Considering online advertising? Stay clear of “fee-splitting” or kick-back laws

In a recent article, Oregon Healthcare News reminded healthcare providers to use caution when looking to boost business and profits by using mutually-beneficial internet relationships. The federal government – and multiple states – have laws prohibiting healthcare industry kickbacks as a means of profit. These laws exist to avoid payment incentives that may not be tied to patients’ best interests. When advertising causes provider’s motives for profit to supersede patient welfare, buyer beware!

Some examples that may run afoul of kickback laws include hosting a vendor on your website in exchange for a fee or receiving a referral fee each time one of your patients purchases the vendor’s product.

When examining online advertising opportunities, healthcare providers are encouraged to research their the applicable federal and state regulations about kickbacks (often referred to as fee-splitting). Check with your individual licensing boards before purchasing advertising.


Is Pilates an effective rehabilitation tool? A systematic review.

An article published in Journal of Bodywork and Movement Therapies details the evidence for including pilates in physical rehabilitation. Pilates is a system of exercise focusing upon controlled movement, stretching and breathing. Pilates is popular today not only for physical fitness but also for rehabilitation programs. This paper is a review of the literature on the effectiveness of Pilates as a rehabilitation tool in a wide range of conditions in an adult population.

Twenty-three studies, published between 2005 and 2016, met the inclusion criteria. These papers assessed the efficacy of Pilates in the rehabilitation of low back pain, ankylosing spondylitis, multiple sclerosis, post-menopausal osteoporosis, non-structural scoliosis, hypertension and chronic neck pain. Nineteen papers found Pilates to be more effective than the control or comparator group at improving outcomes including pain and disability levels. When assessed using the CONSORT and PEDro scales, the quality of the papers varied, with more falling toward the upper end of the scale.

The majority of the clinical trials in the last five years into the use of Pilates as a rehabilitation tool have found it to be effective in achieving desired outcomes, particularly in the area of reducing pain and disability. It indicates the need for further research in these many areas, and especially into the benefits of particular Pilates exercises in the rehabilitation of specific conditions.

The article can be found here:

Improving Resiliency in Healthcare Employees

The high prevalence of stress at the workplace has been well documented; however, few studies have investigated the efficacy of worksite resiliency programs. Until now.

A group from the Mayo Clinic came together to examine the impact of a worksite resilience training program on improving resiliency and health behaviors in healthcare employees. Between 2012 and 2016, 137 adult wellness center members of a healthcare institution participating in a single-arm cohort study of a 12-week resiliency training program were assessed at baseline, end of intervention, and at 3-month follow-up.

The results were statistically significant (p ≤ .01) and improvements were seen at the end of the intervention and extending to 3 months follow-up for resiliency, perceived stress, anxiety level, quality of life, and health behaviors.

The authors report that the results support the premise that worksite programs designed to improve resiliency in healthcare employees have efficacy in improving resiliency, quality of life and health behaviors. Given the importance of stress and burnout in healthcare employees, future randomized studies are warranted to determine more clearly the impacts of this type of resiliency intervention for improving the wellness of healthcare workers.

Evidence for mind, body practice for fibromyalgia

Although there is insufficient evidence that any natural products can relieve fibromyalgia pain (with the exception of vitamin D supplementation, when deficiencies are present) current randomized clinical trials and systematic reviews are providing encouraging evidence that tai chi, qi gong, yoga, acupuncture, mindfulness and biofeedback may help relieve some fibromyalgia symptoms. The American College of Rheumatology (ACR) advises that both cognitive behavioral therapy (CBT) – a therapy focused on understanding how thoughts and behaviors affect pain – and biofeedback, guided visualization, yoga breathing exercises, and non-spiritual meditation that cultivates present moment awareness have been shown to significantly improve symptoms of fibromyalgia. The ACR also recommends integrative medicine such as acupuncture, chiropractic, massage therapy can be useful to manage symptoms as well. Short term use of these therapies offered short term benefits.

It should also be noted that CBT practice, mindfulness, and exercise therapies must be continued for lasting positive effects in patients with chronic pain. Best results are achieved when CBT is combined with exercise, chiropractic, acupuncture, or massage. Providers who treat fibromyalgia or other associated chronic pain patients may want to educate themselves on CBT procedures that may be within scope.



Glucosamine and chondroitin for osteoarthritis

Glucosamine and chondroitin are both produced  naturally in the body and are structural components of cartilage. In general chondroitin alone, has not been shown to be effective in reducing pain in hip or knee arthritis. Supplements containing glucosamine alone, or a combination, may be all that’s needed to achieve results. However, chondroitin alone did not show positive results. Several small studies using combinations of chondroitin and glucosamine show improvements in osteoarthritis of the hand and jaw, while use for hip and knee pain were reported to be helped only in moderate to severe pain patients. Mild pain patients did not experience significant relief. Results for use on low back pain patients showed they fared the same as placebo.

