Like it or not, COVID’s proliferation will impact DCs and chiropractic telehealth for years to come
When patients and health care providers think of telehealth in chiropractic services, the two never seemed to add up. After all, chiropractic care is literally a very hands-on clinical application and seemingly difficult to conduct through a Zoom or Facetime call. Dating back several years, telehealth was an option used sporadically in chiropractic care and was mostly utilized in radiology, where readings of X-rays or MRIs would be transferred via a telehealth visit.
Telehealth’s explosive growth
Telehealth is currently a $2.6B industry, according to IBISWorld, and has grown 25% since 2015, outperforming growth in the life sciences sector. As telehealth became more prominent in other health care disciplines, the Federation of Chiropractic Licensing Boards (FCLB) took notice and launched a proactive exploration of how telehealth could be applied to chiropractic care and what regulatory structures might be needed to ensure patient safety and encourage best practices.
Then everything changed. Across the nation, many businesses closed, schools shut down, and stay-at-home orders went into effect to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thankfully, chiropractors were deemed essential personnel and were able to continue caring for patients. However, many patients under chiropractic care decided to stay home and postpone care instead of seeing their chiropractor. With the coronavirus keeping people quarantined at home, some practitioners adopted telehealth services to continue connecting with and caring for patients.
As telehealth proliferated in the health care industry a different mindset started to take place, and the idea of serving chiropractic patients via this medium started to take shape. Telehealth has its limits in chiropractic, but there might be potential to utilize this platform to align with the CDC guidelines for social distancing. Of course, adjustments simply cannot be done via conference call. However, neuromusculoskeletal telehealth services could include follow-up examinations, risk assessments, advice, patient monitoring and instructions for spinal care.
Regulatory measures for chiropractic telehealth
Telehealth is regulated by the licensing boards, and chiropractors choosing to launch a telehealth platform should follow accepted best practices. Synchronous guidelines dictate that the proper telehealth structure include secure patient messaging, electronic health records, patient scheduling and records application.
Furthermore, emphasis is placed on using computers with HIPAA-compliant security requirements that perform synchronous video capability. It was also advised that chiropractors (and staff) pay particular notice to proper lighting, clutter-free backgrounds, professional appearance, and clearly written educational materials.
FCLB is a clearinghouse of information and works with state chiropractic boards to maintain continuity and regulations particular to the health and safety of patients. It is advised that practitioners seek guidance from their state licensing board and their malpractice carriers regarding telehealth requirements.
Telehealth regulatory model — the Oregon example
In late March of this year, the Oregon Board of Chiropractic Examiners reviewed the state’s telehealth rules and offered clear guidance to chiropractors for offering telehealth services to both new and existing patients.
In their guidance, the Oregon board specified a number of documentation requirements. In addition to primary complaints and the reason for the visit, the board recommends documenting start and end times. If, based on the complaints, the chiropractor determines that care via telehealth is both possible and beneficial in a particular case, he or she then needs to further document personal, family and health histories.
Oregon’s guidance further outlines necessary visual evaluations such as postural analysis and range of motion as well as patient self-reporting including height, weight, blood pressure, pulse and diet.
Based on visual evaluations and patient self-reporting, chiropractors may offer provisional diagnoses, a report of findings, patient PARQ and consent to provide care, as well as clinical recommendations. Again, the Oregon board’s guidance includes fully documenting all findings and recommendations.
Ultimately, as in personal visits, thorough documentation during telehealth practice protects the patient, ensuring the chiropractor is building a complete picture of patient health and offering clear guidance for home care. Additionally, by documenting, chiropractors manage their own risk and reduce exposure to board actions or malpractice claims.
Launching your telehealth practice
A growing number of continuing education providers offer telehealth courses aimed at helping chiropractors under- stand the relevant regulations and documentation requirements as well as explore telehealth-friendly services and workflow scenarios.
For doctors of chiropractic who wish to include telehealth in their own practice, the Federation of Chiropractic Licensing Boards highly recommends including a PACE Recognized telehealth course as part of the process in building this avenue of practice. To protect their patients and themselves, practitioners need to have a solid understanding of the strengths and limitations of telehealth as well as the regulations that govern practice in both the chiropractor’s and the patients’ jurisdictions.
As the industry utilizes this platform more frequently, there is an expectation for updated best practices to be discovered and shared. To date, we are learning that the virtual, telehealth platform will likely grow within chiropractic. The feasibility of real-time telecommunication appears to be an effective supplement that is an option to conventional methods of modern health care delivery. Telehealth, when used properly, enables continuity of care and connection for chiropractors and their patients.
KARLOS BOGHOSIAN, DC, is the current president of the Federation of Chiropractic Licensing Boards, a not-for-profit, 501(c)(3) organization whose membership comprises the United States chiropractic licensing boards, certain Canadian provincial registration boards, and the chiropractic licensing board of New Zealand. FCLB lessens burdens on state government by providing programs and services to its membership.