Presentation to the FCLBMay 2, 2003

Educating the Licentiate,a State licensing Board’s duty

Massachusetts Board of Registration of Chiropractors

Massachusetts Board of Registration of Chiropractors

Edward J. Barowsky, D.C.

Thomas R. De Vita, D.C.

Wayne A. Comeau. D.C.

Joseph M. Boyle, D.C.

David N. Taylor, D.C.

Kirk J. Shilts, D.C.

Lisa A. Grant, Esq.

Why education?

State licensing Boards

• Set the requirements for state licensure

• Set the rules for proper practice

• Set the terms for regulatory compliance

What issues did our Board frequently encounter?

New doctors not understanding their responsibilities, both administrative (ex: license renewal) & clinical

New doctors taking associateships in practices where they failed to use due diligence in learning about the owner’s prior disciplinary or complaint history

New doctors hired into these unscrupulous practices engaged in similar fraudulent billing, because they failed to learn what was being billed under their name

What issues did our Board frequently encounter?

Epidemic poor clinical recordkeeping habits by most chiropractors (pervasive within our profession because of our wide array of practice methods)

Relative scarcity of postgraduate seminars on clinical recordkeeping within our profession

Chronic coding and billing mistakes

Missing or grossly unsubstantiated treatment plans

Improper substitution of an “implied” consent for an “informed” consent

What problems did our Board commonly encounter?

High recidivism of non-corrective action within previously documented deficient practices

Failure to establish and maintain appropriate boundaries in patient-practitioner relationships

Critical need to place problem doctors within a corrective program that has ONE-on-ONE supervision

3 target groups of doctors:

• New licentiates

• Licentiates in practice• Licentiates under disciplinary action

3 educational programs:

• New licentiate Presentation

• Practice Compliance and Recordkeeping Seminar

• Disciplinary Mentors– Clinical Monitors

– Compliance Auditors

New licentiate Presentation

Educational goals:• Instill duty, responsibility and professionalism

• Proactive (preventative) approach

• Highlight vital clinical practice issues

• Discuss patient sensitivity issues

• Explain renewal requirements

• Enlightenment about associate positions

Practice Compliance and Recordkeeping Seminar

Educational goals:• Review state laws, rules and regulations

• Outline basic clinical practice issues– Clinical recordkeeping procedures– Federal recordkeeping issues– Outcome measures– Insurance/ coding issues

• Promote practice compliance planning

Disciplinary Action (consent decree)Practice Monitors

Educational goals:• Instruction for the deficient practitioner on

proper practice procedures

• Provide the doctor with a personal mentor

• Monitor progression through periodic reports

• Focused corrective actions– Clinical recordkeeping assistance (monitors)– Practice compliance oversight (auditors)

Results: Complaint history 1990-2002

020406080

100120140160180200

1990

1992

1994

1996

1998

1999

2001

Totalcomplaintsissued

Complaint history for newly licensed doctors

Year licensed # complaints issued through 2003

1995 21

1996 33

1997 (initial* program) 9

1998 3

(formal program started)

1999 0

2000 15

2001 4

2002 0

Results: # new doctors, time in practice

1995-1998

Doctors: 393

Months practice: 120

Complaints: 66

1999-2002

Doctors: 464

Months practice: 114

Anticipated complaints:

74

Results: Anticipated vs. Actual Complaints

1995-1998

Doctors: 393

Months practice: 120

Complaints: 66

1999-2002

Doctors: 464Months practice: 114Anticipated complaints:

74Actual Complaints: 19

Results: New Licentiate Program

0

10

20

30

40

50

60

70

80

1995-1998 1999-2002

Doctors (10's)

Months inpractice (10's)

Complaints

Complaints(actual 99-02)

Results: New Licentiate Program

• Since implementing our New Licentiate Program, there has been a 74.4% reduction in complaints lodged against our new doctors compared to the statistically expected norm!

Results: Compliance/ Recordkeeping Seminar

• Recognition of a recommended higher standard of recordkeeping (regulations address only those minimal standards)

• Exposure to compliance programs and practice compliance plans

• Awareness of proper coding issues

• Diminished recidivism rates among disciplined doctors (antidotal)

For additional information:

MA Board of Registration. of Chiropractors239 Causeway St.Boston, MA 0114

www.ma.state.us/reg/boards/ch(617) 727-3033, or 3093

Thank you