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Homecoming general session: The Changing Worlds of Healthcare and Education: Synergy in Training Chiropractors for the Future

8/17/2011 (Archived)

Changes in health care and education today are far outpacing anything experienced by past generations. Palmer College faces a myriad of challenges in preparing its graduates to successfully navigate future expectations and new environments. During Saturday’s general session, five of Palmer’s vice chancellors presented on imminent academic, clinical, co-curricular and research issues and how the College is addressing new challenges to best prepare its graduates.

“The Changing World of Chiropractic Education,” Robert Percuoco, D.C., Vice Chancellor for Academics
Dr. Percuoco spoke about the educational trends of outcomes-based learning and assessment, and how Palmer has laid the groundwork over the past several years and is now “ahead of the curve” in its assessment of learning. “The most significant change in education over the last 10 years has been the movement from teaching to learning, specifically outcomes-based learning,” he said.

The College has received high marks from both of its accrediting agencies: the Council on Chiropractic Education (CCE) and the Higher Learning Commission of the North Central Association of Colleges and Schools, having consistently demonstrated competency assessment and learning assessment of its students. “For example, our clinical competency evaluation has changed over the past five years, he said. “We’ve moved from a supervisory to a mentorship model of clinical education and we now measure 18 clinical competencies. Both intern and clinician satisfaction has increased and clinic patients now know their clinic doctor as well as their intern.”

The challenges Palmer faces in the academic arena include enrollment, especially competition from Doctor of Physical Therapy programs (there were nine in 1999 and now there are 206), new CCE enrollment criteria, and the rising cost of education. In addition, the millennial generation students are adept at using technology and expect it in their college classrooms. Laptops and internet have been in use for several years in Palmer classrooms, and educational technologies such as electronic health records are now being implemented in the Palmer clinics on all three campuses, along with “clickers” for faculty to use in surveying electronically during class. “The coming years will require not only new technologies to be implemented on our campuses, but also educational strategies to take advantage of these new technologies,” Dr. Percuoco added.

“The Academic Program,” Dan Weinert, D.C., Davenport Campus Provost

“A college’s curriculum can be viewed as an indicator of the strategic direction of the institution,” said Dr. Weinert at the beginning of his presentation.

He continued by highlighting several curricular enhancements on the Davenport Campus that have recently been implemented or will be implemented in the Fall 2011 trimester:

1) Diagnostic imaging has been incorporated into anatomy classes.
2) A clinical nutrition class beginning this fall will prepare graduates to provide sound nutritional counsel in their practices.
3) A subluxation analysis class will be added to the third trimester curriculum this fall; the palpation class will move from the third to the second trimester.
4) The Business and Practice Management curriculum has been revamped, and a new faculty member was brought on board.
5) A new course in evidence-based chiropractic began in the spring 2011 trimester, which complements the existing information literacy class.

“Through our R25 grant to incorporate evidence-based practices in our curriculum, we are training our faculty to implement it in our curriculum, and they in turn are getting our students involved in a conversation about evidence-based chiropractic,” Dr. Weinert said. “Our graduates need to be information-literate, and they are getting it starting in the first trimester. Palmer had 12 presentations on this subject at the Spring 2011 ACC-RAC conference. We dominated—no question about it.”

“The Davenport Campus is by no means a museum piece,” Dr. Weinert concluded. “We are moving forward in earning the name of the trusted leader in chiropractic education. In the end it’s about student learning. We want to make sure we have the best system in place for our graduates to be phenomenal.”

