October 2003

News from the corn state

by Dr. Jeffrey Shay

This month I have all kinds of tidbits from Iowa, some about chiropractic, and some not. Suffice it to say that there's more going on in this state than most outsiders are aware of.

Most people think there's nothing here but the Field of Dreams, which is a baseball park next to a corn field where Shoeless Joe Jackson has been hiding since 1919. You remember the line from the movie, where Joe says, "Is this heaven?" Kevin Costner answers, "No, this is Iowa." Interesting, in that it's not the same answer most Iowans would have given.

So I've assembled some news releases from various sources ‑‑ the state tourism bureau, the Des Moines Register, the Iowa Chiropractic Society, even Palmer College. Consider this a grand tour of the corn state. Iowa doctors, consider this deja vu.

First, it was announced in the Des Moines Register that the world's largest Cheeto was being brought into the state as a tourist attraction. Apparently a supersized Cheeto turned up in a bag in Hawaii, almost as big as the bag (so it was said). A radio station in Ottumwa bought the Cheeto and is bringing it here to serve as a centerpiece for tourism, with the article saying, "now people in Ottumwa will have something to talk about".

Another item: The Storm Lake High School Marching Band did not participate in the annual Fourth of July Parade. The band director was angry because the group had been parading for several years behind the horses, and (delete 'has') announced they will not play again until this is corrected.

To quote from the Des Moines Register: "Last year, there they had us again, marching right through the horse manure. The kids are trying to watch their music and stay in line. They can't play if they're watching their feet. One kid slipped and almost fell down." He added, "I'm tired of the kids having to zig‑zag through that mess." The article noted the band would not participate even if parade organizers gave every kid a pair of five‑buckle overshoes.

Of course, I should mention the world's largest plastic peanut on wheels, which was touring the state last year and subsequently exhibited in Des Moines. According to news reports, admirers are saying things like, "That's the largest peanut I've ever seen."

But the fun doesn't stop there. We still have the Iowa Chiropractic Society (ICS) and Palmer College.

First, the ICS is offering a HIPAA Compliance Program, with services ranging from a CD with policies and forms (sans a help disk for certified training) to "everything you need" plus consultants who come to your office. Prices range from $425 to $1,795 for non‑members. But wait, there's more! Check the "Send me ICS membership information" blank and get big discounts.

This sounds like a good deal, unless your memory is long enough that you haven't forgotten some of the expensive insurance and workers compensation deals they've produced. And the $1,795 doesn't even include Ginsu knives. Frankly, I'd rather see Dracula appear in my waiting room with a wine list than have those guys materialize in my office.

A better idea: Check out the World Chiropractic Alliance website for free HIPAA forms, or pick up a disk from Life Chiropractic College for $50. The forms on the web have been designed by the WCA attorney especially for chiropractic use. Use your savings to put a scarecrow in your yard to keep away the riffraff.

ICS and Palmer College have a Medicare program, with a chiropractic consultant from Noridian as the featured speaker. This is the same consultant who was named in a lawsuit filed by North Dakota chiropractors for his actions advising Blue Shield in that state.

It is my understanding that Blue Shield settled out of court and avoided having to air their procedures in public. But he has been dusted off and brought into Iowa by the aforementioned chiropractic organizations, who apparently have no concern over the happenings up north.

I received a letter from the University of Iowa asking me to participate in a program evaluating referrals by chiropractors, both to other chiropractors and to the medical profession. Participating in this program are none other than Western States College of Chiropractic and, inevitably, Palmer College of Chiropractic.

In the questionnaire, there are blanks to fill in to answer all kinds of questions about referrals to medical professionals, and how I handle records transfer and communications with them. The only problem is that there is no place on the form to address the actual situation regarding medical referrals in my area.

I have made many attempts to refer patients when I felt it appropriate. There used to be a medical doctor up the street who handled cases professionally and then often returned to them to my office. Unfortunately, he left practice three years ago and died soon afterwards.

Efforts to refer to other medical practitioners have failed miserably. I have never been allowed to talk to any doctor in Muscatine or in most surrounding towns, or even a nurse. My call is either transferred to a clerk or I'm told "send them to the emergency room," even for routine evaluations. The clerk only asks me for the patient's name and insurance carrier, but wants no professional information.

If the patient does see the doctor, he or she is usually told not to return to my office, after being informed that chiropractors are unprofessional at best, and charlatans at worst. One patient I sent to an orthopedist for a second opinion was told that she would not be seen at the area clinic if she persisted in visiting a chiropractic office. A recent attempt to refer to the University of Iowa (yes, the same group doing the study) resulted in being told that no referral could be accepted from a chiropractor for three to four months.

I called Palmer College about this survey, asking them how they can expect accurate results if every question presumed interprofessional cooperation that, frankly, many (if not most) chiropractors have never seen. I was told to write my experiences in the space provided, which was about four inches long. When I called the University of Iowa about this matter, they gave me the same answer. In their next study, they'll probably want a summary of Hamlet on the head of a pin.

So don't be surprised when you pick up a publication running the results of this survey, like JAMA or Palmer Alumni Review. And don't be surprised when you read about all the cooperation between the professions, because the appropriate blank to check was not extant. You know, the one that should have said "asked to forward records to an appropriate orifice."

Refusal to cooperate with chiropractors is nothing new. I would prefer, however, that our chiropractic institutions not participate in this farce. I'm used to farces because I went to school in this town.

When I went to high school here, we didn't have regular social events at the school. Instead, we had a weekly town dance called "Fun Night." It wasn't much fun at all, but calling it "Police Line Up' would have hurt attendance.

Every Friday night all the high school kids would go down to the YWCA, with the guys and gals lining up against opposite walls. The event was chaperoned by several teachers, who played 45s on a close‑the‑top record player. They also had the right to choose the records, since songs with lewd lyrics were banned for our own good, effectively eliminating the Beach Boys, Beatles, or anything else featuring an electric guitar.

As a result, the only tunes they had down there were usually Del Shannon hits, with "Runaway" playing four times nightly. The slow tunes were comprised of Bobby Vinton doing "Blue Velvet," as well as several Platters hits ("Harbor Lights" was mandatory). The low point of the night was when some teachers would try to make the couples dance the Virginia Reel.

Every night during "Blue Velvet," a teacher would blow a whistle, the dance would stop, and the lights would go on. Then the teachers would travel around the dance floor to reposition the dancers' hands, which had to be visible above the waist and not grabbing anything, especially the dancing partner. Then the lights would go out, the music started, and the dancers would resume clutching at each other.

"Fun Night" rules also banned holding hands in front of the building, an offense which could result in a couple being banned from the festivities. Dancers could also be banned if rumored to use tobacco.

My brother and I went every week, but I'm not sure why. The only fun times were the fights that broke out in the back alley where various dancers would discuss whose girl friend was being clutched.

If you're traveling this year, come visit the Heartland. Just keep driving until you hit a time warp. Better yet, just rent "The Music Man."

(Dr. Jeffrey Shay, a graduate of Palmer College of Chiropractic and the WCA's 1996 "Chiropractor of the Year," is the World Chiropractic Alliance Director of Insurance Relations. He welcomes comments or questions regarding any insurance‑related subject appearing in this column. Dr. Shay is available to speak to your state or local organization. Contact him at 1300 Cedar St., Muscatine, IA 52761, or the WCA offices, FAX 480/732‑9313.)