Florida Governor Race. Scott Wins. Keep your eye on PIP.

Florida Governor Race.  Scott Wins.  Keep your eye on PIP.

Dr. Alan Himmel


Well, not much to say about the results of the Florida Governor race. For the sake of Florida drivers and doctors who treat accident patients, lets hope that we have another four years of PIP.

The fact that Rick Scott was the former CEO of a gigantic hospital company may be of benefit.  He likely still has ties to that company, whether it be his buddies who are in favor of first party PIP coverage for accident victims, or he still has his hands directly in the pot; he most likely is not in favor of a total elimination of PIP.

It just bothers me that a man who plead the 5th in an investigation of his company, can still be the governor of a state.  If a person is put on the stand and pleads the 5th, it simply tells you they are hiding information which will be incriminating.  Note the breakdown of the word inCRIMINating.

Ok, so he is a crook and got away with it.  He is not the first person to commit crimes and get away with it and he wont be the last.  But, become governor twice after this?  Amazing, but I wish I could say I am surprised.

Forget being a Chiropractor, be a Neurobiologist

Today you can be a Neurobiologist...

Dr. Alan Himmel

I am a subscriber to Medscape, which for those who don't know, is an email digest of significant new medical research that comes out almost daily from the medical community.  I have been a subscriber for at least the last 10 years, and I highly recommend that anyone who is involved in healthcare should also check this thing out.   

The reason I am writing this post, is that this is the first time since I have been a subscriber, that I have seen Medscape distribute this as news (front page headline, by the way) of an article written by chiropractors (half-doctors) and published in a distinguished and respected journal such as The Annals of Internal Medicine.  I mean, everyone knows that this is a journal that only real and "serious doctors" get their information.  

The article is written by CHIROPRACTORS (plus a MD and a PhD in Biostatistics).  So maybe they got in the journal because they "carefully" placed an MD on the list of authors? Still, the head authors are DC's and the journal accepted the research and published it.

Anyway, let me tell you how difficult this is:  Medical journals have a board of "peer" reviewers who read over submissions to the journal, slice it up with comments, and often times, stamp a big denial on the paper and send it back to the author.  In other words, just because you can write well and you are articulate, and you can back up your paper with actual results and referenced research at the end of your manuscript, these distinguished doctors who make up the peer reviewers and editors often times deny your paper if they simply don't like you or don't agree.

So, I think this is a significant event.  Medscape's subscribers are made up mainly of medical doctors and specialists.  Maybe more than 100,000 doctors read this paper.  

When you try and subscribe to Medscape, you will see that "DC" is not even on the dropdown list where it asks, what your specialty is.   Hint:  pick another specialty when you become a subscriber--maybe someone you have always wanted to be like a Neurobiologist.  

Original Research | 16 September 2014

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH; Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD; Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

[+] Article and Author Information

Ann Intern Med. 2014;161(6):381-391. doi:10.7326/M14-0006

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Background: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.

Objective: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.

Design: Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. (ClinicalTrials.gov: NCT00494065)

Setting: 2 research centers (Minnesota and Iowa).

Patients: Persons aged 21 years or older with BRLP for least 4 weeks.

Intervention: 12 weeks of SMT plus HEA or HEA alone.

Measurements: The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.

Results: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P = 0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, −2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

Limitation: Patients and providers could not be blinded.

Conclusion: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks.

Primary Funding Source: U.S. Department of Health and Human Services.

Topics

back pain ; exercise ; lower limb pain ; manipulation, spinal

2 Easy steps to dealing with Right and Left Lower Back Pain

2 Easy steps to dealing with Right and Left Lower Back Pain

Dr. Alan Himmel

Statistically left and right lower back pain accounts for up to 40% of missed days at work in the US. Notwithstanding any serious injury including fracture, I decided to summarize a series of things that may be done at home in order to speed the healing process and potentially decrease the disability associated with these types of acute injuries.

First.  Keep moving.

Chances are that if you hurt your back, you went to your doctor and he prescribed you pain medication, anti inflammatory pills, and possibly a muscle relaxer.  He then told you to lay down in bed and rest your back for a week.   It turns out that often times is the wrong plan. Although I won't comment on the use of prescription medication, I can tell you that laying in bed can actually delay your recovery.

I suggest to most of my patients to get up and try and walk when they have acute left or right lower back pain.  You shouldn't necessarily do any type of exercise that requires physical exertion, but you should get up on your feet and at least just try walking.  This does wonders for back pain, and I have found that the quicker you get on your feet and walk, possibly even before the inflammation sets in, the better you are going to be.

Second.  Do some stretching.

1.  I like the torso twist.  You can sit or lay on your back and slowly twist your body.  Think of it like you are gently ringing out a towel.  You would need to do the twist to the left and right and just hold yourself in that twisted position on each side for at least 30 seconds.

