Thursday, March 3, 2011

Informed Consent for Treatment Form

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Content to be included:
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Simplest as two separate documents:
  • Consent to be examined...
  1. in the new patient document.
  2. Only one sentence, above the patient signature.
  • Informed consent to treatment plan...
  1. Plan made by doctor.
  2. Pricing and payment plan made by registrar.
  3. Consent with payment made by patient.
~~~~~~~~~~~~~In your new patient forms~~~~~~~~~~~~~~~~~~

INFORMED CONSENT FOR EXAMINATION
I request and allow the doctor and the staff here to examine me. I understand there is mild risk of increased pain or soreness during my examination.

Signed ~ Pati Ent
Date~ March 2, 2011


~~~~~~~~~~~~~~~~~~~~on your letterhead~~~~~~~~~~~~~~~~~~~~~~~~`

YOUR PERSONALIZED PLAN

Goal for Treatment: ~alleviate backache after a fall Feb 22~
Problem: (Diagnosis): ~back ache from fall~
Expectation (Prognosis): ~good for full recovery in six weeks~

Recommended Treatment Schedule: ~2x weekly for 6 weeks, then re-evaluate~

Chiropractic Care: ~three spinal regions & leg~
Therapy Modalities: ~ yes, each visit after chiropractic~

risks: soreness, fractures, disc injuries, strokes, dislocation and sprains
alternatives: physical therapy only, medication, acupuncture, waiting.

Other notes: ~osteoporosis increases risk of fracture~




INFORMED CONSENT FOR TREATMENT
I understand the risks names above. I request and allow the doctor and the staff here to examine and treat me as described above.

Signed ~ Pati Ent
Date~ March 2, 2011

---------------------------
-
~~~~~~~~~~~~~~~~~~


Cautions on this form:
You need to add something to this if the patient asks specific questions, or has increased risk, say for osteoporosis or prior spinal surgery. Leave margin space for this.




All the best to you and yours.
Gary Shannon

Tuesday, March 1, 2011

Informed Consent

This post sponsored by
Hands-On Chiropractic and Massage
13033 SE Rusk Rd,
Milwaukie OR 97222
503-656-8098 www.weadjustlives.com


Gary Shannon here.

Yes, the Chiropractor has to do this. In writing. Every patient.

Doctors are reluctant to give an adequate "PARQ" (Procedure, Alternatives, Risks and Questions) before treating or examining the patient, even though there are few risks. For the patient it's often just another bit of paper to sign.

Since 1991, Oregon Board of Chiropractic Examiners Administrative Rule 811-035-0005 (2) says the patient has a right to information:
(2) The patient has the right to informed consent regarding examination, therapy and treatment procedures, risks and alternatives, and answers to questions with respect to the examination, therapy and treatment procedures, in terms that they can be reasonably expected to understand.
(a) Chiropractic physicians shall inform the patient of the diagnosis, plan of management, and prognosis in order to obtain a fully informed consent of the patient during the early course of treatment.
(b) In order to obtain the informed consent of a patient, the chiropractic physician shall explain the following:
(A) In general terms, the examination procedure or treatment to be undertaken;
(B) That there may be alternative examination procedures or methods of treatment, if any; and
(C) That there are risks, if any, to the examination procedure or treatment

In addition, your malpractice insurance carriers like doctors to use PARQ in writing and signed by the patient. Litigation attorneys who sue doctors hate them: if the suer signed off that the doctor TOLD them that there is a RISK of the problem they are having after care, and they AGREED to care anyway, they have no malpractice case. Without a PARQ in the file, it's only doctor's memory against patient memory.


ONE INFORMED CONSENT SOLUTION

Avoid all this by creating a template form to include with new patient and new exam papers. The OBCE gives an example of informed consent to new licensees as follows:

~~~~~~~~on your letterhead~~~~~~~~~~~

I hereby request and consent to the performance of chiropractic adjustments and other chiropractic procedures, including various modes of physical therapy, on me (or on the patient named below, for whom I am legally responsible) by the above named doctor of chiropractic.

Though chiropractic treatments are usually beneficial and rarely cause any problem, I understand that, like many other forms of health care, there are some risks. These can include, but are not limited to fractures, disc injuries, strokes, dislocation and sprains.

Alternatives to chiropractic treatment for common musculoskeletal conditions may include physical therapy, medications such as muscle relaxers and anti-inflammatory drugs and acupuncture.

I have has the opportunity to discuss with the doctor the purpose and benefits of the recommended chiropractic care, and alternatives to chiropractic treatment have been reviewed.

I further understand that health care providers cannot guarantee the results of treatment. I acknowledge that no guarantee of the outcome of chiropractic care I have requested has been made. I have had ample opportunity to ask questions, and my questions have been answered to my satisfaction.

Patient's name (printed)_______________________ Date____________________
Signature of patient ______________________________________________

or
Signature of parent/legal guardian _______________________________________
(if patient is a minor)

~~~~~~~~~~~~~~~~~~


Cautions on this form:
You need to add something to this if the patient asks specific questions, or has increased risk, say for osteoporosis or prior spinal surgery. Leave space for this.

If you know of additional risks, such as muscle soreness or dizziness, add them to the list above. There is a gray legal area here: Have all the risks above been verified by Chiropractic clinical trials? Is it acceptable to only list scientifically verified risks? What if the doctor disagrees with the validity of the trial? If the doctor personally and professionally recognizes an unverified risk, should he list it? Must he? These unanswered questions underline the difference between ethics and law. The simplest answer: list everything possible, and explain your opinions about them when asked.

Will patients ask questions because of this form? Usually.
Will patients skip care because of this form? Rarely.

As a patient and administrator, I prefer shorter forms that provide more information. I will provide one in a later post.

All the best to you and yours.
Gary Shannon

This post sponsored by
Hands-On Chiropractic and Massage
13033 SE Rusk Rd,
Milwaukie OR 97222
503-656-8098 www.weadjustlives.com

Saturday, January 29, 2011

Reduced Procedure ... Reduced Fees

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Content to be included:

-------------------------------------
The Double Fee Schedule

Cash Discounts... How to do them how to bill them


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CPT Modifier -52 means Reduced Services. NOT reduced price


If you deliver a significantly reduced procedure, you MUST bill it with -52.
If you deliver a complete and full procedure as described in CPT, you MUST NOT use -52

It is the doctor's duty (not an insurance company's) to formulate a balanced fee schedule, If it's ethically appropriate to reduce fees for reduced procedures, you certainly may do so.

There is confusion that some think -52 means "reduced fee" instead of "reduced service" and use it when applying a payment discount for full services, which is completely incorrect. It's not that you can't reduce fee when using -52 ... you certainly can... it's that you don't use -52 when simply reducing fees.


There is, to complicate matters, a warning in CCI edits about fewer than 7 minutes of time code service being unbillable. It might be combined into other services, but that is more complex... thus this article in the works.