Articles August 1, 2014

Common Sense is Your Best Defense

By Stuart E. Hoffman, DC, FICA , President, ChiroSecure

At least once a year, if not every few months, it is a smart idea for the practitioner to stop and take a practical look at all aspects of clinic operations, looking for issues and procedures where changes are indicated just on the basis of common sense. From a professional liability perspective, this is not only sound advice, but a must if you want to minimize your liability exposure especially from those unusual, but alarmingly frequent unexpected quarters.

As the year starts to wind down, now is a great time to do a review of your clinic procedures, physical plant and other practical aspects of your practice location.

Starting with physical layout and patient safety issues, you will want to carefully survey every square foot of your clinic. You will want to look for loose tiles or carpet, cords and wires that might have found their way into walkways, sharp corners on tables, desks, filing cabinets and any other physical items into which patients might easily bump, trip over or fall on. Also, don’t forget to look at anything with which your patients come into contact, including the coffee machine if you have one, making certain that it is up far enough so that it is out of reach of children, and likewise any water cooler, making sure that it is stable and not easily tipped over. Please don’t forget to look at the outside of your clinic, including parking facilities, and your doors and sidewalk.

The next category of items and issues you should review relates directly to your professional activities, and starting with the adjusting tables, make sure that all are stable, in good repair and functioning as they were intended to function. Don’t minimize the importance of keeping your tables in tip-top shape. Injuries to patients because of faulty equipment are 100 percent preventable, and especially when heavy, power-driven lift tables are in use, represent an important risk management area.

The physical plant is the easiest part of your practice to review from a safety point of view, but the clinical operations are by far the most important dimension of any periodic risk management review. It makes sense to look at the various aspects of any busy clinic from the point of view of the greatest likelihood of problems developing, and prioritize your efforts on that basis. Here are some thoughts you might want to consider:

RECORD KEEPING: Are your clinic files up-to-date, in complete and defensible shape, and secured in a HIPAA compliant format? It is frequently said that record keeping is the chiropractor’s Achilles Heal, and that could very well be true. A sound clinical record system, maintained on a timely basis is vital to minimizing your malpractice risks, as well as the best guarantee that third-party payment agencies will honor your claims. This could very well be the area on which you might look to do a major overhaul of your procedures.

PROBLEM PATIENTS: Do you know who your problem patients are and do you have a sound strategy for addressing their concerns and keeping your practice out of the line of spin-off complaints? This is where you need to make sure that your staff is sharing everything that might be problematic in any way with any patient. Don’t hesitate to seek the help of professional colleagues whose judgment and experience you trust, seek advice from your malpractice carrier and you professional organizations. This is another ChiroSecure benefit in having a fellow chiropractor to speak directly to. You do not and perhaps even should not go it alone in such cases. But, you shouldn’t let things go unaddressed either.

COMPLIANCE: Have you reviewed your state, province or national rules and regulations lately? Understanding the current state of the law is a key element in keeping your practice in compliance at all times and out of harms way. Again, this is an area in which you have the ability to prevent issues and incidents by being fully up to date on what the official rules are. Also look at your HIPAA status. This is an easy one to overlook since after the first rush of attention and concern a couple of years ago, this federal privacy program has receded into the background. It is, however, still the law. Visit the official US Department of Health and Human Services, Office of Civil Rights, HIPAA website at for free, accurate and up-to-date information.

COLLECTIONS: Do you know the status of your collections, and do you have a sound plan to address outstanding balances, and avoid problems with otherwise satisfied patients? This issue is key in malpractice prevention since a good percentage of professional liability claims truly stem from the collections process. Once again, this is an area where you might find great benefit in the experience of your professional colleagues. Look for good advice and take it. Above all, act to swiftly resolve any outstanding issues with patients regarding collections before they get blown out of proportion and take on other, unexpected and even more difficult dimensions.

DILIGENCE AT ALL TIMES: A successful, responsible practitioner keeps their eyes and easy open and pays close attention to all phases of their clinic operations at all times. They carefully oversee all aspects of the clinic, including the performance and behavior of staff and associates, and is always looking for, and ready to address small problems before they become big ones. Like in everything else in life, common sense should be your guide. Common sense is the stuff of liability prevention and as an insurer, as well as a longtime practitioner, I know that we both want a trouble-free, and well-directed practice.