Spinal Chat with The PCA

PCA Strategic Business Member Spotlight: North Payment Processing with Ryan Moss

In this PCA Strategic Business Member Spotlight, Mike Barba of the Pennsylvania Chiropractic Association interviews Ryan Moss, Senior Director of Enterprise Sales at North, a payment processing company vetted by PCA to help chiropractors understand and reduce credit card processing costs. North, in payment processing since 1992, specializes in medical merchants, owns its in-house processing platform, and emphasizes dedicated service, integrations with practice management software, and a user-friendly portal for statements, deposits, and transaction visibility. The discussion highlights how hidden “junk fees,” padded interchange, and unclear statements can drive effective rates to 4–5%, while understanding total fees divided by monthly volume helps identify overpaying; North aims for transparent pricing and offers options including traditional pricing and a dual pricing “Edge” program that can pass acceptance costs to patients. Members are encouraged to review agreements, watch for long-term contracts and cancellation fees, and contact Moss for statement-based comparisons; using PCA partners also supports PCA advocacy and education, with a portion of transactions benefiting the association.

00:00 Member Spotlight Intro

00:57 Meet Mike and North

02:09 What North Does

03:11 Why Switch Processors

04:33 Technology and Service

05:49 Hidden Fees Explained

07:18 Reading Your Statement

10:15 Payment Options for Clinics

11:19 Training and Support

12:47 Comparing Providers

15:23 Contracts to Avoid

17:18 How to Get Started

18:21 Partnering Supports PCA

18:54 Final Pitch and Wrap

21:15 Key Takeaways Outro

Contact North, Ryan Moss

Senior Director, Enterprise Sales

P: 818-825-7500

E: [email protected]

PCA Website: https://pennchiro.org/

PCA Email: [email protected]

Created and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

PCA Study Review: Shoulder Pain, Rotator Cuff Tears, and the Problem with One Test Thinking

In this episode of PCA Study Review, a service of the Pennsylvania Chiropractic Association, we review research on shoulder exams, rotator cuff tears, and subacromial impingement.

Shoulder exams can get crowded quickly: Neer, Hawkins, Jobe, Drop Arm, Lift Off, Painful Arc, and lag signs. Most doctors know the names. The deeper issue is whether we understand what each test actually tells us.

The literature reinforces one clear point: no single shoulder test is perfect. This review focuses on lag signs, particularly the External Rotation Lag Sign at 90 Degrees and the Internal Rotation Lag Sign, to identify full-thickness rotator cuff tears.

The larger lesson is not that doctors need one magic test. Better clinical reasoning requires test clusters, context, documentation, and knowing when referral, imaging, or co-management may be appropriate.

For chiropractors, this matters because musculoskeletal care depends on skilled examination early in the care pathway. The opportunity is to evaluate carefully, recognize red flags, document clearly, and treat conservatively when appropriate.

In This Episode

• Why one test thinking can weaken the shoulder diagnosis
• Why lag signs deserve attention in shoulder evaluation
• How high specificity and low sensitivity should affect interpretation
• Why familiar tests are not always the strongest tests
• How test clusters improve clinical reasoning
• When shoulder findings may require referral, imaging, or co-management
• Why evidence-informed documentation strengthens care and credibility

Reference Articles

Zhao, Q., Palani, P., Kassab, N. S., Terzic, M., Olejnik, M., Wang, S., Tomassini-Lopez, Y., Dean, C., & Shellenberger, R. A. Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25, Article 1028, 2024.

Hermans, J., Luime, J. J., Meuffels, D. E., Reijman, M., Simel, D. L., & Bierma-Zeinstra, S. M. A. Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The Rational Clinical Examination Systematic Review. JAMA, 310(8), 837–847, 2013.

Castoldi, F., Blonna, D., & Hertel, R. External rotation lag sign revisited: Accuracy for diagnosis of full-thickness supraspinatus tear—Journal of Shoulder and Elbow Surgery, 18(4), 529–534, 2009.