2.  Do a cat stretch.  The way you do this is to get on the ground or your bed on your knees and hands.  You will then try and arch your back toward the ceiling and hold for at least 30 seconds.  Next you are going to stay in the hands and knees position and arch your back downward toward the floor.

3.  Last, I usually recommend lower extremity stretches.  The usual sitting down and touching toes.  This gets the hamstrings.  Also I recommend trying to stretch the quadriceps by lying face up and trying to flex the knee and put the foot behind your thigh.  Lastly, I advise people to do groin stretches and the best way to do this is in the sitting position on the floor, taking both feet in toward your body and trying to place the soles of the feet together.  From this point, you can slowly and gently pull the feet in toward the body.  Hold for at least 30 seconds to a minute.

So.  Walk and stretch.  The formula is to keep moving.  

I have been in practice since 1996.  I am located in Miramar Florida.  My office number is                          954-659-8600.  My cell phone is 305-979-5549

What Does it Mean when they say PIP is Primary?

What Does it Mean when they say PIP is Primary?

Dr. Alan Himmel

PIP No-Fault Insurance is primary in Florida.  What this means is, if you are involved in a car accident in the State of Florida, and you either have your own car with insurance or are living with a resident relative (living in a house with family member who has a car with insurance) you are required by law to have all claims for injuries filed through PIP.  PIP is primary, meaning that even if you have your own health insurance, Medicare, Medicaid, or group plan, you have no choice but to use PIP first.

Most doctors who treat trauma/accident patients know this, unless they are new and have not been trained or have no experience with these types of patients.

So, what happens if you go see a doctor after a car accident, and hand them your health insurance card?  Well, if the doctor bills health insurance instead of PIP, there is actually a chance that the bill will get paid.  Why?  Because at this point, the insurance company is unaware of the fact that the patient is being treated for a car accident.  They process they claim as they do any other claim.

But, this is what I have seen over and over again over the years.  After a few weeks or months, the health insurance company will send a letter out to the policyholder and ask him a few questions, the most important one being describe the circumstances that led to your injury, and were you in a vehicle at the time of your injury?

If, through these questions, the insurance company learns that the patient was indeed in a car accident, the insurance company will usually proceed in one of two ways:  First, they can ask for the money back from the doctor.  Or second, they can wait to see if there is a legal settlement which will be paid out to the patient, and if so, they can put a lien on the settlement in order to be paid back.

If you have health insurance, you can use it for claims that are over and above the PIP payable amount (Secondary, not Primary). In other words, since PIP mainly pays 80% of the claim, health insurance can pick up the 20%.  You can also submit deductibles to them, and you can submit all claims to health insurance that exceed the $2500 or $10,000 in coverage.  If PIP denies the claim completely for reasons of failure to pay policy premium, or failure to carry, or anything, then health insurance can be billed in these circumstances.  But, remember, if you have a settlement pending that is due to this accident, you will pay the insurance company back from your settlement.

If you are one of those patients who just does not want to use your PIP car insurance for one reason or another, you will find yourself in one of the two scenarios up above.  Chances are, your health insurance will request the money back from the doctor or you will have to pay it out of any settlement you receive.

I have been treating car accident patients since 1996.

Consult with me for injuries relating to car accidents. I can be reached directly at 954-659-8600. Always consult with an attorney with issues regarding the law.  I am not an attorney.

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL.  33027

Can Whiplash Cause Concussion?

Can Whiplash Cause Concussion?

Dr. Alan Himmel

Talked about it before.  Let's talk about it again.  Can a mild whiplash cause a concussion?  The literature says, yes.  And, I have had several patients over the years, and one currently, who has the affects of post concussion syndrome.

Attorneys who represent injury clients need to be aware of this issue as well.  The most recent patient that I am treating who I am sure has suffered a concussion, has all of the symptoms of this injury, including headache, vertigo, disorientation, and confusion.  This will be a patient who will tell you that their head just doesn't feel the same since the accident.  It can be very frustrating to the patient, and the patient may find themselves searching doctors who could figure it out.  Oddly enough, attorneys will very often dismiss concussion, wanting to focus the claim on disc injuries and the usual soft tissue findings. Why?

I think that the major sticking point for attorneys is simply not understanding the physics involved in a car accident, and not knowing what a concussion actually is.

You don't have to strike your head against the inside of the car and you don't have to get hit in the head by something to cause concussion.  Think of it like this:  The brain is encased within the skull and around the brain is a thin layer of fluid which separates the brain from the inside of the skull so it does not touch (among other purposes of the fluid). The fluid is called cerebral spinal fluid or CSF.  So, the brain, in a way, is swimming in this fluid and the small fluid space between the brain and the inside surface of the skull is like a barrier because you don't want the brain to touch anything.

Okay, now think about what will happen to a person's head when at rest, when the car he is in is hit from behind.  The person's head will move in the direction of where the force came from.  This is one of Newton's laws of motion.  Every action has an equal and opposite reaction.  But, what about the brain which is "floating" within the skull?  It too, must obey the laws of physics, and at this point, the brain will then crash into the inside of the skull on the opposite side.  Right there is your concussion.



