Eat When You’re Hungry…

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And stop when you’re full.  I’m not a big fan of giving unsolicited nutritional advice. So this blog is not going to have anything to do with food or nutrition. What I would like to discuss is medical necessity and maintenance care.

Most third-party payers (insurance companies and benefit administration groups) will not include maintenance care as a covered benefit. Maintenance care is defined as treatment meant to keep you at your current health level. What they expect from doctors is to treat you for a specific problem and work toward a specific goal, namely, improving your current health status. Headaches are a great way to illustrate this idea. Let’s say you have a headache and you come into the office for treatment. As a result of the treatment, the headache lessens in either intensity or frequency over the course of five visits. All five of these treatments are medically necessary. One week later, you schedule an appointment and you have not had a headache since your last visit. Your goal is to keep the headaches from returning. This visit is considered maintenance care and would not be covered by your insurance company. However, if you have had two less-intense headaches during that same week, but do not currently have one on the day of your visit, we are still treating your headaches, and therefore your visit is medically necessary.

This can be confusing—in both scenarios, you come into the office for treatment and you are not currently in pain. The difference is whether or not you have reached your treatment goal of relieving pain due to headaches. This type of health care actually makes a lot of sense. Treat the problem until the problem is gone and when it’s gone, stop treatment and enjoy your life. Eat when you’re hungry…and stop when you’re full.

Of Timing Belts and Trigger Points

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Many of you know that I’m a big car guy. I am particularly fond of (obsessed with) Toyota Land Cruisers, but I also drive a 1990 Honda Accord. The 4-cylinder engine in my Honda is what they call a “zero-tolerance engine.” This means that when a piston reaches top-dead-center it is actually in the same space that the valve was in when the valve was open. The only thing keeping the piston from hitting the valve is the timing belt. Replacing the timing belt costs $300-400. If the regular maintenance schedule is ignored and the timing belt wears out, the piston will hit the valve and a new engine is necessary. Replacing the engine costs $2000-3000.

So what does that have to do with trigger points? Trigger points have both latent and active phases. Latent trigger points are not painful unless direct pressure is applied to the trigger point. Active trigger points are painful without any pressure at all. After an hour of myotherapy, we hear many of our patients say “I had no idea I was that sore.” What this says to us is, “I had no idea I had so many latent trigger points.” Generally, it is easier to treat latent trigger points than it is to treat active trigger points. The same is true with treating injuries. It is much easier to treat minor injuries in the first 72 hours than it is to treat an injury that is more than two weeks old. There was a study in the peer-reviewed journal Spine (25 (14), 1782-7) which found that nearly 90% of whiplash patients that received early, active treatment were pain-free six months after the injury. Only 15%, however, were pain-free at six months following standard treatment protocols.

With our “zero-tolerance lives,” where we place so many demands on our bodies, it is much more cost-effective to treat trigger points and injuries when they are new. If you consider the number of visits, pain and suffering, and possible time off work, it just makes sense to seek treatment early and regularly to keep our bodies performing at optimal levels.