Patient dissatisfaction is more than a customer service issue – it can escalate into complaints, regulatory scrutiny, and even malpractice claims. For podiatric medical physicians and surgeons, addressing concerns promptly and professionally is essential to protect both patient relationships and legal risk.

As we start the new year, it is a great time to review regulatory updates and implement necessary changes to reduce your risk. This article summarizes billing and coding changes as well as HIPAA updates.

In a busy medical practice, daily demands often take precedence over administrative tasks like performance evaluations. However, conducting annual office staff reviews is one of the most valuable investments a practice can make. Regular, structured evaluations strengthen team performance, support staff development, and ultimately enhance the quality of patient care.

Scope-of-practice violations are among the most common – and costly – regulatory risks for doctors and medical practices. These occur when:

• A provider performs tasks they are not legally permitted or trained to do.
• Tasks are delegated to staff whose licensure does not authorize those activities.

It is not uncommon for patients to seek chiropractic care as a non-pharmacologic option to manage chronic pain. However, these patients can present unique challenges. Chronic pain often involves multiple mechanisms such as neuropathic, inflammatory, musculoskeletal, or central sensitization. Imaging and lab tests do not always correlate with reported pain levels. Chronic pain patients may be frustrated, depressed, anxious, and/or catastrophizing. They may have unrealistic expectations that their pain can be eliminated, when a more reasonable expectation may be to improve function, coping, and quality of life.

In today’s rapidly evolving healthcare landscape, many physicians are seeking ways to grow their practices without compromising the quality of care. Scaling a medical practice involves more than simply seeing more patients - it requires strategic expansion of operations, staffing, technology, and patient engagement systems. When done correctly, it can increase profitability, improve efficiency, and enhance patient satisfaction. Below are steps you can take to scale your practice.

When it comes to today's healthcare environment, cyber security breaches are an ongoing concern for providers and their practices. From phishing emails to ransomware attacks, healthcare organizations are frequent targets due to the high value of patient data and the complexity of medical systems.

Nearly everyone texts to communicate. It’s quick, easy, and convenient. However, texting with patients carries professional, legal, and ethical risks, including:

1. Privacy and HIPAA compliance. Standard texting is not secure. Messages can be intercepted, viewed on shared devices, or accidentally sent to the wrong number. Therefore, any patient’s personal health information sent via text risks a HIPAA violation and possible fines.

Professional boundaries are the ethical, legal, and relational limits that define the interactions between healthcare professionals and their patients. They protect the therapeutic relationship by ensuring that it remains focused on the patient’s health, safety, and well-being. Maintaining these boundaries is crucial for fostering trust, preserving professional integrity, and avoiding conflicts of interest.

Patients recording, either audio or video, their encounters with healthcare providers has become increasingly common. While healthcare providers may be alarmed when a patient asks to record their visit, it is not necessarily a bad thing. Recording patient encounters has both risks and benefits.

Staff turnover places a significant strain on an office's finances and resources. It increases expenses related to recruiting, hiring, and training new employees, along with the cost of covering temporary staffing needs. Productivity often declines as attention is diverted to focus on the hiring and onboarding process. Additionally, turnover can negatively impact staff morale, especially when the remaining employees must take on extra responsibilities to compensate for vacant roles.

Managing office staffing and handling time-off requests effectively is key to maintaining smooth operations, avoiding staff burnout, and ensuring good patient care. 

Having difficult conversations with patients and their family is one of the most challenging yet important responsibilities in healthcare. These conversations can involve topics like delivering bad news, discussing prognosis, setting boundaries, addressing non-compliance, or managing unrealistic expectations.

Here are some steps you can implement to optimize difficult conversations you need to have with your patient.

While most healthcare providers are compassionate and want to provide optimal care to their patients, implicit biases exist. Healthcare providers may not be aware of implicit biases, which may be subtle and unintentional, that can influence clinical interactions, lead to a lack of trust between the patient and the healthcare provider, and result in healthcare disparities.

You strive to provide quality care and good customer service to your patients. But inevitably, you will have a patient or patient’s family member that is not satisfied with the care you (or your staff) provided.

Physician burnout is a long-term stress reaction characterized by emotional exhaustion, depersonalization (indifference toward or detachment from work), and a decreased sense of personal achievement. Physicians are especially prone to burnout with almost half of physicians reporting at least one symptom of burnout.

Causes and Effects of Burnout
Physician burnout not only negatively affects physicians and their families, but it also puts patients at risk. Evidence suggests that physician burnout worsens the quality of patient care, increases the risk of medical errors, and decreases patient satisfaction.

