If you decide to quit the practice of chiropractic but you don’t want to just shut your doors and walk away, you should consider selling the practice. If you opt to sell your practice there are two distinct ways to do so. One way, if you are incorporated or operate as a formal business entity such as an LLC or a PA, is to simply sell the stock in your business entity to a willing buyer.
Doctors of Chiropractic in Texas need to be aware that the Texas Board of Chiropractic Examiners is taking a hard line on compliance with the requirements imposed on all health care providers through what is commonly known as “HB 300”.
HB 300 was a piece of legislation passed by the Texas Legislature in 2011 that added additional provisions to Texas’ statutory version of HIPAA.
The new provisions of the law enacted in 2011 revised the Texas Patient Privacy Act, found at Texas Health and Safety Code, §181.101, to require that ALL licensed health care providers must provide job specific training to ALL new employees within 60 days of their employment.
The training to be provided must relate specifically to the new employee’s duties for the health care provider. The employer must keep a log of all training sessions conducted.
The legislative revisions also require that all health care providers must conduct specific job related re-training of their employees every two years. Failure to comply with the requirements imposed under this new law could result in regulatory sanction by the Texas Department of Health Services (and possibly by the licensed providers’ state licensing board).
The Texas Board of Chiropractic Examiners has just adopted a new rule laying out specific criteria for all doctors of chiropractic with regard to how they must conduct examinations, make diagnoses and treatment plans and document their services. You can read the text of newly adopted Board Rule 80.5 by going to the TBCE’s web site.
The new rule has incorporated documentation guidelines that have previously been established by the American Chiropractic Association’s Clinical Documentation Manual, the American Medical Association’s CPT Code Book, the 1997 Documentation Guidelines for Evaluation and Management Services and the Chiropractic Service Manual Guidelines set forth by CMS.
Under the TBCE’s new rule all patient records for an initial visit must include: patient history, description of symptomatology or wellness care, exam findings, including imaging and lab records when clinically indicated, diagnosis, prognosis, assessment(s), treatment plan, treatment provided or recommended and, periodic reassessment(s) when appropriate (minimum of once per CY). Each patient’s visit following the initial visit will be considered a “subsequent visit” unless there is a new illness or injury. The following information must be reported in each patient’s file on each subsequent visit: (1) an updated history including a review of chief complaint(s) and changes, if any, since last visit, (2) a physical examination including examination of the area(s) involved in the diagnosis and an assessment of any change in the patient’s condition since the last visit, and (3) the treatment provided – including (1) documentation of treatment provided, (2) documentation of patient’s response to the treatment on the date of service, and (3) change(s) in the treatment plan or planned referrals, if indicated.
Texas doctors should immediately take care to implement changes to your practice protocols if they vary, at all, from the requirements of the board’s new rule, as summarized above. It is anticipated that the board will begin reviewing doctor’s documentation in all enforcement cases pending before the board. Failure to implement and adhere to these expanded documentation protocols can result in adverse sanctions against a doctor’s license. Not being aware of the new rule’s requirements will not be a valid defense.
Proposed Amendment to TBCE Scope of Practice Rule 75.17
The Texas Board of Chiropractic Examiners has published the following proposed amendment relating to its Scope of Practice Rule 75.17. This Rule is intended to define the practice of chiropractic and the limits of chiropractic scope of practice. The following is the text of the Board’s proposed rule (proposed changes to the existing rule are underlined). Comments may be submitted by anyone as to any aspect of the proposed rule, its fairness, thoroughness or undue limitations. Any comment must be submitted to the Board no later than March 2, 2013.
§75.17.Scope of Practice.
(a) – (d) (No change.)
(e) Treatment Procedures and Services.
(1) (No change.)
(2) In order to provide therapeutic care for a patient or patient population, licensees are authorized to use the therapeutic modalities listed in this paragraph. All therapeutic modalities provided by Doctors of Chiropractic in Texas must comply with the chiropractic scope of practice as defined by the Texas Occupations Code §201.002. [:] [Read more…]
Zero Tolerance from TBCE for Regulatory Violations
All Texas chiropractors need to be aware that the Texas Board of Chiropractic
Examiners is operating at a zero tolerance level with respect to regulatory
Even if a totally meritless complaint that has nothing to do with the doctor’s
medical records is filed against a doctor, the Board, on its own, can (and most
often does) request copies of the doctor’s medical records (even if the doctor’s
medical records have no relevance to the stated nature of the complaint filed
against the doctor) and use them to try to identify a regulatory violation.
If the Board requests copies of your records the Board will carefully review those
records to determine if you have adhered to all regulatory requirements imposed
under the Texas Chiropractic Act. [Read more…]
Proposed Revisions to Documentation Requirements by the Texas Board of Chiropractic Examiners
The Rules Committee of the Texas Board of Chiropractic Examiners is considering expanding the breadth of the documentation requirements imposed on doctors of chiropractic under its regulatory program. The new documentation program currently under consideration by the Board would significantly increase the amount of information doctors are required to record and input into their documentation involving patient exam findings, bases and rationale for their diagnosis and their daily record of patient treatments. The Texas Board is following the lead of several states that have already incorporated significantly greater documentation requirements into their chiropractic regulatory program. Florida and Georgia are several of the state regulatory programs that the Texas Board has been analyzing.
Beware of Limited Service Chiropractic Franchises
Doctors of Chiropractic need to take extra care to do their “due diligence” before buying into the “Chiropractic Franchise” programs that advertise that they offer only “Adjustments” on a “membership basis”.
Chiropractic Franchise programs are being marketed to doctors across the country and in Texas, in particular, that purport to offer a very streamlined program of “adjustments” and nothing else.
Under these limited practice franchise programs the doctor’s “clinic” would only offer adjustments, with no therapy programs or other type of passive services being provided. Patients could walk in, or purchase “memberships” under which they would receive a discounted price for [Read more…]
HIPAA/HITECH Final Rule – Patient Disclosure Options
Under the final HIPAA/HITECH rule issued in January 2013 patients are given a right to obtain restrictions on the disclosure of health information in electronic or any other form to a health plan for payment or healthcare services with respect to specific items and services for which the patient has paid in full on a cash basis, out of their pocket. These requests for restrictions must be granted by the doctor unless disclosure of the treatment is specifically required by law. Note, the doctor must also include this right in his/her Notice of Privacy Practices.
Doctors are not required by this rule to maintain separate health records or segregate restricted health information, but they must “employ some method to flag or make a notation in the record” that their patient has requested that disclosure of certain information be restricted. Of special significance, [Read more…]
Closing Down Your Chiropractic Practice – Do’s and Don’ts
I was recently asked what a doctor needs to do if he has decided to close down his practice. InTexas the Board of Chiropractic Examiners does not have a rule that outlines the requisite procedures that must be followed if a doctor wants to quit the practice of chiropractic. So we’ll look at what is generally required of a physician and assume that the same criteria would apply to a doctor of chiropractic.
You should give your employees suitable advance notice of your intent to close down. Next you need to notify your patients and/or their legal representatives of your intention. [Read more…]