As a native Minnesotan, I was raised to follow rules. Rules governed farming, education and nearly every other aspect of our lives. To be honest, rules gave us comfort and predictability. We knew that if we adhered to the rules set forth, we would reap positive results (or at least avoid admonishment).
Following the rules is an imperative that is ingrained in me and has served me well in my personal and professional paths. Unfortunately, I have observed some recent behavior in the chiropractic world that leaves me unsettled. I hope that I am not witnessing a trend.
I recently attended a prominent chiropractic seminar at which doctors take courses that qualify them for license renewal. I saw a handful of registrants check in to a given session, leave the room and then return near the end of the session to "prove" their attendance. I was so frustrated by this behavior that I left the seminar feeling rather defeated. As a proponent of continuing education, not only for licensure but also for mastery of a given technique or strategy, I feel the doctors who failed to attend the full course were not only cheating the system, but also cheating themselves out of a tremendous professional growth opportunity.
When our state board of chiropractic examiners took a hard line on inadequate record-keeping, many of the doctors reacted strongly, complaining that the regulatory body was overstepping its bounds and being too aggressive. Somewhere along the way, those doctors forgot why the board exists in the first place: to protect both patients and doctors. After all, shouldn't we seek to offer the best patient care possible, which includes keeping accurate and substantial documentation on each patient? Why would we want to put our patients at risk, and for that matter, our practices, by not keeping proper records? And if those considerations don't resonate, then think about the third-party payers who cannot justify reimbursement because of substandard record-keeping.
It is detrimental to our profession when a few of us elect to sidestep guidelines or rules, especially when so many others are working diligently to maintain the integrity of chiropractic. It does more than just detract from our credibility; there is clearly an explicit price to be paid when rules are broken.
I am still a firm believer that the majority of chiropractors are following the rules and ultimately realizing great benefits as a result. I can think of two colleagues in particular who recently underwent Medicare audits. Because their documentation was intact, they did not incur any fines or additional fees from Medicare and could take pride in the fact that their practices were managed efficiently and in conjunction with regulatory standards. By following the rules, these two doctors did not suffer financially as a result of the audit and have even stronger confidence that a system that supports rule-following is one that pays dividends in the end.
I also know that following the rules can lead to positive patient outcomes. The doctor who adheres to the guidelines associated with a given chiropractic technique is more likely to see results in their patients than the doctor who is unwilling to commit to the rules. Utilizing proper technique will help the patient heal faster and also protects the doctor from extensive third-party investigation.
For example, a patient who is treated three times per week for a year without seeing results is probably not being treated using the correct protocols. This not only leaves the patient suffering, but also calls into question whether all of these visits can be reimbursed by insurance. In more than one case that I can think of, reimbursements were declined because the insurance company couldn't support so many visits that apparently weren't yielding results.
By following the rules, we maintain our professional credibility, help support our bottom lines, and protect the overall integrity of chiropractic profession. So, the next time you feel compelled to skip a step in documentation, leave a course early, or deviate from technique protocol, remember that the value of following the rules far outweighs the consequences of trying to skirt them. Know that in the process, you are upholding the chiropractic image for which we all strive.
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