measuring objective health providing whole food nutrition · with neck, cranium, mandible, thoracic...

Disclaimer Standard Process® sponsors these webinars to provide health care information to health care professionals and to provide them with the opportunity to hear about the views, recommendations, and experiences of other health care professionals.

Standard Process has not evaluated the legal status of any products, other than its own or those of MediHerb®; services; or recommendations with respect to state or federal laws, including scope of practice. Standard Process does not and cannot accept responsibility for errors or omissions or for any consequences from applications of the information provided and makes no warranty, expressed or implied, with respect to the information provided.

Dr. Hemmer’s recommendations for Standard Process and MediHerb product dosages are sometimes different than the doses that appear on the product labels. Please refer to the product labels or to the product descriptions found in the product catalogs and at standardprocess.com for the Standard Process dosage recommendations.

Dr. Bill Hemmer owns and operates a successful chiropractic and functional medicine practice in Tuscola, Illinois. He is also a co-founder of Functional Wellness Systems, a comprehensive business system rooted in providing specific guidance on how to effectively integrate functional medicine into any existing health care practice.

Has Practice Ever Been More Frustrating?

• More paperwork

• Less re-imbursement

• Should you try to go cash only?

• What will happen to all of your insurance patients?

• All you want to do is help the most people you can and make a good living for you and family

• Why is that so hard?

This Webinar is Designed to Answer:

• First question is – What do your patients really want from you?

• How can you navigate the changing insurance model and provide what your patients want at the same time?

• Then provide your patients and the insurance companies with objective data that highlights the value and quality of your care.

• Finally, provide a seamless path for all of your patients to pay you directly while also accepting what insurance coverage they have available.

What Your Patients REALLY WANT: • They want to feel better

• They want care NOW

• They want to be treated with kindness

• They want hope and certainty of treatment

• They want continuity, choice and coordination among providers

• They want to pay as little as possible while assured insurance or third party coverage is available if necessary

• They want highly qualified clinicians demonstrated by using testimonials not statistics

JAMA.AMA-Assn.org at SCELC- University of Southern California on December 28, 2011

What Your Patients REALLY WANT:

• Convenience—especially for patients 30 and older

• Access—after hours access for 18 to 49 year olds, weekend availability for 50 plus

• Value—eliminating out of pocket charges for 18 to 49 year olds plus convenience and service trumps free for patients 50 and over knowing how much a visit will cost up front

• Reputation—didn’t matter much to anyone under 65

• Quality—treatment by a doctor and having the latest in cutting edge technology was most important

www.advisory.com/research/market-innovation-center/expert-insights/2014/get-the-primary-care-consumer-choice-survey-results

Can Your Current Practice Provide What Patients (and Insurance Companies) Want? The new model of care is based on ascension of patient awareness

• Patients want convenient symptom-based care right now

• Patients want to build a relationship with you and your team

• Both patients and insurance companies want specific measures to track progress and assess value and quality of your care

• Both groups want the latest technology to be used

• Both groups don’t want any surprises from your fees

JAMA.AMA-Assn.org at SCELC- University of Southern California on December 28, 2011 www.advisory.com/research/market-innovation-center/expert-insights/2014/get-the-primary-care-consumer-choice-survey-results

Old Becomes New Again

Meet Patients Where They Are Your practice is a convenient place to address their symptoms today

You can provide them with: • Hope • Certainty • Continuity • Kindness • Cost transparency

• Quality Care

JAMA.AMA-Assn.org at SCELC- University of Southern California on December 28, 2011 www.advisory.com/research/market-innovation-center/expert-insights/2014/get-the-primary-care-consumer-choice-survey-results

Provide Insurance Companies What They Want

The 4 parts of the Merit-based Incentive Payment System (MIPS)

1. Physician Quality Reporting System (PQRS)

2. Value Based Modifiers (VBM)

3. Meaningful Use (MU)

4. Clinical Practice Improvement Activities (CPIA)

http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips

What MIPS Means to You and Your Practice This will be the new grading scale for anyone sending claims to insurance companies starting with Medicare Part B in 2017 it will effect reimbursement in 2019.