Miller, C. A., Forrester, G. A., & Lewis, J. S. The Validity of the Lag Signs in Diagnosing Full-Thickness Tears of the Rotator Cuff: A Preliminary Investigation. Archives of Physical Medicine and Rehabilitation, 89(6), 1162–1168, 2008.

The shoulder is complex. Rotator cuff disease is common. Pain provocation tests can mislead when used carelessly.

The opportunity is to read the research, revisit the exam, and sharpen the clinical reasoning that protects patients and strengthens the profession.

PCA Website: https://pennchiro.org/ PCA Email: [email protected]

PCA Deep Dive: Pennsylvania’s Chiropractic Scope Fight; Modern Care vs. Outdated Laws

In this episode of PCA Deep Dive, we examine one of the most important questions facing chiropractic in Pennsylvania:

What happens when modern chiropractic education, modern patient needs, and conservative care collide with an outdated scope-of-practice law built for another era?

Pennsylvania’s chiropractic scope of practice is nearly 50 years old. While the profession, patient expectations, education standards, and healthcare delivery models have changed dramatically, Pennsylvania law has not kept pace.

This episode explores the real-world impact of that mismatch, including restricted practice authority, rural access challenges, workforce pressure, delegation barriers, insurance friction, and the hidden cost of limiting conservative, non-pharmacological care.

We also discuss research from West Virginia University showing that Pennsylvania ranks among the most restrictive states in the country for chiropractic scope of practice. The result is a paradox: highly trained doctors operating under low autonomy.

But this is bigger than one bill.

This is the scope fight.

It is about whether Pennsylvania’s chiropractic law will finally reflect modern education, modern patient needs, and modern conservative care.

In This Episode

• Why Pennsylvania’s chiropractic scope of practice is nearly 50 years old
• How outdated scope laws affect access, efficiency, and patient choice
• Why does Pennsylvania rank among the most restrictive states for chiropractic scope
• How regulatory ambiguity can function like a practical ban
• Why rural communities feel these restrictions more sharply
• How workforce shortages and limited training pipelines affect access
• Why HB 1106 matters for delegation and clinic efficiency
• How scope modernization connects to non-opioid care and the future of chiropractic in Pennsylvania

Get Involved

Policy does not change from the sidelines.

PCA’s Lobby Day is June 9 in Harrisburg, and we need chiropractors from across Pennsylvania to show up, meet with elected officials, and help tell the story of this profession.

We know it is a practice day. But this is one of the most important opportunities we have to show the strength, seriousness, and unity of chiropractic in Pennsylvania.

If you cannot attend, please consider supporting the PCA PAC. One hundred percent of PCA PAC donations go directly toward supporting chiropractic advocacy and the future of the profession in Pennsylvania.

WVU study on Pennsylvania’s outdated scope of practice:

Register for PCA Lobby Day on June 9:

Support the PCA PAC:

Learn more about HB 1106 and delegation restoration:

PCA: https://pennchiro.org/

Email the PCA: [email protected]

PCA Study Spotlight: The Hidden Circuit of Chronic Pain

Stanford’s Hidden Chronic Pain Circuit: A Better Framework for Explaining Persistent Mechanical Pain

This episode of PCA Study Spotlight reviews a Stanford Nature study describing a “hidden” looping circuit between the spinal cord and brain that appears to selectively drive chronic mechanical pain in mice while remaining distinct from pathways involved in acute, protective pain and normal touch. In mouse models, silencing nodes in the loop reduced injury-induced mechanical hypersensitivity due to inflammation or nerve injury, whereas repeated activation could create lasting hypersensitivity in healthy mice. The host emphasizes this is basic science, not a chiropractic or manipulation study, but argues it offers chiropractors a clearer framework for communicating chronic pain: persistent pain may reflect altered nervous system processing and sensitization rather than ongoing tissue damage, supporting more accurate, respectful patient conversations and reinforcing the value of conservative care without overclaiming mechanisms.

