 26. The normal curves of the spine give the spine strength and flexibility.

The innate intelligence of the body relies on these basic principal ideas of physics. If the body loses the good curves, it will innately develop bad curves as a self preservation instinct.

One study showed that 88% of cases with a scoliosis above 30 degrees had a Kyphotic neck.

Another study showed that 100% of scoliosis patients had what is known as anterior dorsal saucering or lordotization. This is based on the idea that a straight road is shorter than a bridge going over the same road. The magnitude of the loss of the thoracic lordosis was directly related to the increase of the thoracic Cobb angle. Posterior to anterior or adjusting the “high side of the rainbow” will make the scoliosis worse. Anterior thoracic adjusting is recommended.

As the innate intelligence of the body reacts to the adverse mechanical tension on the spinal cord via the spinal canal, it is easier to go through the valley than over the hill. In normal left lateral flexion of the thoracic spine, as the spine bends to the left, the normal rotation is that the spinouses will rotate to the right. In scoliosis patients, the spinouses will rotate into the concavity, which is abnormal spinal biomechanics. But, this rotation allows the spinal cord to go through the valley rather than over the hill. This abnormal spinous rotation is responsible for the rib hump.

It would seem to make sense that if you want to correct the bad curves (scoliosis), you have to improve and correct the good curves (lordosis, kyphosis, and lordosis).

A loss of cervical lordosis can increase the spinal canal by 25% and the diagonal fibers of the dura mater can cause a pincer effect of 30#s to 40#’s. This adverse mechanical tension on the spinal cord will cause the spine to twist, turn and rotate to innately reduce the adverse mechanical tension on the spinal cord.

Based on this premise that the scoliosis patient has adverse mechanical tension on the spinal cord, a number of additional tests for scoliosis may be utilized.

The first check is a posture check. Due to the loss of the cervical lordosis the individual will have a tendency to have forward head posture with abnormal flexion cervical posture. This is observed as a “Librarian Pose” with the tilt similar to looking over the top of a pair of glasses.

The standard posture for a scoliosis patient could be a right head tilt with right head rotation, a right high shoulder and a right high hip. Note: Normal posture would have a low shoulder and a high hip on the same side.

In most scoliosis, the thoracic spine will move away from the heart to the right side. If this is not observed, an MRI is recommended as 50% of left thoracic curves may have a pathological origin.

In anecdotal research of over 1,000 scoliosis patients, it appears that birth trauma maybe a causative factor in scoliosis. The alar ligament has been found to be unstable in 95% of scoliosis adolescent patients with a history of birth trauma; induced labor, cesarean section, forceps delivery, breech birth, epidurals, long labor and impatient obstetricians who may simply turn the head and pull without allowing the correct shoulder presentation.

Aside from anterior to posterior open mouth lateral flexion x-rays or a DMX (digital motion x-ray) the best clinical test for alar instability is the Alar test. The patient goes into maximum cervical extension with the eyes closed and a lateral deviation is noted. If the head drops to the one side, the alar instability is probably on the opposite side.

Left deviation equals right alar instability. This would be a diagnostic factor in ordering anterior to posterior open mouth lateral flexion x-rays or a DMX (digital motion x-ray.

Based on the loss of cervical lordosis, many scoliosis patients will not be able to touch their chin to their chest. This is an example of aggravation of adverse mechanical tension on the spinal cord. In the Cervical Flexion Tests, Scoliosis patients could not touch their chin to their chest (8). This may be due to Occiput / Atlas flexion malposition.

CLEAR Scoliosis Institute also recommends that Adam’s Test with the scoliometer be done in a forward bending position as well as a prone position.

The Spinal Meningeal Tension Test is done with the patient bending over to touch their toes and then putting the cervical spine into flexion. This will elongate the spinal cord and any areas of pain or tightness should be noted. Frequently this position will cause tightness in the hamstring. This may not be a muscle problem as much as a spinal nerve problem.

The Cox sign is a test for disc problems. The Cox Test may be an early scoliosis test for children at the age of 6 on up. Note that the Adam’s test is usually done at the age of 10, when it may be too late. Early detection is the key component in corrections scoliosis.

The Cox test is done with the patient supine with a Kyphotic neck support and a lumbar lordosis support. The knee is locked and the leg is slowly brought up to 90 degrees. Pain and or a lifting of the hip on the involved sign are a positive Cox Test.

Again, early detection is the key to early scoliosis correction. You can find a CLEAR Scoliosis Doctor at This Doctor will work with you to co-manage your patient.

References available upon request at

Dr. Dennis Woggon graduated cum laude from Palmer College of Chiropractic in 1974 with a Bachelor of Science in Biology. He was born in Milwaukee, grew up in Onalaska, Wisconsin and attended WSU-La Crosse. Dr. Fred Barge was his Field Doctor. He founded the St. Cloud Chiropractic in St. Cloud Minnesota in 1974. He is licensed in Minnesota, Wisconsin, Florida and Hawaii. Dr. Woggon taught seminars in Pettibon Spinal Biomechanics at Palmer College in Davenport for 25 years. He has lectured worldwide, including two trips to Vladivostok, Russia, to work with the Doctors regarding scoliosis. He has written numerous publications and books on Chiropractic, spinal biomechanics and scoliosis. He was certified in Video fluoroscopy by Palmer College in 1992. He began CLEAR Institute in 2000, which has become a nonprofit organization to teach the public and Doctors how to help scoliosis with Chiropractic. CLEAR stands for Chiropractic Leadership, Education And Research. Dr. Woggon utilizes a Digital Motion X-ray unit and static x-rays to understand how to work with the CLEAR Scoliosis Protocols. He was a featured speaker at the Digital Motion X-Ray Certification Seminar at Parker College in 2018. The goal of CLEAR Institute is to implement an effective chiropractic system of scoliosis care to help people worldwide through research and spinal rehabilitation.

“At that point in life where your talent meets the needs of the world, that’s where God wants you to be”. Albert Schweitzer

2019 MCA Awards Gala

MCA 2019 Awards Gala

Feeling lucky? Minnesota Chiropractic Association invites you to take a chance and join us for an evening of celebration as we recognize those making a difference in chiropractic during our 1st Annual Awards Gala! The fun-filled event will feature your favorite casino games, as well as great food and drinks, music and much more.

Register Now!   Download the Registration PDF

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