1. Presentation to the FCLB May 2, 2003 Educating the Licentiate, a State licensing Board’s duty Massachusetts Board of Registration of Chiropractors

2. Edward J. Barowsky, D.C. Thomas R. De Vita, D.C. Wayne A. Comeau. D.C. Joseph M. Boyle, D.C. David N. Taylor, D.C. Kirk J. Shilts, D.C. Lisa A. Grant, Esq.

3. Why education? State licensing Boards Set the requirements for state licensure Set the rules for proper practice Set the terms for regulatory compliance

4. What issues did our Board frequently encounter? New doctors not understanding their responsibilities, both administrative (ex: license renewal) & clinical New doctors taking associateships in practices where they failed to use due diligence in learning about the owner’s prior disciplinary or complaint history New doctors hired into these unscrupulous practices engaged in similar fraudulent billing, because they failed to learn what was being billed under their name

5. What issues did our Board frequently encounter? Epidemic poor clinical recordkeeping habits by most chiropractors (pervasive within our profession because of our wide array of practice methods) Relative scarcity of postgraduate seminars on clinical recordkeeping within our profession Chronic coding and billing mistakes Missing or grossly unsubstantiated treatment plans Improper substitution of an “implied” consent for an “informed” consent

6. What problems did our Board commonly encounter? High recidivism of non-corrective action within previously documented deficient practices Failure to establish and maintain appropriate boundaries in patient-practitioner relationships Critical need to place problem doctors within a corrective program that has ONE-on-ONE supervision

7. 3 target groups of doctors: New licentiates Licentiates in practice Licentiates under disciplinary action

8. 3 educational programs: New licentiate Presentation Practice Compliance and Recordkeeping Seminar Disciplinary Mentors –Clinical Monitors –Compliance Auditors

9. New licentiate Presentation Educational goals: Instill duty, responsibility and professionalism Proactive (preventative) approach Highlight vital clinical practice issues Discuss patient sensitivity issues Explain renewal requirements Enlightenment about associate positions

10. Practice Compliance and Recordkeeping Seminar Educational goals: Review state laws, rules and regulations Outline basic clinical practice issues –Clinical recordkeeping procedures –Federal recordkeeping issues –Outcome measures –Insurance/ coding issues Promote practice compliance planning

11. Disciplinary Action (consent decree) Practice Monitors Educational goals: Instruction for the deficient practitioner on proper practice procedures Provide the doctor with a personal mentor Monitor progression through periodic reports Focused corrective actions –Clinical recordkeeping assistance (monitors) –Practice compliance oversight (auditors)

12. Results: Complaint history 1990-2002

13. Complaint history for newly licensed doctors Year licensed # complaints issued through 2003 1995 21 1996 33 1997 (initial* program) 9 1998 3 (formal program started) 1999 0 2000 15 2001 4 2002 0

14. Results: # new doctors, time in practice 1995-1998 Doctors: 393 Months practice: 120 Complaints: 66 1999-2002 Doctors: 464 Months practice: 114 Anticipated complaints: 74

15. Results: Anticipated vs. Actual Complaints 1995-1998 Doctors: 393 Months practice: 120 Complaints: 66 1999-2002 Doctors: 464 Months practice: 114 Anticipated complaints: 74 Actual Complaints: 19

16. Results: New Licentiate Program

17. Since implementing our New Licentiate Program, there has been a 74.4% reduction in complaints lodged against our new doctors compared to the statistically expected norm!

18. Results: Compliance/ Recordkeeping Seminar Recognition of a recommended higher standard of recordkeeping (regulations address only those minimal standards) Exposure to compliance programs and practice compliance plans Awareness of proper coding issues Diminished recidivism rates among disciplined doctors (antidotal)

19. For additional information: MA Board of Registration. of Chiropractors 239 Causeway St. Boston, MA 0114 www.ma.state.us/reg/boards/ch (617) 727-3033, or 3093 Thank you