Chiropractors are Slow to Comply with Regulatory Changes
The regulation of the health care industry has increased considerably over the past few years and some chiropractors have been slow to comply with the new requirements. The Office of Inspector General (OIG) released the final Compliance Program Guidance for Individual and Small Group Physician Practices over a decade ago. The OIG Compliance Program was a guidance that included the steps to perform voluntary self-audits to help health care providers and suppliers avoid submitting erroneous claims and engaging in fraudulent conduct involving federal health care programs. The era of voluntary health care compliance came to an end with the Patient Protection and Affordable Care Act's (PPACA) mandate requiring all health care providers to implement formal compliance programs as a condition of their enrollment in federal health care programs. Yet many chiropractic practices have not implemented the OIG Program including the selection of a Compliance Officer, staff compliance training, self-audits, correction and reporting. PPACA also saw the advent of HITECH HIPAA (Health Insurance Portability and Accountability Act) which brought new regulations concerning Protected Health Information (PHI). Many chiropractic practices have not yet upgraded their old one page Notice of Information Practices and implementation procedures to the new nine page HITECH version.

Chiropractors Need Improvement in their Documentation Skills
According to the most recent OIG report on "Inappropriate Medicare Payments for Chiropractic Services," published in 2009, Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47% of claims meeting the study criteria. Business Insurance Magazine estimates 5%-10% of all BCBS claims are paid incorrectly, which is echoed by Aetna's estimate of 11% payment errors. In the era of the post-payment audit, it is vital for you to support the medical necessity of the care you deliver by objectively documenting your patients' functional improvements. Functional improvement refers to the effectiveness of the care delivered in improving patients' ability to carry out their activities of daily living. Outcome-based documentation validates patients' subjective complaints to third-party payers and improves patients' motivation to follow through with your recommendations for care by assisting you in establishing clearly defined goals for care.

Chiropractors Have Been Slow to Embrace EHR
The buzz about how electronic health records (EHR) will transform health care delivery in the United States keeps growing. The federal government and the Centers for Medicare and Medicaid Services (CMS) brought increasing attention and urgency to the issue with the HITECH Act (the Health Information Technology for Economic and Clinical Health Act). HITECH provides for federal stimulus money to be paid to eligible health care professionals (including chiropractors) for implementing and using certified EHR products. Those chiropractors who implemented an approved EHR and used it "meaningfully" beginning in 2011, are eligible for significant bonus payments from Medicare, up to $44,000. The first incentive checks have been mailed and early-adopter chiropractors have already received the maximum first year payments of $18,000 from the EHR stimulus program. HITECH is ambitious and has a fast timeline. Those chiropractors who do not implement a certified EHR system in their practices in a timely fashion risk losing a portion of the incentive payments. Those who wait until 2015 will see the incentive change into a penalty, as an increasing percentage of their Medicare payments are deducted for non-compliance.

Chiropractors are not National Organization Joiners
There are approximately 60,000 doctors of chiropractic in active practice in the United States and yet the combined membership of all our national organizations is less than 18,000. Compare this to the AMA's current membership of approximately 209,000 members. The economies of scale are not in favor of the chiropractic profession.

The AMA has an annual lobbying budget of tens of millions of dollars and during the health care reform debate, the AMA contributed on a scale that made it one of the largest political contributors in American history. The arguments made by some chiropractors for not joining a national organization are varied, but follow common themes. They wonder if membership can impact their own practice ("What's in it for me?"); they perceive bickering and disunity on a national level and don't want to partake; they perceive that if they belong to their state association, they don't need to support a national organization.

"United we stand, divided we fall" is a phrase that has been used in mottos from nations and states to popular song lyrics. Chiropractors would do well to heed its wisdom.

Next Month: Opportunities and Threats.

Dr. Mark Sanna, a 1987 graduate of New York Chiropractic College, is a member of the ACA Governor's Advisory Board and a member of the President's Circle of NYCC and Parker College of Chiropractic. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com).