MIPS is the consolidation of Meaningful Use (MU), the Physician Quality Reporting System (PQRS) and the Value Based Modifier (VBM).

MIPS payment adjustments are based on a Composite Performance Score (CPS) of 4 different categories and will change over time as your grade changes: 1. Quality (50%) 2. Advancing Care Information (ACI, renamed from Meaningful Use) (25%) 3. Clinical Practice Improvement Activities (CPIA) (15%) 4. Resource Use (10%)

http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips

What MIPS Means to You and Your Practice

75% of MIPS composite score is from Quality and Advancing Care Information for the first year – then move to 50% in 2018 and 30% in 2019.

Each practice must measure a minimum of 6 Quality and Advanced Care Information Metrics—one of which must be a Cross-Cutting measure that best reflect their practice.

http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf

6 Metrics I Use in My Practice The 6 Quality and Advanced Care Information Metrics I have chosen are:

1. Preventive care and screening: Body Mass Index screening and follow-up plan

2. Pain assessment and follow-up

3. Functional outcome assessment

4. Functional deficit: change in risk-adjusted functional status for patients with lumbar spine impairment

5. Functional deficit: change in risk-adjusted functional status for patients with neck, cranium, mandible, thoracic spine, ribs, or other general orthopedic impairments

6. Preventive care and screening: screening for high blood pressure and follow-up documented

Measure Objective Improvements

1. Preventive care and screening: Body Mass Index screening and follow-up plan

2. Pain assessment and follow-up

3. Functional outcome assessment

These measures will satisfy both your patients and insurance company – everybody wins!!

Then move on to the next phase of Health Restoration.

Clinical Practice Improvement Activities (CPIA) Under MIPS, a clinician can earn up to 60 points by reporting any combination of “medium-weight” or “high-weight” activities of a possible 100 points

• CPIA accounts for up to 15% of total MIPS composite score

I have chosen 3 CPIA “high-weighted” activities

1. Expanded practice access

2. Beneficiary engagement

3. Integrated behavioral and mental health

https://www.gpo.gov/fdsys/pkg/FR-2016-05-09/pdf/2016-10032.pdf

Resource Use

This accounts for the final 10% of the MIPS Composite Score.

There is no reporting requirement for clinicians.

This measure is calculated based on the claims collected by CMS.

http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips

WHO CARES???

Your patients do!! So should you!!

• Your patients want you to submit charges to insurance even if they won’t meet their deductible.

• Your patients want you to get to the root cause of their problem and create a relationship and a plan to address it.

• Your patients want to know what you are going to measure and track to document they are getting better and might not have to see you so much.

Phases of Health Restoration

Assess Each Patient in a Meaningful Way

Laboratory Data Classic and functional

laboratory samples are collected.

Dietary Intake and Questionnaires Subjective metrics such as a 24-hour dietary recall, questionnaires and medical history are collected.

In-Office Measurements Common measurements are collected such as body

circumference measurements, body composition, and blood pressure differentials.

Physical Capacity Strength, cardiovascular,

flexibility and balance tests are performed.

Health Triangle Chemical: Positive • Good Diet • Supplements • Balanced Hormones • Balanced Immune System • Balanced Gut Bacteria Negative • Pollution • Standard American Diet • Medications • Food Additives

Mental: • Stress Handling Problems • Unhappy with situation • Unhappy about Finances • Strained Relationship • Spirituality

Physical: • Overweight • Joint challenges • Old Injury • Surgery

• Poor/No Exercise

DNA: • 30% Cannot Change • 70% Can Change by

living a healthy lifestyle

• Epigenetic Theory – Turn on/off parts of genes without changing the sequence of the genes

DNA

Physical

Present Options

Mental

Attitude

Dietary

Habits

Correct

Exercise

Lifestyle

Behaviors

Supplements

& Herbs

20% 20% 20% 20% 20%

= 100% Ideal Stress Handling Ability

+ + + +

It all starts with digestion!

