Check it out

Published: 2010-11-24 13:59:49
Author: Kathy Mills Chang | ChiroEco | November 2010

To “indoctrinate” means to instruct a person in a doctrine, principle, or ideology — usually with a specific point of view. Chiropractic professionals would certainly agree that indoctrinating a patient to chiropractic is an important step in the education process.

This is especially true for a patient who has never seen a chiropractor before. In your fast-paced practices, sometimes it’s easy to overlook the standard operating procedures necessary to properly indoctrinate the patient and sufficiently lay the groundwork for excellent recordkeeping.

If you’ve flown recently, you may have noticed the pilot walking around the aircraft before it’s pushed back from the gate, using a checklist to ensure everything is in order and ready for flight.

Even pilots with decades of experience routinely use checklists. Similarly, it’s important for you to have a checklist for those first few visits with a new patient to be sure nothing vital is missed.

During the first several visits, you want to indoctrinate the patient into care and lay the groundwork for documenting medical necessity and clinical appropriateness. If you begin each new patient encounter or episode of treatment with a checklist of the most critical items to cover, you’ll maintain a consistent standard of care.

Following all the key steps not only allows for ease in completing a sequence of events, but it also confirms that highly important compliance issues aren’t being missed. This allows every team member to contribute to those all-important introductory visits.

The new-patient checklist should contain the visit number and the action steps to be completed each visit. The list should be reviewed by all key team members on each of those initial visits.

If you use a chart-based system, the checklist should be inserted at the first visit and stay near the top of the file throughout the first several visits. This keeps it front and center and helps ensure nothing is missed.

After the checklist is completed, it should be reviewed by the doctor or office manager. The checklist can also be reviewed by the treatment team as part of a weekly meeting.

Examine the checklist(s) and assess whether or not each item was completed satisfactorily. Strive to correct any lapses you discover.

In time, desired patient outcomes will improve, patients will be better educated and indoctrinated, and all the necessary documentation will be in place. Routinely auditing and reviewing your patient charts and files is a necessary part of your compliance program, and so is the use and review of your checklists.

What to include

Here are some items to include on your patient-visit checklists:

Visit one. Documentation, compliance, and patient education should all be part of this list.

Patients who have never seen a chiropractor before may feel as if they have entered a foreign land. What you do on this visit may set the tone for the remaining visits the patient experiences in your office.

Educational items:

• Office tour: Give the patient a brief tour of the office to show them your treatment and rehabilitation areas. This helps set the patient at ease.

• Doctor’s CV:

Provide a copy of the doctor’s curriculum vitae or resume. It’s important for a patient to understand  his or her new doctor’s interests, education, and work history.

• Practice brochure: Hand patients information about chiropractic, the doctor and team, and office policies.

• Condition-related brochure: Send patients home with information about their condition to read before the next visit.

Compliance-related items:

• Copies of an identification card and insurance card: Verify the patient’s identity. Insurance fraud is something to guard against.

• Complete history: This is the beginning of excellent documentation and the establishment of medical necessity.

• Examination forms: Meticulous recording of findings sets the tone for proper diagnosis and linking to treatment. These three items must be in harmony to prove the necessity and clinical appropriateness of care.

• Outcome assessment tools: Identify the functional goals you want to achieve and assess the patient’s activities of daily living.

• Diagnosis form: Establish the diagnosis and the order in which you’re prioritizing conditions.

•Treatment plan: Fill out a plan of care that includes the goals and objective measures that round out and tie your plan together.

Visit two. Once your patient has returned for the second visit, a report is vital to answer such important questions as: What’s wrong? How long will it take to resolve? How much it will cost? Additionally, other documentation-related paperwork and activities are necessary.

Educational items:

• Report of findings: Everyone wants to know what has been found and what it means to them. Don’t skimp on educational materials to help the patient understand his or her condition. Whatever they take home, they will share.

• Brochures or information about treatment: If the patient begins care at this visit, he or she needs information about the adjustment, therapy, or other services you are providing.

• Patient financial paperwork: Explain your internal financial policy to the patient. Get an agreement in writing about what the financial picture will look like.

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