00:00 Series Purpose

00:25 Study Overview

01:09 Important Caveats

01:40 Why Pain Persists

02:22 Mapping The Loop

03:52 Clinical Communication

04:45 Fear And Function

05:34 Beyond Structural Stories

06:00 Touch Versus Pain

06:55 Layered Pain Biology

07:31 Practical Takeaways

08:16 Read And Reflect

08:47 Closing Thoughts

Study Citation Wang, Q., Lee, J. H., Nachtrab, G., Yuan, Y., Yuan, L., Qi, W., Mohr, M. A., Xiong, J., Horowitz, M. A., & Chen, X. (2026). Deconstruction of a spino-brain–spinal cord circuit that drives chronic pain. Nature. Published online April 1, 2026. DOI: 10.1038/s41586-026-10296-y. Official article:

Suggested Show Notes Format Study discussed in this episode: Wang, Q., Lee, J. H., Nachtrab, G., Yuan, Y., Yuan, L., Qi, W., Mohr, M. A., Xiong, J., Horowitz, M. A., & Chen, X. (2026). Deconstruction of a spino-brain–spinal cord circuit that drives chronic pain. Nature. Published online April 1, 2026. DOI: 10.1038/s41586-026-10296-y. Read the study here:

Optional Short Version Wang Q, Lee JH, Nachtrab G, et al. Deconstruction of a spino-brain–spinal cord circuit that drives chronic pain. Nature. Published online April 1, 2026. DOI: 10.1038/s41586-026-10296-y.

PCA Contact information:

PCA Website: https://pennchiro.org/

PCA Email: [email protected]

PCA Study Spotlight, Chiropractic Research, Chronic Pain, Pain Science, Central Sensitization, Neuroscience, Musculoskeletal Care, Conservative Care, Patient Communication, Spine Care

PCA March President’s Address with Dr. Andrew Heck | Legislative Progress, Advocacy & Northeast Chiro Summit

In this special Spinal Chat episode from the Pennsylvania Chiropractic Association, PCA President Dr. Andrew Heck shares the March President’s Address with updates on spring momentum and ongoing legislative, regulatory, and reimbursement challenges. He reports progress on delegation restoration through House Bill 1106, scope modernization, copay reform, and the sports working group’s efforts on return-to-play physicals and sideline care, as well as continued Capitol meetings led by PCA leadership and staff. Dr. Heck thanks nearly 70 members and non-members for supporting the postcard campaign and emphasizes that engagement from doctors, staff, patients, and communities strengthens chiropractic’s voice. He also previews the Northeast Chiro Summit (May 1–3) at the Kalahari Resort, noting record attendance and encouraging participation, membership, PAC support, and advocacy involvement.

00:00 Welcome and Setup

00:39 Springtime Reflection

01:13 Legislative Progress

01:56 Member Advocacy Push

02:27 Northeast Summit Preview

03:08 Conference Details

03:25 Closing Thanks

03:33 Get Involved Call

04:11 Final Sendoff

PCA Contact information:

PCA Website: https://pennchiro.org/

PCA Email: [email protected]

Spinal Chat, Pennsylvania Chiropractic Association, Dr. Andrew Heck, President’s Address, Chiropractic Advocacy, HB1106, Scope Modernization, Copay Reform, Sports Chiropractic, PCA PAC, Northeast Chiro Summit, Pennsylvania Chiropractors

PCA Deep Dive: Covered but Not Accessible. The Chiropractic Copay Crisis in Pennsylvania

This episode argues that rising deductibles, copays, visit caps, and administrative barriers are pricing patients out of conservative musculoskeletal care, reshaping treatment choices, and increasing downstream costs. Citing the RAND Health Insurance Experiment, it notes chiropractic use drops about 50% with 25%+ cost sharing and that chiropractic demand is more price-sensitive than general medical care. Studies on high-deductible health plans show patients reduce spending largely by skipping care, disproportionately harming lower-wage workers. In contrast,e a Johns Hopkins study links higher out-of-pocket costs to reduced non-pharmacologic care without reducing opioid use. Evidence shows that removing copays reduces downstream physician services, surgeries, and injections, and that chiropractic coverage correlates with lower total spending. The script highlights Pennsylvania billing data, federal Medicare parity bills (HR 539/S 106), DOJ comments on ERISA misuse, Massachusetts’ prior-authorization ban for non-opioid pain care, and Pennsylvania’s proposed 20% cost-sharing cap and Medicare fee payment floor, concluding with a call to action.