Digestive Overview

Digestion is considered the foundation of health by many physicians. If you cannot digest, then you will not be able to uptake many minerals, fats, and vitamins necessary to get healthy.

Main Digestive Organs:

1. Stomach

2. Liver and gallbladder

3. Pancreas

4. Small intestine/large intestine

2

3

4

1 2

4

Digestion is Like a River

• Problems always flow downstream.

• If you start at the mouth and work your way downstream, problems take care of themselves naturally.

• Miss a step and it’s harder to manage problems downstream.

Digestion as a River

There are 4 parts to the river:

1. Stomach acid production

2. Pancreatic enzyme production

3. Bile production

4. Bowel flora balance

2 3

4

1

4

Stomach The stomach produces gastric acid which is responsible for protein metabolism. When protein is not fully digested, putrefaction often occurs in the lower stomach and in the small intestine.

Stomach Survey Statements:

• Heart burn • Upset stomach • Incomplete protein digestion • Foul smelling flatulence and stool

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

Upper Gastrointestinal Tract Chronic stress can decrease chloride, B vitamins, magnesium and zinc which are used to make hydrochloric acid. Hydrochloric acid production is reduced with aging.

Top Survey statements:

• Foul smelling gas • Stomach discomfort • Poor skin and nail growth • Thin and coarse hair • Low muscle mass

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

The goal of gastrointestinal supplementation is to promote healthy digestive function. Hydrochloric Acid (HCl), made in the stomach activates enzymes to breaks down protein. It is made from the electrolytes, chloride, and B Vitamins. Under prolonged stress, these nutrients are deficient and HCl potency is diminished.

• Zypan® combines pancreatin, pepsin, and betaine

hydrochloride to facilitate healthy digestion.*

• Enzycore is a comprehensive blend of enzymes, glutamine, and whole food ingredients designed to support healthy digestion and maximize nutrient absorption. Enzycore is a vegetarian product.*

• Gastrex® supports digestion and stimulates cleansing of the upper gastrointestinal tract.*

Upper Gastrointestinal Tract Supplementation

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Stomach Support • Zypan combines pancreatin, pepsin, and betaine hydrochloride to

facilitate healthy digestion*

• Increases available acid to aid in mineral and protein digestion

• Most people need more acid not less. If they’re still having problems with burning in their stomach take more Zypan not less

• If they are hesitant have them try organic apple cider vinegar first (about a teaspoon with some water) with each meal

• 3-9/day after meals

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Stomach Support • DiGest Forte–a combination of Gentian, Ginger,

Tangerine peel, Wormwood and Feverfew

• These herbs have been used for hundreds of years as, “Bitters”

• Stimulates gastric juice output and appetite

• Promotes healthy gastrointestinal tone

• Supports healthy digestion and intestinal function*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Pancreas Why is the pancreas one of the slowest regenerating organs? Because of the daily stress on the gland. It produces hormones that regulate glucose metabolism, growth, and fat metabolism.

Top Survey Statements:

• Sugar cravings • Compromised carbohydrate metabolism • Compromised energy production • Frequent urination • Sleepiness after eating

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

Pancreatic enzymes primarily digest carbohydrates. Years before insulin resistance, a stressed pancreas will stop producing adequate amounts of these enzymes.

Survey statements:

• Pancreatic enzyme deficiency • Vegetable matter in stool • Insulin resistance • Light/sweet smelling flatulence

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

Pancreas

The goal of pancreas supplementation is to provide digestive enzymes for carbohydrate metabolism and help support the integrity of the pancreatic beta cells that produce insulin used for energy metabolism.

