Blog, Chirosecure Live Event June 10, 2023

Compliance Risks Associated with Nutrition and Wellness Programs

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Hi everyone. This is Michael Miscoee with Miscoe Health Law for this week’s edition of ChiroSecure’s Growth Without Risk Program. Today we’re gonna talk about some compliance risks that are associated with nutrition and wellness programs. Now in a straight chiropractic office, it’s not unusual for practices to offer nutrition supplements wellness programs and things of that nature.

However especially with when nutrition turns into pure weight loss or other holistic methods to control a patient’s blood sugar or things of that nature, you need to be cautious because I’ve seen a couple providers get themselves in a little bit of hot water. Because they forget what the scope of their license is.

So in most states, the scope of chiropractic license is focused on diseases, injuries that have to do with the articulations of the spine and or extremity joints. Now what that means is and if you read your scope very carefully in every state, it tends to focus on the subluxation, which is no big surprise in, in which case, when you’re into providing treatment to patients for a variety of conditions.

Let’s just start with weight loss. Okay? So we have obesity. Without doing an evaluation, identifying subluxation and associated musculoskeletal problems for which may be obesity is a comorbid factor. Then, and you go jump straight to obesity. You run into concerns about practicing outside your scope of practice because you’re not relating the condition that you’re treating to some condition in the spine.

And that is a mistake. Now, I’m not saying that you necessarily have to manipulate patients who are doing weight loss but in states where that restriction exists, you need to at least offer it. As an issue, and then identify that the nutrition, weight loss program, whatever it is To address a comorbid factor, which is chronically, causing back pain or whatever it is.

So there’s gotta be a hook there to bring your diet, exercise programs into compliance with your scope of practice and also be cautious about your marketing back pain due to, so when you market. Straight up weight loss. Then again you’re getting into medical nutritional scope of practice.

And I’m not saying it’s completely outside your scope of practice in most states, but you need to watch that very carefully cuz I have seen licensure board issues come down and Address that issue. And usually it’s by a complaint by a competitor or a competitive discipline where you’re treading on their turf.

So don’t leave yourself open in that respect. The other thing about when we talk about wellness practices, and I’ve seen practices get involved in nutritional programs, not designed for weight loss, but they’re more focused on people with diabetes or other diseases. And these programs are designed.

To help them become, let’s say, medication independent. And you need to especially be cautious here because now you’re treading in medical turf and again, there’s a general scope of practice issue. How do you relate that to a condition? In the spine or related to a subluxation number one. But number two, when you are doing a weight loss program and getting in the business of advising people about their A1C or their diabetes, those conditions are definitely outside the scope of chiropractic practice in most states.

There are some states where it arguably might be, and you also need to be very careful. To coordinate any diet, nutrition, exercise program with the patient’s medical provider and let the medical provider make the decisions about what they’re gonna do with their medication. Those are decisions that, that you’re often not licensed to make.

And that is probably the quickest way not to get a complaint from your board, but to get a complaint from the medical board. And that’s a little bit more difficult to address because obviously the medical board. Has no tie to you. So clipping you with practicing medicine without a license is Not a big stretch for them, especially if they think you’ve crossed the line.

A number of things that you also need to consider with these types of programs, not just the wellness programs, but the diet programs and things of that nature but especially the wellness programs is patient testimonials. Had a practice that was involved in this and they had patient testimonials like, I did this program and I got off my insulin meds, or I did this program and I got off this med hypertension or statins for high cholesterol and things of that nature.

And that may be true. Okay. And especially if it’s true where the plan was coordinated with the patient’s medical doctor and the medical doctor took ’em off. When the patient is making it sound like that was your call and your plan and all of that. And you’re using that testimonial to induce others to select you as a provider.

There’s a question of whether the ad advertisement using the page’s testimonial is misleading, so you need to be very careful there. And I have seen testimonials get folks in trouble. And the same is true like for the multidisciplinary practices doing air quote regenerative medicine which is a term you can’t use anymore.

In fact, I had a client use the word regenerative therapy in a marketing piece, and they got a letter from the fda. I had to clean up all of their social media sites, their website, and all of that other stuff to get rid of that language. But nonetheless, that aside, Using patient testimonials to get your message out is the same thing as you saying the word.

So if you can’t say it for reasons that it might be misleading or construed to be misleading then you need to be you need to eliminate the testimonials. Patient testimonial, trying to get the patient to say the right thing. I did this program and my doctor agreed, to reduce my medication.

And I think, this was very helpful to me that, that might do it, but it, they make me nervous because the idea of licensure restrictions relative to Misleading, a potential patient are very ambiguous, and it’s whatever the board says it is. The cost of those cases and defenses is rather significant.

And you need to find a better way to market, market the program for general wellness. Things of that nature. But again, be cautious and mindful of your scope of practice and make sure that your marketing, ties in, ties that in as a comorbid condition to, musculoskeletal symptoms so that you can justify why you’re doing what you’re doing.

As I mentioned, the licensure liability is probably the biggest risk with these types of programs, but don’t also forget consumer protection liability. In most states there are consumer protection laws that protect patients from air quote, predatory anybodys. So whether it’s banks, lenders, tax professionals doctors and so forth.

Your state attorney general’s office has a computer consumer protection division. Somebody makes a complaint, the air starts an investigation. Who knows where that goes? I’m thinking about it strictly from the expense perspective. Sometimes those investigations be looped into your license licensure board because usually the investigatory arm of most licensure boards comes to the state ags office.

So again, just be cautious in your marketing. As a general role, in my experience, I’ve been doing this 25, 30 years. Any marketing that is super effective is usually problematic, and I know that’s terrible, but I remember the days when, the yellow page was all you could do. There are many ways to market.

Again, if you keep your marketing focused on conditions especially conditions and comorbid factors that relate to the spine and are well within your scope of practice, I think you mitigate your risk rather substantially. Other things you can do, avoid testimonials or if you get testimonials, show them only one-on-one to a patient.

Don’t put ’em. On your website or things of that nature and then make sure that you tell the patient what they can say and what they can’t say. If in fact everything that a patient says has to be a number one, true B verifiable, and C Avoid having them make wild claims or claims that suggest that you’re practicing outside your scope of practice.

With those tips in mind, I think these programs can be very effective. They can be profitable. Most all of ’em are cash. A big believer in the cash model. Cash meaning non-covered services, no insurance billing whatsoever. And in which case Those are where the profit centers are these days.

Watch your Ps and Qs. Make sure you go back. It’s maybe been a few years since you took your state licensure boards. Go back and read your regs relative to scope of practice. What you’re looking for is the definition of chiropractic. , you’ll find a statutory definition. Usually there will also be a regulatory definition.

Look at the things that the practice of chiropractic involves, and then also look at the things that they don’t like it. When you do that or That they’ll sanction you for if you do them. Look at those very carefully. Keep those in mind in your marketing and I think you’ll be fine.

So that’s all we have time for today. I hope that was informative and helpful, and we’ll see you next time.