00:00 Why Care Costs More

00:51 The Bill Fear Factor

01:59 Rand Experiment Lessons

04:35 Smart Shopper Myth

06:25 Deductibles And Visit Caps

08:31 Maintenance Care Gap

10:06 When Patients Switch To Pills

11:05 Proof Reform Saves Money

14:02 Pennsylvania Billing Shock

14:59 Medicare Parity Fight

16:48 State Reforms In Motion

17:44 Pennsylvania Copay Blueprint

19:35 What You Can Do Now

20:35 Final Call To Action

References

Baicker, K., & Chandra, A. (2015). JAMA Internal Medicine.

Johns Hopkins University study evaluating the impact of high deductible health plan enrollment on nonpharmacologic treatments. (2023).

Legorreta, A. P., et al. (2004). JAMA Internal Medicine. Also referenced as: Comparative Analysis of Individuals With and Without Chiropractic Coverage.

Lentz, T. A., et al.; ATI Physical Therapy and Duke Clinical Research Institute. (October 2025). Physical Therapy & Rehabilitation Journal.

RAND Health Insurance Experiment. (1974–1982). Findings later analyzed in: Shekelle, P. G., Rogers, W. H., & Newhouse, J. P. (1996). Medical Care.

Smith, M., & Stano, M. (1997). Journal of Manipulative and Physiological Therapeutics.

Swedish randomized controlled trial on maintenance care. (2018).

Texas A&M study evaluating employee behavior in high deductible health plans.

University of California, Berkeley, and Harvard study on high deductible health plans.

USC Schaeffer Center study on the financial burden of high deductible health plans. (2023).

Whedon, J. M., et al. (2024). Journal of Integrative and Complementary Medicine.

JAMA Network Open clinical trial analyzing the addition of chiropractic care to standard military medical care.

Government, Legislative, and Policy Documents

American Chiropractic Association. Chiropractic Medicare Coverage Modernization Act Talking Points. (2025).

Chiropractic Future. Comments submitted to the Department of Justice Anticompetitive Regulations Task Force. (June 2025).

Massachusetts Session Law, Chapter 285. (2024).

Medicare. 2025 Physician Fee Schedule.

PCA Website: https://pennchiro.org/

PCA Email: [email protected]

PCA Deep Dive: Beyond the Adjustment, Why Functional Nutrition Matters in Modern Conservative Care

This episode of PCA Deep Dive introduces the Functional Nutrition Working Group 100-Hour Certification in Functional Nutrition, developed by the Pennsylvania Chiropractic Association in academic partnership with the University of Bridgeport.

The conversation makes the case that today’s patients are more inflamed, more metabolically compromised, and more clinically complex, making chronic disease and dietary inflammation central to musculoskeletal recovery and recurrence. Using Pennsylvania obesity data and the concept of cytokine-driven “chemical casts,” the episode explains why a technically sound adjustment may not hold when biology is working against healing.

The episode also highlights a profession-wide gap in nutrition counseling. Nearly 90% of chiropractors already provide some form of nutrition guidance, yet 65% of respondents in a New York survey said they did not feel adequately prepared for in-depth nutritional counseling. This program is presented as structured, academically grounded education, not as scope expansion or a supplement sales model.

Topics include systems biology, functional blood chemistry trends, gut-immune pathways, cardiometabolic risk, herb-drug interactions, referral awareness, and the program’s two-part design, Phase I foundations and Phase II clinical integration.

Episode Timeline

00:00 Welcome and Mission

00:20 Modern Patient Complexity

01:23 Why Mechanics Fail

02:09 Metabolic Dysfunction Explained

04:10 Four Pillars Framework

04:25 Inflammation Locks Joints

06:30 Training Gap in Nutrition

08:35 Not Scope Expansion

11:23 Program Structure and Rigor

12:26 Deep Curriculum Highlights

14:36 Future of Conservative Care

16:25 How to Get Involved

Functional Nutrition Working Group 100 Hour Certification in Functional Nutrition: https://fnwg-functional-nutritio-drmknx5.gamma.site/

PCA Website: https://pennchiro.org/

PCA Email: [email protected]

PCA Deep Dive: Dentists of the Spine; Why Chiropractic Should Be the First Stop

Why does modern healthcare still send so many patients with uncomplicated back and neck pain into the wrong doorway?