• Diaplex®: General pancreas support containing key ingredients from Zypan®, Arginex®, A-F Betafood®, Betacol®, Pituitrophin PMG®, Chromium and Pancreatrophin PMG®.* 3-9/Day

• Gymnema: This product helps reduce sweet cravings and helps suppress/inhibit sweet taste sensation.* 3/Day

• Multizyme: Contains digestive enzymes to support the proper breakdown of proteins, carbohydrates, and fats.* 3-9/Day

Pancreas Supplementation

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Liver and Gallbladder

The liver produces bile that is stored in the gallbladder. When the gallbladder is full, then bile production slows. Bile emulsifies fat and transports hormones.

Survey Statements:

• Gallbladder and liver discomfort • Bloating • Floating fat particles on toilet water • Light colored stool • Occasional constipation

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

Liver The liver is the main hormone and toxin detoxifier. It activates blood sugar hormones (glucagon and insulin).

Top Liver Survey Statements: • Poor skin health • Sclera color changes (blood shot or yellowing)

of the eye • Poor vascular integrity (easy bruising) • Poor sugar and excess hormone handling

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

The goal of liver supplementation is to support hormone synthesis

and fat metabolism.

• A-F Betafood®: Supports bile production in the liver

and healthy bile flow in the gallbladder.*

• Choline: Supports healthy cell membrane structure and function, provides support for methylation reactions, supports healthy liver and gallbladder function, and supports a healthy nervous system.*

Liver Supplementation

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Digestion is Like a River

• Bile production–fat digestion

• Extremely important part of detoxification and elimination

• Also part of thyroid health

• Loss of gallbladder magnifies the problem

Cholacol®

• Supports gallbladder function

• Source of bile salts

• Helps enzymes break down fats

• Supports healthy elimination*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

HiPep • This product contains Deglycyrrhizinized

Licorice, Meadowsweet and Chamomile (flower and flower essential oil).

• Promotes healthy mucosal tissue within the upper gastrointestinal tract

• Promotes healthy tone and function within the upper gastrointestinal tract

• Assists the normal functioning of the esophageal sphincter*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Small Intestine/Large Intestine Primary and secondary digestion, vitamin and mineral uptake, and neurotransmitter creation.

Small Intestine Survey Statements:

• Leaky gut • Food allergies • Occasional constipation • Bloating

Large Intestine Survey Statements:

• Loose stool • Dehydrated stool

"Tuscola Pain and Wellness Center Correlated Results taken from in-house symptom survey 2014-2015"

Digestion is Like a River

• Bowel flora balance • Immune function • Assimilation • Neurotransmitter production • Vitamin production

Weed and Feed

Gut Flora Complex on the weekend 2 capsules 3 times a day on Saturday and Sunday.

ProSynbiotic capsules 2 three times per day Monday through Friday.

Repeat for 6 to 10 cycles.

Zymex® Capsules • Proprietary blend of defatted wheat germ,

lactose, and enzymatically processed Tillandsia usneoides and beet root

• Promotes a healthy pH range in the intestinal tract

• Encourages a healthy intestinal environment to maintain proper gastrointestinal flora*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Golden Seal 500mg • Helps maintain healthy mucous membranes • Relieves mild temporary digestive complaints • Assists in maintaining healthy breathing

passages to support free and clear breathing • Helps maintain healthy mucus function • Stimulates digestion • Supports the liver*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Okra Pepsin E3

• 4-6 tablets per day for 4 to 6 months

• Supports mucosal tissue in the intestines

• Supports bowel function

• Provides bowel cleansing*

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Is Their Weight Problem the Chicken or the Egg?

• We will never know what the “normal” microbiota looks like because our bacteria will never be like it was in the 1940s

• 90 percent of the cells in your body are bacteria living in you and on you

• 10 percent of the cells are actually human

• Less than 100 strains of bacteria out of thousands are detrimental to human health–most forge symbiotic relationships

• Microbial genes contribute more to health than human genes do

After Addressing Digestion Then What?

To Learn More

drbillhemmer@hotmail.com

Thanks for your attention

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