Hour One:

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the cervical spine
• Identify, analyze and interpret the importance of an increase ADI
• Identify normal/abnormal anatomical soft tissue structures (i.e.: calcifications of carotid/vertebral arteries and thyroid cartilage) of the cervical spine
• Recognize the importance of specific laboratory and diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the cervical spine

Hour Two:

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the thoracic spine
• Identify normal/abnormal anatomical soft tissue structures (costal cartilage calcifications, trachea and bronchial air shadows, heart, diaphragm, hilar region, aortic knob etc.)
• Recognize the importance of specific diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the thoracic spine

Hour Three

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the lumbar spine and pelvis
• Identify normal/abnormal anatomical soft tissue structures i.e.: vascular calcifications like abdominal aortic aneurysm, mesenteric lymph nodes etc
• Recognize the importance of specific laboratory and diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the lumbar, lumbosacral spine and sacroiliac joints

• Cite the difference between Therapeutic Exercise and Therapeutic Activities
• Properly document all aspects required when utilizing timed therapy services
• Assimilate payer policy details to ensure proper code utilization
• Discuss common errors when documenting and billing exercise therapy services

Educational Objectives: for Documentation

Hour 1 and 2

• Identify the correct amount of time a chiropractic record must be maintained with specific differences for that of an individual under the age of 18 as well as records related to a civil, criminal or administrative proceeding
• Keep appropriate records and maintain required information and provide requests for information and records from licensee’s.
• Describe various types of patient encounters and levels of documentation, and determine how to properly document each encounter.
• List the various governing bodies and organizations which may impose requirements on your record keeping of the patient’s health chart.
• Identify key components of the office entry forms and relate the importance of follow up and systems review.
• Compare and contrast various outcome assessment instruments, describe the importance of these tools and properly use and score various outcome assessment instruments.
• Recite tests traditionally thought of as objective and tests traditionally thought of as subjective in the context of reliability and validity.
• Define the characteristics of a good outcome assessment tool, and be able to properly implement it in clinical practice.
• Compare and contrast the various types of electronic health records available.
• Itemize the requirements of a “paperless” office.

Educational Objectives: for Ethics

Hour 3

• Identify legal prohibitions against promising healthcare cures, guaranteeing treatment results, and deceptive patient communication.
• Distinguish between appropriate and inappropriate communication relating to patients' healthcare prognoses and progress.
• Explain scientific literature linking patients' mental states with healthcare outcomes.
• Demonstrate alignment between compliance with states' current patient communication restrictions and instances of patient encouragement that foster mental states favorable to desired healthcare outcomes.
• Explain office procedures and staff training which are likely to ensure ongoing ethical patient communication and the documentation thereof.

Educational Objectives: for Risk Management

Hour 4

• Appropriately disclose charges to patients
• Identify potential problems associated with sharing fees with non-healthcare professionals.
• Demonstrate anti-trust issues associated with setting professional fees
• Explain connections between co-pay waivers and violations of the False Claims Act
• Describe the appropriate delegation of authority in a Chiropractic office to avoid licensure complaints
• Assess parallels between fee-splits and principles of ostensible agency that can lead to malpractice liability.
• Compare and contrast fee-splitting and the corporate practice of medicine.
• Legally provide Prepaid Treatment Plans

• Recognize lumbar disc signs and symptoms.
• Differentiate disc prolapse from disc extrusion.
• Identify anatomical structures related to lumbar disc conditions.
• Describe neuro-muscular physiology as it relates to disc injuries.
• Determine appropriate exam procedures for diagnosing disc conditions.
• Assess static range of motion coupled with cross-plane evaluation.
• Analyze dynamic joint motion using outcome-based assessment tools.
• Interpret manual muscle testing using eccentric break testing protocols.
• Grade muscle tone and discover muscle palpation techniques.
• Interpret neurological tests to determine levels of disc involvement.
• Design treatment plans based on exam findings.
• Apply manual manipulation techniques to address the lumbo-pelvic joint lesions.
• Demonstrate manual methods to reduce abdominal and pelvic muscular dysfunction.
• Create new muscle memory patterns to correct chronic conditions.
• Compare pre- and post- treatment findings to support care plans.

• Properly document “doctor thinking” daily in routine patient visit documentation
• Recognize the role of the PART documentation process in Routine Office Visit notes
• Identify and execute the key components of written assessment in daily documentation
• Recognize aspects of documentation and coding of Route Office Visits (ROV) whether active treatment, preventative maintenance, or wellness care.
• Distinguish the unique components of Subjective, Objective, Assessment and Plan

• Outline methods used and estimations as to the incidence of vertebrobasilar ischemia.
• Review and describe cerebrovascular anatomy and hemodynamics
• Discuss proposed patho-physiological mechanisms believed responsible for subsequent vertebrobasilar ischemia.
• Review and discuss past and present scientific literature to explore the evolution of what we think we know about the process of cervical spinal manipulative therapy and potential vertebrobasilar ischemia.
• Identify radiographic signs of a vertebral artery dissection.
• List and discuss the uses, pros and cons of current examination tools as they apply to vertebral artery dissection.
• Explore issues and examination procedures related to patient assessment as well as vertebrobasilar ischemia recognition
• Define and contrast currently suggested procedures
• List and describe the most common red flags for a patient “at risk” for suffering Vertebrobasilar Ischemia
• Recite list of scientific studies relating to laboratory testing of plasma Homocystine levels and its relationship to Vertebrobasilar Ischemia from vertebral artery dissection.
• List examples of bias against chiropractic cited in both the popular media as well as in biomedical journals.
• Critically review landmark articles regarding the issue of cervical manipulation and vertebrobasilar distribution ischemia.
• List studies suggesting that a high plasma homocystine level may be associated with vertebrobasilar dissection.
• Cite studies suggesting that increasing folic acid intake can reduce plasma Homocystine levels.
• Identify laboratory tests that may be useful in helping calculate an individual’s risk of suffering vertebrobasilar stroke

