Managing clinical risks has always been a hot topic in traditional medicine. There is nothing that scares a physician or hospital like the smell of a malpractice action, and over the years the legal profession has fine-tuned the art of keeping providers out of the courtroom. A good healthcare lawyer can often be invaluable in monitoring the legal landscape to make sure that a practice is up to date in conforming with recent court rulings that might apply directly to the way providers interface with patients, hospitals and even their peers.
This form of risk management is highly sophisticated in traditional medicine. But that’s not the case in functional medicine. Most healthcare lawyers are unfamiliar with it. It seems every state has a different set of rules governing acupuncturists, chiropractors, nutritionists, nurse practitioners and many of the clinicians engaging in functional medicine. When it comes to NDs and MDs working in the field there is little legal case law that address their role and even less oversight from the states addressing them as functional medicine providers.
This kind of risk management is critical to your practice and its future. But with no guidelines, what can you do? Here’s a quick overview of some of the basics.
Research the state laws that apply directly to your specialty. Most chiropractors are already regulated, for example. Acupuncturists, too. But laws vary from state to state. Make sure you are in total compliance. Look to national organizations for advice and direction in this area. And if you are working with insurance companies and making claims for payment for your services, make sure that you are in compliance with everything they require so there will be no denials; make sure you see if the insurance companies require any particular limits of malpractice coverage, too.
Luckily there seem to be ample sources of professional liability insurance for chiropractors, acupuncturists and nutritionists. Even nurse practitioners and nurses.
If you are an ND, contact a malpractice company and see how and if you can secure coverage; there are more and more showing up. However, be sure to see what your state law requires, if any, and what the requirements are for insurance companies (if you are going to file claims). Did you graduate from a licensed school? That may have an impact on things. Check with the IFM. I would strongly recommend you insure yourself in a way that an MD would, with a policy with a “per claim” amount, a “total claims” amount, and secure one that has tail coverage. Monitoring the type of traditional coverage an MD has is a smart move.
If you are working with an MD, look at the coverage they have. In terms of the coverage, match it, so there’s consistency among the doctors in the practice.
If you’re an MD, you’ve already dealt with malpractice and probably know all you need to about coverage requirements. Regardless, talk with your professional liability insurer and make sure they understand the scope of your practice and that you aren’t paying for coverage you no longer need.
There are some more pieces of the professional liability situation that you need to make sure you address, too. Functional Medicine is built around collaboration between various providers and physicians. Make sure that everyone you refer to has professional liability insurance (have them send you the “face sheet” from their policy), and make sure it’s current and active. At least annually contact your governing body (IFM, American Association of Nurse Practitioners, American Chiropractic Association, etc.) and see if there have been any court cases that might want you to change reconsider the limits of your coverage; your liability carrier should have this kind of information, too.
Finally, document, document, document. Make sure your patient records are thorough and current. If you refer to other doctors or providers, make sure it’s part of the patient record, and for what reason. Make sure the patient clearly understands why you are making the referral, and if your role with them will change. Talk directly to the physician you have recommended about the patient and document the conversation. Then send a referring letter to the physician you’ve suggested and make sure to request an update on the patient after their visit. Follow up and document if the patient did or did not follow your recommendation.
This can be a bit of work. Risk management is a big subject, but extremely important to your future. Remember that although functional medicine is still working through many of these issues, if you follow the safeguards traditional medicine has developed you’re on the right path to protection.--TOM ELLIS
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