In this episode, we examine what happens when patients enter the fragmented “spine supermarket” of urgent care, primary care, pain management, imaging, medication, and premature surgical referral, despite guidelines that support reassurance, activity, conservative care, and avoiding early imaging in most uncomplicated cases.

We explore how this failure is not just inefficient, but harmful. When the wrong doorway becomes the default, patients may be exposed to unnecessary imaging, fear-based decision-making, escalating interventions, and long-term disability. From there, we unpack the Primary Spine Practitioner model and make the case for chiropractic physicians as the evidence-based, conservative front door to spine care.

This episode also examines how that role manifests in real-world systems, including Washington State guidance on traumatic brain injury referral following motor vehicle collisions and the growth of chiropractic services within the Veterans Health Administration.

We close by examining a new challenge, consumer AI tools that often reproduce legacy “see your MD first” referral patterns, even when the evidence points elsewhere.

This is a conversation about triage, authority, policy, and the future of conservative musculoskeletal care.

What We Cover

• Why spine care often fails before treatment begins
• The “spine supermarket” problem in modern healthcare
• How the primary care bottleneck contributes to poor routing
• Why early MRI findings can worsen fear avoidance and chronicity
• The difference between symptom management and true musculoskeletal triage
• The Primary Spine Practitioner model
• Why chiropractors are positioned as first-contact providers for uncomplicated spine pain
• The importance of diagnosis, care planning, and referral authority
• Washington State guidance on post-MVC concussion and TBI recognition
• What the Veterans Health Administration shows about chiropractic integration
• How consumer AI tools may repeat old bias in new forms
• Why policy, payer, and digital routing reform matter

Why Spine Care Fails 02:32

The Spine Supermarket 04:44

Primary Care Bottleneck 07:09

MRI Fear Cascade 09:56

Iatrogenic Chronic Pain 10:53

Primary Spine Practitioner 12:11

Chiropractic Authority 14:27

Dentist of the Spine 17:28

Washington TBI Case 21:56

VHA Integration Proof 24:07

AI Repeats Old Bias 27:21

Fixing Digital Gatekeepers 29:21

Wrap Up and Call to Action

PCA: https://pennchiro.org/

Email the PCA: [email protected]

PCA Deep Dive: Cleared for the Pros, Benched for High School

Regulatory Clarity in School Athletics: Return-to-Play, Sideline Care, and Statutory Authority in Pennsylvania

In this episode of PCA Deep Dive, we examine a policy disconnect affecting student athletes across Pennsylvania.

Doctors of chiropractic with advanced sports credentials serve on professional and Olympic medical staffs nationwide. Yet under current Pennsylvania interscholastic athletic policies, those same licensed providers may face restrictions when working with high school athletes.

Why?

This episode explores:

• The difference between scope expansion and scope confirmation
• Pre-participation exams and current PIAA barriers
• Return-to-play decisions for musculoskeletal injuries
• Sideline care and advanced sports chiropractic credentials (CCSP, DACBSP)
• Rural healthcare shortages across Pennsylvania
• The referral loop and cost burden on families
• How neighboring states like Ohio and West Virginia approach the issue
• Whether current athletic association policies align with the Pennsylvania Chiropractic Practice Act

This discussion is not about expanding the scope.

It is about regulatory alignment.

When 60% of Pennsylvania counties are designated as healthcare shortage areas, restricting the availability of trained providers raises serious questions about efficiency, access, and modernization.

If licensed professionals are already authorized under statute to diagnose and manage musculoskeletal injuries, should athletic policies reflect that authority?

We examine the legal framework, the training standards, and the policy implications for families, schools, and communities.

