The nice thing about chiropractic, it's a very cause-and-effect. You adjust someone, there’s improve. Now that improvement is not linear were everything is perfect, there's ups and downs and there's no little hills and valleys, but over time you can definitely see an improvement. What these forms help you do is to just focus on that. It says, functional outcome deficiencies result in impairment or physical function just so that there's a lot of movement, loss of function, “I can't do things at home,” so pretty straightforward. What do we use for these, all the things you're used to Oswestry, Roland Morris, Neck Disability Index and you can see all these listed here. Notice they're even listening shoulder, the DASH form, which is the shoulder and hand because Medicare does cover things that are in the extremities. It's just that it's related to the spine. You might have a patient with myositis of the right shoulder or hand, so long as you relate it to a cervical subluxation, you're fine. What form would you use for this patient? I would expect the DASH from, disability of the arm, shoulder and hand. It's any of these types that measures not just how much it hurts, but how it affects them functionally. Now, what you cannot use here though at the very bottom you notice it says VAS, don't use a VAS scale that we use because that's just pain. We need something that's going to be functional. The two that Medicare recommends though are the simplest ones we've all been using overtime, which is the Oswestry or Low Back Index and Neck Index, but again any of those are acceptable. Here's an example of the Oswestry and you'll notice the first question is about pain, but notice every other question is about functional things, “Can you take care of yourself, can you comb your hair, can you lift, can you walk, can you sit, how can you stand, sleeping?” What I love about a form like this is think of how much less work it's for you because the patient fill this out before the visit and you simply score it. Again, the nice thing is not every time. This is done on the initial visit and basically every re-exam or at least every 30 days. Again, what does this help us do, demonstrate the effectiveness of the care. Here is what I love, Medicare now is going to see how effective chiropractic is because this means we're going to have all these follow-ups that show the improvement and even better, let's imagine over time when Medicare is collecting all of this data, what if they start noticing that do you know every person that goes to a chiropractor is having far less issues with blood pressure. We all are familiar with a [inaudible 00:37:20] study from the University of Chicago, where blood pressure was lower down. I'm kind of giving big picture here, but again these type of assessment helps our profession because it really is the chance to demonstrate, “His when you get rid of these subluxations, yes it may get rid of that immediate pain, but what if it starts correlating to all these other things that after 10 years we notice people who go to chiropractors don't have X, Y and Z type issues that people that don't go to chiropractors.” I'm really for this, as much as it may seem like a hassle, I'm for this. Again, this of it, most of us do these anyway. We've been doing them for years, so nonetheless I’d say, “Let's just make sure we tell Medicare we've done it.” When the patient’s done this form, we simply report it to Medicare. We're informing Medicare that this is done. We do it on the first visit and the follow-up. It says here, we're informing Medicare when there's a
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