Chiropractic Assistants ... Their Surprising Role on Your Practice's Risk Management

Chiropractic assistants (CAs) often have a great deal of patient contact. As a result, they can impact your practice's risk management in the following ways:

Posted in Risk Management on Wednesday, May 30, 2018

Doctor's Orders

While most CAs already know it's not acceptable to offer health care advice or perform treatments without your authorization, they may find it difficult to refrain from doing so when trying to accommodate patient requests. For example, a patient may ask during therapy: "My neck isn't hurting, can you apply the therapy to my mid-back instead?" The CA needs to know this isn't an option, unless cleared by the doctor.

Resource for Recordkeeping

CAs can help ensure records are accurate, reflect the patient's condition and course of treatment, and communicate effectively with other health care providers by verifying:

• The patient's responses to your questions, clinical findings, and differential diagnosis or clinical impressions are included.
• Your plan of care and the patient's response to treatment is provided.
• Documents are never altered, are written legibly and only standard abbreviations are used. The CA can place a sticky note on questionable entries and bring it to your attention – they should not file these documents until you review them.
• Lab reports are initialed by the treating doctor before they are filed. This is particularly important in a multidisciplinary practice.
• Entries and diagnostic test results are initialed whenever performed by anyone other than the doctor.
• Clinical records match billing records.
• Ink, not pencil, is used (or notes are transcribed) and no lines are skipped or left blank.
• Negative comments about the patient are not included.
• The practice maintains the original records. (Tip: Many facilities have machines that can copy X-rays instead of sending these out.)
• Copies are carefully reviewed before sending them out. Charts copied by staff can contain copies of "sticky notes" not meant to be part of the patient's record, embarrassing the doctor.
• An updated log of copies of files sent out is maintained.
• Records are kept in accordance with state law (e.g., records may need to be maintained longer for pediatric patients).

Confidentiality Issues

While patients have the right to receive copies of their records, confidentiality is crucial to protect their privacy and to adhere to HIPAA requirements.

The CA should not disclose health-related information to the patient's family members or acquaintances without a signed release or authorization from the patient. In addition, the CA must be careful with patient files and when discussing patient information so that confidential information is not viewed or heard by other parties.

Patients with Hidden Agendas

While the great majority of patients want quality chiropractic care, a few may have a hidden agenda. Your CA can be a valuable resource by letting you know whenever a patient shows the following "red flags":

• Attempts to schedule appointments for the last spot of the day or only after hours.
• Dresses provocatively or asks personal questions such as: "Is the doctor happily married?"
• Disregards staff instructions or behaves rudely toward staff.
• Makes unusual comments such as: "I really can't afford to come here for treatment," "I felt dizzy after my last treatment," or "My family doctor doesn't like my coming here."

By effectively dealing with patients who have a hidden agenda, your CA can assist the practice in focusing on patients who truly need the care.