00:00 Why This Matters

01:19 Friday Night Football Setup

02:18 The Pro vs High School Paradox

03:06 Scope Confirmation Not Expansion

04:23 Three Pillars of Access

04:36 Sports Physicals and PPEs

05:41 Return to Play Authority

06:17 Sideline Care and Credentials

07:48 Rural Shortage Crisis

09:12 The Referral Loop Problem

11:18 Other States and Legal Logic

13:34 Counterarguments and Safety

15:40 What PCA Is Asking For

17:12 Final Take and Call to Action

PCA Sports Working Group: https://pca-sports-working-group-vmf8wp8.gamma.site/

PCA: https://pennchiro.org/

Email the PCA: [email protected]

PCA Deep Dive: From Quackery to Copays; The Structural Battle Over Access

Here’s a tight, high authority summary you can use:

In 1963, the American Medical Association formed the Committee on Quackery with a documented mission to contain and eliminate the chiropractic profession. That campaign ultimately led to Wilk v. AMA, a landmark antitrust case that ended the formal boycott in 1987.

But removing a ban did not guarantee inclusion.

In this episode, we examine how explicit barriers evolved into economic architecture. From accreditation pressure and referral isolation to copay design, network narrowing, vertical integration, and outdated Medicare statutes, the mechanisms changed. The incentives did not.

Major clinical guidelines now recommend non-drug, non-surgical care as first-line treatment for most spine pain. Yet payment structures frequently steer patients elsewhere.

This episode explores how access is engineered and why professional participation remains essential in shaping the future of conservative care.

00:00 The AMA’s “Committee on Quackery” — Containment & Elimination (Cold Open)

02:15 From Bans to Spreadsheets: How Access Gets Engineered

03:12 Setting the Stage: Chiropractic’s Rise in the Late ’50s

04:05 The Iowa Plan: Robert Throckmorton’s Blueprint to Target a Profession

05:34 Weaponizing Accreditation: JCAH Rules, “Cultist” Labels, and Ethical Isolation

08:08 Real-World Fallout: X-Rays Denied, Practices Closed, Careers Threatened

11:34 The Leak: “Sore Throat,” Scientology Infiltration, and the Smoking-Gun Documents

13:38 Wilk v. AMA Begins: The Antitrust Battle That Drags On for a Decade

13:48 Court Victory: The AMA Boycott Is Ruled Illegal

14:23 Phase Two: Ending the War Didn’t Mean Inclusion

14:53 The VA as a Real-World Control Group for Integration

15:38 What the Data Shows: Explosive Growth & Opioid Alternatives

17:05 The Modern Pivot: From Explicit Bans to the ‘Architecture of Access’

17:47 Consolidation & Vertical Integration Explained (Follow the Money)

18:43 Downstream Revenue: Why Conservative Care Can Lose the System Money

20:36 Benefit Design ‘Nudges’: Copays, Velvet Ropes, and Channeled Choice

21:57 Network Narrowing: Market Power Pushes Independents Out-of-Network

23:37 Medicare’s ‘Zombie Law’: Paying for the Adjustment but Not the Exam

25:51 Zooming Out: Evidence Says Conservative First, Payments Say Otherwise

27:33 What Patients Can Do: Question the Incentives Behind Your Care Path

28:54 Final Wrap + Call to Action: Advocacy, Policy, and Staying Engaged

PCA: https://pennchiro.org/

Email the PCA: [email protected]

Copyright Notice

PCA Deep Dive and Spinal Chat are proprietary productions of the Pennsylvania Chiropractic Association.

All episodes, audio recordings, transcripts, graphics, and related materials are protected by applicable copyright laws.

No portion of these podcasts may be reproduced, distributed, transmitted, modified, published, or otherwise used in any form without prior written permission from the Pennsylvania Chiropractic Association.

Limited quotation for educational or journalistic purposes is permitted with proper attribution.

State chiropractic associations are encouraged to share episodes and approved materials directly with their members. Together, organized professions are stronger.

For licensing requests, partnership inquiries, or permission to republish content, please get in touch with the Pennsylvania Chiropractic Association directly.