What Practice Guidelines Should You Be Using
Why are guidelines so important and what guidelines in the injury market are excessively important, especially for you, the treating provider?
A treatment guideline is developed after many of your peers have come together and have committed a significant amount of time and energy to analyze several different research models to put forth recommended treatment guidelines for any profession.
There are several types of treatment guidelines. There can be chiropractic treatment guidelines; there can be physical therapy treatment guidelines; there can be orthopedic surgery treatment guidelines.
Guidelines are best practices established by your profession that you will be judged by. That is probably the most important thing that I’m going to tell you today. Here is the important part. You should be listing what guidelines you use in your private practice. What if someone says, “Hey, I think you over-treated in the injury market.”? It does happen and these are things that you must be cautious of and take into consideration and protect yourself from.
If you list what guidelines you use, those are the guidelines by which you’re judged by. If you say, “Look, I use the ICA best practice guidelines for my treatment guidelines”, those are phenomenal guidelines for Doctors of Chiropractic to be using. I train doctors to list those guidelines as the primary guidelines that they use. There are also practicing chiropractic clinical practice protocols, PCRP, and you will want to use those guidelines as well. Those are the only subluxation-based guidelines in chiropractic.
Many chiropractors get confused with chiropractic guidelines and the term subluxation. The term subluxation is the same as a spinal instability. A spinal instability and a subluxation are the same thing. You must have misalignment of the bone, mis-motion of the bone causing nerve interference, motor sensory, or pain problem at that level. You must identify that.
If you are a subluxation-based provider, you need to use subluxation-based guidelines because those the guidelines that you must be judged by. In clinical practice, chiropractic clinical practice guidelines, CCP guidelines, and ICA best practice guidelines.
The ICA best practice guidelines will cover your Croft guidelines. They’re included in that. If you looked at the treatment for general conditions under the ICA best practice guidelines you’re very much still going to like those guidelines because it gives you, as a chiropractor, a lot of latitude for treatment and it is your guideline.
If you do an impairment rating, you can use the impairment guidelines. If you’re going to do disability rating you have to use disability guidelines. Be sure you state what guidelines you are using. This is very simple. Here is an example:
Patient: Mary Smith
Treatment: I’m am utilizing the CCP guidelines, the ICA best practice guidelines, and The AMA Guides to Evaluation of Permanent Impairment for any impairment that I discover.
You need to list your guidelines. Now, why is this important? Well, in the injury space you’re going to notice things called ‘utilization reviews’ and independent medical examinations. If someone says that the care was medically unnecessary, they must refer to a guideline. If you’ve listed what guideline you use, you must be judged by that guideline because that’s the guideline you’ve listed.
Most doctors are not proactive enough about what guidelines they use, and they don’t take the time to read the guidelines. You need to not only list your guidelines, but you need to read the guidelines. Read your ICA best practice guidelines. Some of the top chiropractors in the US spent a lot of time producing those guidelines, and they’re phenomenal guidelines. You want to look at those guidelines and utilize them.
When you read them I think you’ll be shocked at how much latitude you have as a doctor, and now, if you’re citing that you use those guidelines and somebody has said something contrary to the guidelines, you now have a great rebuttal material for your utilization reviews or any IMEs that you get. Or in the worst-case scenario, let’s say that you have a post-payment review and somebody is saying, “Hey, we think you over-treated and we want the money back.” Well, now you’re actually set up so that you don’t really have a problem with that when you’re trading within your guidelines and you know your guidelines. Guidelines are really, really important today.
And remember, a lot of times in an IME, or in a utilization review, a doctor will say, “Well, here’s a research paper that states a position that I’m taking.” Remember, a guideline usurps that. Guidelines go through all the research and they form a guideline. And that guideline kind of becomes a law. And until you change the guideline, it’s not changed. No matter how much new research comes out or everything else, until the guideline has changed, the guideline is present. It’s like a law. It could be a bad law, but until the law is changed, it’s present and it stays intact.
So doctors, one of the easiest things, if you want to have a much easier time in the injury market, a much easier time navigating payment and billing, and all the various stresses that you run into, listing out your guidelines on each and every case is a really great way to start. You will like the results long-term. You’ll be able to sleep better at night when you understand exactly what you’re doing and why you’re doing it, and the fact that you have a lot of consensus. Your profession has consensus that what you’re doing is correct.
Remember, everything I teach is about objectivity. Objectivity means things are written down. You can show exactly if you have a ligament condition. Good, here’s the consensus on it. Here’s what the impairment guides say on it. Here’s what a lot of research says about it. Here’s what Medscape says about it. You want consensus, and consensus reduces the adversarial nature of the personal injury market, and guidelines are a huge part of that.
So again, doctors, list your guidelines that you’re using with each and every patient and in the long run, you’ll have a lot easier time navigating the personal injury market.
For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.
For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com