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Mark van Hemert, DC, DACS
The design of this article is to give the chiropractic profession an introduction into the value and usefulness of clinical outcome assessment procedures. Using outcome assessment methods of case management gives the chiropractic profession an effective way to document the need for care.
This results in receiving the compensation for services they rendered.
In today's environment of manage care, the attending clinician's care is constantly being reviewed and challenged.
The chief areas of concern for the third-party payers is over-utilization and costs. Over-utilization is a problem in chiropractic, whether it be real or only perceived by outside reviewers.
This perception can only be overcome on a case by case basis by objectively proving that care provided was reasonable and necessary. Á Due to the acceptance of the Mercy guidelines
(Guidelines for Chiropractic Quality Assurance and Practice Parameters) by the insurance industry, the document is the authoritative reference to counter the insurance industry's attempt to limit quality and the quantity of care.
The primary reason the Mercy guidelines carry a high level of acceptance and credibility by the insurance industry, is because its ratings are based on scientific evidence.
A synopsis of today's situation reveals that the care rendered by the attending clinician is constantly being challenged by the third-party carriers. IME opinions of excessive care or no permanent impairment are detrimental to the patient's medical/legal case.
Cases that involve acute injury with associated liability frequently require the intervention of the court system or workers' compensation system to resolve the case.
This inherent intervention leaves the door wide open for the probing eyes and opinions of the IME. Due to a lack of knowledge and documentation by the attending physician, patients receive inadequate medical care and inferior documentation of their injury, rational for therapeutic care, determination of maximum improvement, and final impairment.
Third-party carriers are aggressive in their review of care to determine the point of maximum improvement. Many clinicians feel that if patient care is within the guideline numbers, their fees will be paid.
However, the therapeutic necessity of care is frequently being challenged. A lack of knowledge of the practice guidelines does not substantiate the patient's contractual right to receive care to the maximum ability of the injury to respond to active care and improved function.
power... the 1980s witnessed a shift in power from the providers of health care to the payers of it ... and those practitioners whose services are labeled worthless could face financial ruin ... chiropractors are especially vulnerable."
Read More of this article
- Well Managed Chiropractic Soft Tissue Injury
- Managing Soft Tissue Injury with Chiropractic
- Soft Tissue Treatments Personal Injury Case
- Frequency of Care for a Soft Tissue Injury
- Treatment Times for a Soft Tissue Injury
- Orthopedic Supports for Soft Tissue injuries
- Special Tests for Soft Tissue Injuries
- Narrative Reports for Soft Tissue Injuries personal Injury Cases
- End Points of Care Personal Injury Case
- Prognosis & Fees Personal Injuries Personal Injury Case
- An Introduction to Outcome Assessment Personal Injury(Part 1)
- Outcome Assessment personal Injury(Part 2)
- Personal Injury Outcome Assessment(Part 3)
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
ADJUSTABLE MOUSE PLATFORM Website to learn more about or Buy Ergo Nav
Chiropractic San Diego Website to make an appointment
Better Health Steve Jones
