Areas of Concern with Chiropractors
By definition, chiropractors are considered “doctors” who are capable of providing medical care and treatment in workers’ compensation cases. They are sometimes suspect as they do not have a formal medical education that an “MD” obtains through an accredited medical school. The focus of their medical education is concentrated on the diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system. There is also an emphasis on a holistic approach to health care that includes an understanding of the central nervous system plays.
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
Factors to Consider When Evaluating Chiropractic Care
There are various areas where members of the claim management team should focus their review of billing and provider issues related to chiropractors. These areas should include the following:
- Evidence of a reasonable treatment plan: This plan should be reasonable based on the nature and extent of the work injury. It should include information on the duration of care and its frequency.
- Documentation of the details of the treatment: A common complaint of chiropractors is their treatment notes outline the same complaints and care provided with every visit – it is almost as if the provider was using the “copy/paste” function on a word processor.
- The degree and duration of relief resulting from the treatment: A review of what is stated in chiropractic medical records should always be reviewed for consistency. This includes whether the care being provided is advancing the patient’s care and consistent with their deposition testimony, and findings at an independent medical examination.
- The frequency of treatment: This element evaluates how often the injured employee is treating and how they are scheduling appointments. Initial care with a chiropractor is typically set at certain intervals. After a period of time, that care should diminish, or be on an as-needed basis.
- The relationship of the treatment to the goal of returning the employee to suitable employment: A successful return to work should be the goal of any medical care and treatment provided to an injured employee. This becomes paramount when dealing with chiropractic care as frequent, ongoing care can leave someone at their baseline with no improvement in pain relief or functional ability; and
- Cost of Chiropractic care: This is an important factor to consider, especially when an injured employee is seeking approval for care after 10-12 weeks of care.
Issues to Review When More Care is “Required”
When it comes to chiropractic care, it is important to obtain detailed information from the injured employee on how they were referred to the chiropractor. Closer scrutiny should take place when this is someone the employee has seen in the past or based on a family member referral. A claim should be heavily scrutinized if the chiropractor shares a building with, or located in close proximity to a physical therapist also treating the injured employee.
Other issues to consider when challenging excessive care, or approving additional chiropractic care should include:
- The injured employee’s opinion as to relief obtained;
- The duration of relief from symptoms;
- Whether symptoms return once care stops;
- The use of other “alternative” medical care;
- Whether the injured employee is psychologically dependent on chiropractic treatment;
- Whether the frequency of treatment is warranted;
- The cost/benefits analysis regarding treatment provided compared to the relief obtained;
- The employee’s overall activities and the extent of the employee’s ability to work; and
- The potential for aggravation of an underlying condition.
Conclusions
The goal when approving medical care and treatment should always concern the nature and extent of the injury and getting the employee back to their pre-injury condition. This can be obtained through chiropractic care. When handling a claim involving this treatment modality, it is important to be vigilant and ensure it is effective in providing lasting relief.
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