Now, keep in mind that concussion is not always possible to see on MRI or CAT scan.  Concussion is regularly diagnosed based on neurological symptoms, signs, and complaints.  Lawyers and insurance companies want objective proof, but they cannot always have it with concussion.  The lawyer who is representing the client with concussion, must be aware of these things.  A lawyer who is representing injury clients must be an expert in the law, and although its not required to be trained like a physician, he should also have a working knowledge of different types of injuries involved.

So, keep an eye out for a concussion when whiplash is involved.  They are generally not life threatening, but concussions can be quite serious, and recurrent concussions can be even worse.

I can be reached at 954-659-8600

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL. 33027

The Changes to the Florida PIP law have worked to stop fraud: True or False?

The Changes to the Florida PIP law have worked to stop fraud:  True or False?

Dr. Alan Himmel

The articles are beginning to come out stating that the changes in the PIP laws that occurred in 2012 have decreased the rate of fraud, and costs to insurance companies, and ultimately to consumers.  This is a good thing if its true.  It may be that the decreases in payouts are due to the $2500 insurance cut off, or the 14 day rule, which states that you better get to a doctor within 14 days or you get $0.00 in coverage.  It may also be due to the fact that now, there is no coverage for acupuncture or massage, two effective, safe, alternatives to medications and surgery.

As a practitioner who sees accident patients in FL, doctors now have two less options to offer patients when they are suffering from painful injuries from automobile trauma.  Plus, patients have to get better with 75% less insurance coverage than they had in the past, since not all patients will have an "emergency medical condition"  (EMC) which is supposed to allow the patient to have their full benefit.

So, I ask you:  What do you think is the true reason that insurance companies are reporting savings?   Could the answer be that there is now more opportunity for the insurance carriers to deny coverage, since the payouts are capped now in many cases?  Or, could it be true that the savings is due to less fraud?   I would be one of the first to start celebrating if I was sure that the savings to insurance companies was about the reduction in crime, but I am not 100% sure about that one.

Emergency Chiropractic Florida

Emergency Chiropractic Florida

Dr. Alan Himmel

I decided to create another website:   www.emergency-chiropractor-florida.com

I named it Emergency Chiropractic of Florida because I continue to see patients who have been to the hospital or other doctor after a car accident, and it has been determined that they have an "emergency medical condition."  The designation of emergency medical condition or (EMC) allows the patient to seek follow up care and be covered by his PIP insurance up to his full coverage limits. Without the EMC, he is limited to only 25% of the coverage he pays for.  Not all of my car accident patients actually do have a bonafide EMC, and as a matter of fact, the EMC is only present if certain medical providers such as an MD or DO say it is present.

Nevertheless, these emergency patients often end up calling me because of my experience and my knowledge in regard to the proper treatment, management, and documentation of these types of injuries.  This comes with practically 18 years experience.  If you have been injured in a car accident, please call my office.  The number is 954-659-8600.

Dr. Alan Himmel

FL EMERGENCY MEDICAL CONDITION PIP DENIALS BEGIN

FL EMERGENCY MEDICAL CONDITION PIP DENIALS BEGIN

Dr. Alan Himmel

Just as predicted, there are some companies who are ignoring Emergency Medical Conditions and denying PIP coverage beyond $2500.   So, a medical provider, in many cases a specialist, will look at and examine a patient, and say, "Yes, without medical treatment, this patient is likely going to suffer long term permanent impairments,"  and write it exactly as the law is written, and certain insurance companies are having the doctor's notes and records reviewed by one of their doctors to say that its not true.

I just had a patient with an shoulder impingement syndrome denied.  The patient cannot raise her arm up past 90 degrees in any direction.  She cannot take a half gallon of milk out of the fridge due to pain and weakness in her shoulder, and an insurance company doctor says she needs no further treatment. The MRI alone was more than half her PIP benefit.

Surprisingly, this denial is happening with major providers.  You would think that the small rip-off companies would be doing this, but as I said, even the big boys are doing it.

So, what do you do?  As a doctor who spends a lot of time with patients one on one (sometimes more than an hour), I have to make a decision.  The decision is whether to release the patient from care, or to continue treating in the hopes that in the end, a suit can be filed, and the insurance company will eventually pay.  SInce this whole EMC thing is a new thing in Florida, there are a lot of unknowns.

The first unknown is whether a suit can be won in the first place.  Lawyers cannot guarantee a win. And, as I said, this is a new program in FL, so there is not a whole lot of new case law.   Secondly, if a suit is won, will the WHOLE bill be paid, or will only part of it be paid?  What if a Judge says, pay the bill, but only 20% of it?  Can they do that?  A colleague of mine seems to think so.  He may be right.

My patient with shoulder impingement I am continuing to see and treat.  She is doing better and better. Without treatment her condition would likely turn into frozen shoulder.