Telemedicine is an option for New York Chiropractors, your patients, and your practice

As we in New York begin to experience the exponential surge of COVID-19, members are questioning how they can care for their patients. Some offices remain open as part of essential services, while others have decided to close because of the risk factors. Geography and patient population seem to be the biggest determinants in this professional choice.

For those who are open, we applaud the efforts to follow best practices by limiting the patients being seen by prioritizing urgent and acute care, spacing out office visits to avoid gathering in the reception area, spacing reception furniture, and emphasizing sanitary methods. We know this has an impact on your practice and thank you for continuing to put patients and community first.

For those offices that cannot remain open or have patients that cannot attend face to face visits, you may want to consider caring for your patients via telemedicine. Whether a patient’s decision to avoid face to face visits is based on the patient’s personal risk factors or the risks to someone else in the family, it is understandable and unfortunate that their in-office care must be interrupted. While providing the exemplary hands-on care chiropractors are known for may not be possible, there may still be a roll for you in your patient’s treatment.

Telemedicine may be an option for your patients and your practice.

An executive order from the Governor’s office has expanded opportunities for telemedicine, "to permit other types of practitioners to deliver services within their scopes of practice.” It then defers to the individual state agencies for further guidance.

This is what led to chiropractors being able to perform telemedicine for New York’s injured workers. It also led to DFS adopting similar language allowing chiropractors to perform telemedicine for No Fault injuries.

The question has remained, what about those patients covered by major medical insurance or self-pay patients. Would they be eligible for telemedicine services if they can’t attend in-office visits?

The DOH, which would have influence over telemedicine services for major medical, self-pay, and Medicaid populations has adopted language to expand the provision of telemedicine services as well. In reviewing this information, we believe it can be interpreted to allow chiropractors to perform telehealth services during the COVID-19 crisis so long as the treatment provided is “within the provider’s scope of practice.”

To provide telemedicine within the chiropractic scope of practice, providers would need to provide service similar to what they would do in office but without the hands-on portion. Using verbal or video assessment, one would need to be able to assess and detect imbalance, asymmetry, or loss of ROM. The provider would then need to be able to guide the patient to correct these through self-care measures, options include but are not limited to: positional relief, ROM or joint mobilization exercise, stabilization exercises, end-range loading, neurogliding, yoga, breathing techniques, and movement pattern training. Chiropractors may wish to advise on ergonomics, stress management, exercise (type, intensity, and volume), hydration, and nutrition to enhance optimal wellness during this stressful and unprecedented time.

We have reached out to the State Board for Chiropractic and the State Education Department on this matter. As you can imagine, their backlog is significant, and we aren’t sure when we will get an official answer from them. Given the immediacy of this situation and the needs of our patients, the Governor’s Executive order and the actions of the Workers Compensation Board and Department of Financial Services, we believe that there is an appropriate and permitted use for telemedicine by Doctor of Chiropractic during the COVID-19 crisis.

In addition to reaching out to the State Board, the NYSCA Insurance Committee has been discussing the application and coverage of telemedicine services with a variety of carriers over the last 3-4 weeks. We have received information from many carriers, including Aetna, UnitedHealthcare, CDPHP, Medicare, and Emblem BCBS. As you might imagine, there are differences in guidelines and billing. We are assembling some detailed information and guidance to best assist you in caring for your patients.

To ensure you have the most appropriate, up to date information on the use of Telemedicine as it relates to doctors of chiropractic in New York, we have brought in Dr. Tim Bertelsman from ChiroUp. The rules and process are not complex. As such, a one-hour webinar will provide you with the knowledge from a known expert to get you started.

Click here to sign up for the telemedicine webinar through New York Chiropractic College.

Please note, as this presentation is rapidly selling out (only $15 for NYSCA members), we will be adding additional webinars as needed.

NYSCA members and NY chiropractors strive to provide exceptional patient-centered care. Telehealth represents one way that we could serve patients who are unable to attend face-to-face office visits during this crisis.

Be well, be safe, and help those that you can while minimizing risk.

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