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Dynamic Chiropractic – January 1, 2007, Vol. 25, Issue 01
Dynamic Chiropractic
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Dynamic Chiropractic

Agreement on Best Practices Protocol Highlights Annual COCSA Meeting

Members Elect New Leadership, Approve Policy Statements

By Editorial Staff

In November 2006, at the Congress of Chiropractic State Associations (COCSA) annual meeting in Baltimore, COCSA and the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) came to an agreement on the first chapter of the CCGPP's "best practices" document.

At an informal forum, CCGPP leaders offered in-depth presentations, followed by an open discussion of ideas and concerns regarding the document.

The discussion addressed concerns that had been raised since the release of the first draft of the council's low-back evidence synthesis. As the discussion concluded, COCSA delegates unanimously approved a final set of recommendations for the low-back draft. In fact, Mr. Russ Leonard, executive director of the Wisconsin Chiropractic Association, an outspoken critic of the initial draft, prefaced the COCSA vote by applauding the council's patient-centered model. Maryland Chiropractic Association President, Dr. Don Hirsh, praised those involved on both sides of the discussion for their professionalism and willingness to work together toward a common goal.

Best Practices Recommendations

  • Consider the written recommendations received and make the appropriate revisions to the current draft to allow for the concerns, additions and omissions to be considered and follow this procedure for future drafts.
  • Change the name of the document to truly reflect the intent and use of the document.
  • Ensure expanded input allowing the duly elected CCGPP representatives to truly act as liaisons between the member associations and the CCGPP Board.
  • Consider redrafting the document's overview and introduction to make it easier to read and understand, including a shorter more concise narrative, written in non-academic language with bullet points for better understanding.
  • The process will remain open so as to allow other organizations, researchers and concerned stakeholders to be included.
  • Consider rewriting the research compilation to make it more user-friendly to those affected.
  • Ensure that the commentary process will be well advertised in advance so the stakeholders will be fully engaged.
  • In the absence of higher levels of evidence and research, consider the use of the clinical experience and case studies/course studies.

Upon stakeholder review, the CCGPP then agreed to "resubmit the low-back draft to stakeholders for comment on the 'user-friendly' status format and for consideration of responses to stakeholder comments," and also agreed to change the title of the best practices process/document - it is now known as the Chiropractic Clinical Compass. The chiropractic profession and all other stakeholders will be notified 45 days prior to the release of the new low-back draft; upon such notification, stakeholders will have 45 days to respond.

"We are pleased to have had this opportunity to address the concerns of COCSA representatives, and to put to rest the misconceptions and misinformation which has been circulated in the past regarding our initial draft of the evidence synthesis and stratification for low back conditions," noted Dr. Wayne Whalen, CCGPP chairman. "We always knew that reasonable minds would appreciate the necessity for this project, and are reassured that as a mature profession, we are capable of examining our strengths and weaknesses in a conscientious and evidence-influenced approach," said Whalen. "It is gratifying to us to have been able to see the level of professionalism and concern for patient interests which were exhibited during the discussion."

Several years ago, COCSA commissioned the CCGPP to develop a best practices chiropractic document, intended to address recurring problems with third-party payer reimbursement and coverage issues. The first phase of the process involves a stratification of the scientific evidence for commonly encountered conditions, using accepted methodology and consensus strategies. Said stratification has involved a comprehensive review of current literature and consensus development. The resulting document, an evidence-based approach to patient care, will be used to assist chiropractors by combining evidence, physician experience and patient preferences.

The initial chapter of the best practices document, the "low back and related lower extremity conditions" draft, was released in May 2006 for stakeholder comment, including chiropractic providers, patients, third-party payers, chiropractic students and others.

The "low back" chapter is the first of seven expected to be released. Such chapters as "cervical spine," "thoracic spine," "upper and lower extremities," "soft tissue" and "wellness and special population issues" currently are under development.

While agreement on the best practices process was a highlight of the 2006 COCSA meeting, it certainly was not the only highlight. Set to the theme of "Sailing into the Future with a New Vision," the meeting featured more than 120 delegates from 50 state chiropractic associations. Delegates participated in round table discussions and workshops aimed at improving their operations and overall effectiveness in serving their members and advancing the chiropractic profession. Other highlights of the 2006 meeting included the following:

Resolution on Proper Documentation and Record-Keeping

COCSA membership approved a resolution emphasizing its support of the OIG Task Force Action Plan. (The Association of Chiropractic Colleges, the American Chiropractic Association, and the Federation of Chiropractic Licensing Boards also are members of the task force.) The resolution states, in part:

Resolved, that COCSA encourages member state associations to provide approved training seminars for their member doctors; and be it

Further resolved, that COCSA will work with state associations to ensure proper training of their documentation and recordkeeping instructors, and be it

Further resolved, that COCSA will continue to work with the OIG Task Force to represent the interests of all state associations to ensure that their member doctors develop proper documentation and recordkeeping practices.

Mission and Vision Statements

Earlier this year, the COCSA Board approved changes to its mission statement and adopted a vision statement. In Baltimore, the board presented and received unanimous membership approval of both statements. According to the new mission statement, "The mission of the Congress of Chiropractic State Associations is to provide an open, nonpartisan forum for the advancement of the chiropractic profession through service to member state associations." The COCSA vision statement reads: "The Congress of Chiropractic State Associations is the forum for unifying the profession and inspiring the achievement of universal understanding and utilization of chiropractic.

Congress Leadership for 2007

The following individuals were elected by COCSA membership to serve the congress in 2007:

  • President: Dr. Jerry DeGrado (Kan.)
  • 1st Vice President: Dr. Jeff Fedorko (Ohio)
  • 2nd Vice President: Dr. John Galbreath (Ill.)
  • Treasurer: Dr. Kate Rufalo (Pa.)
  • Secretary: Dr. Walt Engle (Pa.)
  • Past President: Dr. Stephen Simonetti (N.Y.)
  • District 1 Director: Dr. Don Hirsh (Md.)
  • District 2 Director: Dr. Ken Hughes (Mich.)
  • District 3 Director: Ms. Lili Montoya (Fla.)
  • District 4 Director: Dr. David Kassmeier (Neb.)
  • District 5 Director: Mr. Bill Howe (Calif.)
  • At-Large Director: Ms. Kathy Chittom (La.)

CCGPP Representatives to COCSA

  • District 1: Dr. Tom Augat
    Maine Chiropractic Association
  • District 2: Dr. David Radford
    Ohio State Chiropractic Association
  • District 3: Dr. Robert Hayden
    Georgia Chiropractic Association
  • District 4: Dr. Jeff Askew
    North Dakota Chiropractic Association
  • District 5 - vacant
  • At Large: Dr. Len Suiter
    Missouri State Chiropractors Association.

The 2007 COCSA meeting will be held in Nashville from Nov. 7-11. For more information, visit www.cocsa.org.

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