May 2007

Colorado DCs question need for 'burdensome' documentation rules

Doctors in Colorado have long applauded their state's Licensing Board for setting and maintaining what they say are among the highest standards for documentation in the country. That's why many are arguing against the need to impose even more stringent regulations, which they claim would create administrative and financial hardships on most chiropractic practitioners.

At its March 2007 meeting, the Colorado Board of Chiropractic Examiners voted 3‑2 to move forward on new documentation requirements. The four chiropractors on the Board were split on the issue, with Reiner Kremer, DC and James Thatcher, DC, voting in favor. The deciding vote was cast by the Board's lay member. A public hearing and final vote are scheduled for May 10.

Nationally, problems with documentation ranks as one of the most common causes for lawsuits and board complaints. Yet, in Colorado, as Ken Spresser, DC, a leader of the contingent opposing the new rules points out, documentation is often a secondary problem.

"When the Board of Examiners in Colorado requests notes on a particular patient they secondarily find a documentation issue. Many licensees suffer more penalties from the documentation issue instead of the original complaint," says Dr. Spresser, who has served as a delegate to the American Chiropractic Association, trustee for the Foundation of Chiropractic Education and Research, and Board member on the United States Bone and Joint Decade.

A survey of 44 state boards, conducted by Spresser and his colleagues, found that Colorado's record keeping rules are already more stringent than 86% of other states.

"There are about a half dozen states that have more burdensome regulations regarding documentation; 55% of the states have no documentation requirements," Spresser explained in a letter to Colorado doctors. "In the quest for information, one state responded, 'We really try not to regulate ourselves out of business up here.' The same cannot be said for Colorado; two years ago over 500 chiropractors did not renew their licenses."

Critics of the proposed regulations also looked at similar rules governing other Colorado licensed health care providers and found that no documentation requirements were imposed on medical doctors or physical therapists. Only dentists had documentation requirements, and those were "less arduous than the current chiropractic documentation rule," Spresser notes.

The Colorado Chiropractic Board used the American Medical Association's "Documentation Guidelines for Evaluation and Management of Services" as a model for creating the new documentation rules, even though those guidelines were meant as non‑mandatory suggestions rather than legally imposed regulations.

The Council on Chiropractic Practice guidelines note that "since record‑keeping practices may be technique/method specific and may depend on the practice objective of the practitioner, chiropractors should develop a method of reporting the care they provide to their patients that is consistent with their practice objectives."

The nearly three pages of new regulations were proposed, Spresser stated, in response to Federal government criticism of chiropractic documentation, mainly relating to Medicare claims.

"The real reason medical doctors and chiropractors want to avoid Medicare is because of the troublesome documentation requirements," Spresser commented in his letter. "In the end would you want to be accused by Medicare of health care fraud and mail fraud because your documentation/record keeping wasn't up to their chosen standard? If that occurred, you would be blacklisted everywhere. The toilsome documentation/record keeping requirements should be for those who CHOOSE to participate in managed care programs and Medicare where it is know that additional documentation is necessary on every patient."

He also warned that the new rules "will be a fiscal burden for the regulatory boards and will cost several chiropractors their licenses."

Terry A. Rondberg, DC, president of the World Chiropractic Alliance agreed that the current regulations are not only adequate but exemplary. "Quality recordkeeping is an essential part of patient safety and quality of care, as well as a key to risk management," he stated. "The Colorado Board of Examiners is to be commended for already having regulations that require above average standards for documentation."