• Learn a systematic approach to feature identification of arthritis
• Identify radiographic features of arthritis
• Develop a differential diagnosis of arthritis
• Apply knowledge to classify unknown cases

HOUR 1: Metabolic Mechanisms and Rationale for Use

• Compare and contrast different approaches to therapeutic carbohydrate restriction (low-carbohydrate diets, very-low-carbohydrate diets, and ketogenic diets.)
• Describe the effect of dietary carbohydrate restriction on blood glucose regulation.
• Summarize the metabolic effects of insulin beyond controlling blood glucose.
• Outline how carbohydrate restriction affects fuel partitioning.
• Summarize the process of ketogenesis.

HOUR 2: Therapeutic Applications for Ketogenic Diets

• List three effects of carbohydrate restriction besides weight loss.
• Distinguish between applications for which a strict ketogenic diet may be most effective and those for which a more flexible low-carb approach may be sufficient.
• Name at least three conditions ketogenic diets have been shown to improve or put into remission.
• State three areas of emerging research for ketogenic diets.
• Discuss the potential synergies and areas of concern when combining a GLP-1/GIP receptor agonist medication with carbohydrate restriction.

HOUR 3: Practical Implementation & Troubleshooting

• Give examples of the foods that can be included in a ketogenic diet and the foods that are best avoided.
• List three factors that frequently prevent people from achieving their desired results on a low-carb or ketogenic diet.
• Contrast the pros & cons of measuring blood sugar and ketones.
• Summarize what occurs during the adaptation period (a.k.a. “keto flu”) and how to ease the transition.
• Recognize routinely prescribed medications that may need to be adjusted quickly upon adopting a low-carb or ketogenic diet.

HOUR 4: Ketogenic Diet Myths & Misperceptions

• Summarize the history of clinical use of ketogenic diets and other forms of carbohydrate restriction.
• State the differences between nutritional ketosis and diabetic ketoacidosis.
• Describe the effects of carbohydrate restriction on cardiovascular disease risk.
• Outline the effects of carbohydrate restriction on liver and kidney function.
• Recall the absolute contraindications for a ketogenic diet.

• Identify which supplements are commonly used in exercise and sport
• Determine the benefits and risks of individual ergogenic aids
• Discuss the role that individual vitamins have in exercise and sport
• Examine the role that individual minerals have in exercise and sport
• Investigate the value of sport drinks
• Ascertain when fluids are most beneficial in sport
• Apply how exercise effects the immune system
• Review the positive and negative effects of exercise
• Identify the role of antioxidants in sport and exercise

• Discuss various diet and lifestyle factors involving hypertension
• Recognize the relationship between various minerals and hypertension
• Distinguish the nutritional aspects of various related cardiovascular conditions
• Identify the relationship between various herbs and peripheral vascular diseases

Educational Objectives: for Documentation portion:

Hour 1 and 2

Educational Objectives:  Documentation

• Discuss key items related to the OIG reports regarding chiropractic services
• Discuss Executive Order issued by the White House titled reducing improper payments and eliminating waste in Federal Programs
• Discuss what triggers an audit and key items to consider if audited
• Discuss Medicare’s guidelines for necessity of chiropractic care as it relates to covered services, x-ray/diagnostic reimbursements, Quality Payment Program (QPP), diagnosis coding requirements and Medicare’s appeals process  
• Discuss appropriate use of modifiers
• Discuss Medicare’s documentation requirements when utilizing Medicare’s ABN (Advanced Beneficiary Notification) form
• Recognize the key components regarding good documentation and record keeping
• Identify the legal requirements of informed consent and the key elements of the informed consent process
• Discuss why doctors are held to higher standards
• Describe the 21 NCQA guidelines for record keeping
• Document progress notes (SOAP) to meet insurance guidelines and medical necessity
• Apply the PARTS system and its transformation utilizing a new method AIR S & M
• Utilize CMT coding appropriately

Educational Objectives: for Ethics

Hour 3

• Perform communication with patients and the public at large such that it informs, instructs and doesn't mislead.
• Discuss the parallels between accurate communication and ethical conduct.
• Administer healthcare practice compliant with HIPAA, state confidentiality statutes, and relevant rules, regulations and state court cases applicable to patient confidentiality.
• Comprehend the commercial, regulatory, social and familial interests seeking to obtain and/or are served by the release of patient information.
• Develop effective office systems and policies for securing and documenting patients’ informed consent
• Appropriately disclose charges

Educational Objectives: for Risk Management

Hour 4

• Assess court and Office of Inspector General rulings relating to anti-kickback restrictions.
• Demonstrate how anti-kickback and Stark legislation is both viewed and enforced by relevant professional boards and state and federal enforcement agencies to avoid fraud
• Explain how to avoid misleading claims
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to patient referral arrangements.
• Properly Delegate authority in your office
• Identify parallels between Stark self-referral laws and anti-kickback restrictions.

• Identify some of the functions of Co Q10
• Use Co Q10 for as appropriate as a supplement
• List the issues of performance changes with Co Q10
• Discuss the reasons for, and application of, Co Q10 for patients with Parkinson Disease and migraines