Contraindications for use should be noted with patients on Coumadin (warfarin), or other blood thinning agents and with diabetic or pre-diabetic patients. Glucosamine may impair blood sugar systems in the body. One study showed long term, moderate doses of glucosamine, damaged kidneys in rats. Although animal studies may not apply to people, this study does raise concern.

Providers may wish to prescribe glucosamine alone or a combination supplement for use with hand and jaw pain, or for moderate to severe hip and knee pain, if the patients are not blood sugar compromised, or on blood thinners.

More info at

Federal agencies partner for active and veteran chronic pain management research

The Department of Health and Human Services (DHHS), the Department of Defense (DOD), and the Veterans Administration (VA) released a press statement on September 20, 2017, describing a six-year, $81 million project to focus on developing, implementing, and testing chronic pain management related conditions using ‘non-drug’ approaches. The National Institutes of Health (NIH) will be the lead agency in this partnership. Approaches to be studies include, but are not limited to: Mindfulness, meditation, movement interventions such as structured yoga, tai chi, manual therapies such as spinal manipulation, massage and acupuncture, psychological and behavioral interventions (cognitive behavioral therapies) involving more than one integrated care model per treatment plan.

National Center for Complementary and Integrative Health (NCCIH), a part of NIH, is contributing more than half of the total funding and is the lead for this multi-agency initiative. The focus is to ‘advance better practices for pain management’ to combat the opioid crisis.

This is encouraging news for integrative healthcare providers who have been using some or all of these care plans in their practice. Providers with military patients may want to inform them of this multi-agency study, as well as follow its outcome.

Pediatric chiropractic care for neck pain: Retrospective Case Series

Pub Med and the US National Library of Medicine, in cooperation with the National Institutes of Health, published a Journal of Canadian Chiropractic Association retrospective study of 50 pediatric cases. Children ages 6-18 years of age were treated for uncomplicated neck pain using five visits over 19 days. Treatment was limited to spinal manipulative therapy in 96% of the cases. Significant improvement was recorded in 96% of the files reviewed, concluding mechanical neck pain appears to be successfully managed by chiropractic care in this retrospective study.

Tattoo ink can mimic lymphoma

Pigments used to create tattoos can cause inflammatory reactions in both epidermis and dermis which can penetrate more deeply into the body, affecting lymph and other areas. Giant cells were extracted from lymph nodes adjacent to ink, on this subject. Other studies repeat this finding, causing providers to mistake lymphadenopathy for cancer, melanoma, or other more serious disease states. Patients may experience symptoms similar to malignant conditions such as swollen nodes, severe cluster headaches, and worsening autoimmune conditions. In some cases, patients with tattoos showed migrating ink in adjacent lymph nodes that formed granulomatous reactions leading to sarcoidal, necrobiotic sardoidal granulomas, which can be the first sign of systemic sarcoidosis. In one patient, treatment required biopsy of over 15 lymph nodes to rule out cancer.

Providers who find lymphadenopathy in tattooed patients should be aware of potential differential diagnosis confusion, and must consider referral to rule out potential serious diagnoses. It is currently unknown if the chronic lymphadenopathy seen in patients with tattoos can be a cause of cancer.

Center for Mindfulness offers online courses

MBSR (Mindfulness Based Stress Reduction) from University of Massachusetts Medical School’s Center for Mindfulness, offers an eight-week program designed to assist anyone with one of several conditions:

  • Anxiety and panic attacks
  • Work, family, and financial stress
  • Asthma
  • Gastrointestinal distress
  • Grief
  • Cancer
  • Heart disease
  • Chronic illness
  • High blood pressure
  • Depression
  • Pain
  • Eating disturbances
  • PTSD
  • Fatigue
  • Skin disorders
  • Fibromyalgia
  • Sleep problems

The course includes exercises in mindfulness meditation, gentle yoga stretching, group dialogue aimed at enhancing awareness in everyday life, systematic instruction in formal MBSR meditation practices, with opportunities to check in with teachers and online resource materials and video conferencing. High speed internet connection is advised. Mobile devices such as phones and tablets are not recommended. You can view the course curriculum, tuition and payment plans by clicking on this link or by calling (508) 856-2656.

This information may be used for continuing education by some providers. In addition, this course may give you a deeper understanding of how to better use this mindfulness with patients.

Mind Body Practices for Age-Related Conditions

The US Department of Health and Human Services, National Institute of Health NIH lists four tips that may be of interest to geriatric patient populations. In particular, older adults are turning to integrative providers who are more likely to promote health and well-being. Familiarizing yourself with yoga, tai chi and/or qi gong may be beneficial to aid fitness goals as well as relaxation. Conditions which may be helped include, but are not limited to: osteoarthritis, menopausal symptoms, sleep problems and shingles. These ‘active’ practice suggestions are generally considered safe for most healthy adults and can be modified with minimal effort when patient need requires. In addition, adding ‘active’ home plans often shows greater patient improvement, than ‘passive’ care alone.