“Clinic Affairs,” Kurt Wood, D.C., Vice Chancellor for Clinic Affairs
Dr. Wood began his presentation with the goal of the Palmer Chiropractic Clinics on all three campuses: to have our graduates be prepared for the challenges of contemporary practice. He then went on to talk about the factors influencing this clinical education goal:

• Laws, regulations and compliance
• Educational standards
• Third-party payment systems
• Case management mentorship
• Evidence-informed practice
• Technology

Dr. Wood described several of the federal laws that are impacting chiropractors and other healthcare professionals, and how the Palmer Chiropractic Clinics are responding. For instance, the Tax Relief & Health Care Act of 2007 established the Physician Quality Reporting System (PQRS), which is currently voluntary, but failure to participate in PQRS by 2015 will result in reimbursement penalties. In response, Palmer’s Davenport, Florida and West Campus clinics began participation in CMS-PQRS in July 2011.

Another example is the American Recovery & Reinvestment Act (ARRA) of 2009, which offers financial incentives to providers for using federally certified electronic health records (EHR), and meeting “meaningful use” requirements. The Palmer Chiropractic Clinics’ response is to employ HER at all Palmer campus clinics by the third quarter of 2011. “Meaningful use” will be established during the College’s 2011/12 fiscal year.

The Patient Protection & Affordable Care Act (PPACA) of 2010 (new healthcare law) requires physicians to report and repay any overpayments from Medicare within 60 days of the overpayment being identified. To comply with this provision, the Palmer Chiropractic Clinics are establishing means of identifying potential overpayments through pre-submission claims review, and are continuing their record of returning any “identified” overpayments to respective Medicare carriers.

Another provision of the PPACA is to restructure the Medicare reimbursement model to a Patient Centered Medical Home (PCMH) model. The PCMH is an approach to providing comprehensive primary care that facilitates partnerships between individual patients and their personal providers, and when appropriate, the patient’s family. The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health.

In response to the PCMH provision, Dr. Wood said that he serves on the Iowa Department of Public Health Patient-Centered Medical Home Advisory Committee, and the Davenport Campus clinics are working toward satisfying the NCQA (National Committee for Quality Assurance)-PCMH standards to become credentialed as a Patient Centered Medical Home.

“In conclusion, it’s best to say, like Roseanne Rosannadanna on “Saturday Night Live,” that ‘it’s always something,’” Dr. Wood said. “There’s always something we have to respond and react to, and we never let the grass grow under our feet.”

“Student Engagement and Preparing to Enter Practice,” Kevin Cunningham, D.C., Ph.D., Vice Chancellor for Student Success
Palmer has traditionally delivered the chiropractic education and clinical competency aspects of its D.C. program well, and continually strives to improve in these areas, Dr. Cunningham told the audience. But there is another important aspect of a well-rounded graduate of a Doctor of Chiropractic program, and that is the so-called “soft skills” of strong communication skills and business acumen.

To improve its education in these areas, the College opened the Palmer Center for Business Development in 2008. This co-curricular program augments the Business and Practice Management curriculum and is free of charge to students and alumni. It is in addition to the already robust offerings on the Palmer campuses that enhance student engagement outside of the classroom.

“On the Davenport Campus alone we have 60 active clubs, with one-third of them being technique-oriented,” Dr. Cunningham said. “There are six professional organizations, and student leader groups such as the Vogt Leadership Society and the Palmer Student Alumni Foundation are involved in numerous community projects throughout the year. In fact, 55% of our students have been involved in community service while at Palmer. Our Student Council puts on a community race, the Palmer N8K Charity Run that raises awareness of chiropractic in the community and raises funds for a cause. We have three active fraternities and one sorority. Nearly 700 students participate in one or more intermural sports this past year, and we have nine club sports, such as rugby and hockey.”

But Palmer administrators knew there was more to be done to improve students’ preparation to enter private practice, and the Palmer Center for Business Development was born of the need to enhance that component of the educational process.

“Palmer College needs you today more than ever,” Dr. Cunningham told the alumni. “I want to talk about your time and talents today, not your treasures. The students aren’t taking advantage of the Center the way I want them to. The Center offers a co-curricular experience that is free. We have two full-time staff members and we bring in the best people in chiropractic and business to talk to them about preparing for the future. We also have several alumni helping us with our program in a consulting capacity. Any alumnus is able to participate in the ‘Ask the Coach’ webinar series.”

Dr. Cunningham described the new Palmer CareerNetwork launched on July 25 that features a “match.com” type system matching students and alumni looking for positions with alumni who have positions available, a video resume development program, a practice location software program, an alumni mentoring program and more. “Just go to our website and join the network. Alumni may utilize any of these services free of charge.” To register, visit https://palmer-csm.symplicity.com/employers.

“The Palmer Center for Chiropractic Research: On the Leading Edge of Chiropractic Science,” Christine Goertz, D.C., Ph.D., Vice Chancellor for Research and Health Policy
The Palmer Center for Chiropractic Research (PCCR) is “100% committed to making sure the research we do is pragmatic and absolutely relevant to what chiropractors do,” stated Dr. Christine Goertz in her presentation during Saturday morning’s general session. The term describing the focus of the PCCR’s research initiative is “translational research,” which means translating research to clinical practice on several levels. For instance, translational research encompasses translating basic science findings into clinical applications, translation of results from clinical studies into everyday clinical practice and healthcare decisions, a “bench to bedside and back again” approach in science where researchers and practitioners work together to achieve common research goals, and working in multi-disciplinary teams.

This kind of research is critically important to the chiropractic profession, Dr. Goertz said, because “there are a lot of unanswered questions in chiropractic, such as:

• What techniques work best for which patients and/or conditions?
• What is ‘optimal dosing’ for chiropractic care? (This is a controversial area with many parameters to examine, and research is just beginning.)
• What’s the best way to deliver a given technique?
• How much are treatment effects due to the adjustment vs. other therapies vs. non-specific effects (like office environment, demeanor of the practitioner, staff, etc.)?
• How cost-effective is chiropractic care? (A lot more research is needed in this area.)
• What is the effect of chiropractic care when it’s compared to other forms of health care?

There are challenges to research that will answer these kinds of questions, Dr. Goertz said. “For instance, clinical trials tend to show only mild to moderate positive results, while the results in clinical practice are more dramatic. We’re aware of this dichotomy and are trying to find ways to address this scientifically. In addition, funding agency reviewers often demand that chiropractic studies include a sham or other control group, which complicates research.”

She went on to describe the pragmatic clinical trials being conducted at Palmer, which feature experienced clinicians and a warm, inviting clinic atmosphere that closely mirrors a regular chiropractic office. “Our study participants treat us the way yours do you—by bringing us cakes and telling us they'll miss coming to the clinic,” she said. “We have protocols that emulate real practice, including full-spine adjusting, flexibility in the number of patient visits, along with the scientific rigor necessary for a clinical trial.”

Another challenge is conducting research that translates into policy, she added. “We need to recognize future healthcare delivery trends and make sure our science is at the forefront, and this means asking the right research questions. It will be critical to conduct more comparative effectiveness research and look into issues of cost-effectiveness and collaborative care, since the healthcare of the future must be more cost-effective and collaborative in nature.”

And last but not least, there is the challenge of the cost of doing research and diversifying funding sources, Dr. Goertz said. “For example, we recently finished data collection for a low-back pain study. There were 221 participants, but we spoke with 1,688 people on the phone and had 734 baseline visits from prospective participants. Forty-five people worked on this study for six years from the grant submission to the article being published in a peer-reviewed journal—at a total cost of $1.9 million. Our annual budget of $7-8 million pays for about four clinical trials.”

Diversifying funding sources, Dr. Goertz concluded, “will be about the people.” Those people include the PCCR faculty and staff members “who dedicate more time than you realize to conduct research; along with those people who care enough about what we’re trying to do that they’re willing to give us millions of dollars in funding; it’s about all of you making sure we’re asking relevant questions; and it’s about the patient—patient-centered research will continue to be our focus as we continue to move forward.”