Workplace violence in healthcare settings is on the rise, putting providers at risk physically, emotionally, and legally. According to the Occupational Safety and Health Administration (OSHA), healthcare workers are five times more likely to experience workplace violence than workers in other industries. For chiropractors, this presents not only a safety concern, but a risk management priority. Implementing strong de-escalation techniques can protect staff, improve patient care, and reduce liability.

The Growing Threat of Workplace Violence in Healthcare
Healthcare environments are particularly vulnerable to aggression and violence. Contributing factors may include:

To have a thriving practice, you must have patients. While it is great to get new patients, it is important to focus on retaining established patients, too. If you create loyal patients, they not only return to your office for appointments, but they promote your practice to their friends and family which is great for business.

All healthcare professionals like to receive positive online reviews. It’s a great way to let people know about you and the exceptional care you provide. Which, in turn, can help send new patients your way. 

In the United States alone, approximately 8.6 million sports-related injuries are reported each year. All types of sports have a potential for injury, whether from the trauma of contact with other players or from overuse or misuse of a body part. By far, the most common injuries are sprains and strains.

As a doctor, you use your knowledge, experience, and medical judgment to determine the best course of treatment for your patient. However, adult patients with decision-making capacity have the right to choose or refuse to follow your treatment plan.

Patients are important for chiropractors. They allow the chiropractor to keep a steady stream of new patients and inject meaning into their practice as they help relieve symptoms for individuals in their community. Of course, patients also keep the clinic running profitably and allow the clinic to expand patient services. Retaining patients is important, too, for gauging success metrics like patient satisfaction and referral sources.

The Need for Fairness in Healthcare
In a perfect world, healthcare access and provision would be fair for all people, regardless of ethnicity, race, religion, gender, socioeconomic status, geographic location, language, age, disability, and other variables. Unfortunately, this is not always the case. To help address disparities in healthcare and improve patient outcomes, here is some guidance for practicing patient-centered and culturally competent healthcare. 

According to the U.S. Centers for Disease Control and Prevention (CDC), cardiovascular disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. Traditional treatment for cardiovascular disease often involves dietary and lifestyle changes, medication, or invasive procedures.

Measures to Strengthen Cybersecurity in Healthcare under HIPAA

You might be wondering what a dental practice has to do with chiropractic medicine. Well, unfortunately, your chiropractic practice could be just as vulnerable to a HIPAA violation as any other healthcare practice. This recent case illustrates the devastating repercussions of failing to comply with the HIPAA Right of Access Rules. Read below to find out how this happened.

Artificial intelligence (AI) is generally defined as computer systems that can perform complex tasks that previously only a human could do, such as reasoning, decision-making, or problem-solving. AI is rapidly being integrated into our world, including healthcare. Proponents of the use of AI in healthcare believe it has the potential to make healthcare more efficient, less expensive, more accessible, and safer for patients. 

AI Software for Medical Documentation
One of the more common uses of AI in physician offices is software for medical record documentation. This AI software is being marketed as a tool to make documentation more accurate and less burdensome. AI medical documentation tools work by using advanced algorithms and machine learning techniques to analyze and interpret large amounts of data related to healthcare, including patient records, lab results, and clinical notes. A key component of these tools is natural language processing (NLP), which allows the AI to understand and generate human-like language.

You may have staffed your practice with well-qualified people, but now they need proper training to understand your practice and its culture, their role within your practice, your policies and procedures, patient population, state and federal requirements such as HIPAA and OSHA, and other office practices. (If you need help with hiring, read our blog article, “Hiring the Best Staff for Your Practice”!)

Most practitioners are highly aware of the importance of maintaining medical malpractice insurance coverage to protect themselves financially in the event of a malpractice claim. However, practitioners are less aware of the administrative claims they could face.

To provide the best care for your patients and run an office practice, you need help. You need a staff that reflects your values, fits in with your office culture, increases the efficiency of your practice, and helps maintain a positive working environment.

Therefore, it is crucial to hire staff that are well qualified for their respective positions, can work effectively as part of a team, and adapt to the dynamic nature of a chiropractic medical office. They must be able to effectively communicate with patients, families, other members of your healthcare team, other healthcare professionals, and foster relationships with all these various parties. Staff members should be customer service-oriented, dependable, friendly, compassionate, flexible, able to manage conflicts, willing to learn, and deeply committed to patient privacy.

A patient suffers cardiac arrest while waiting in the exam room. An elderly visitor falls in the waiting room, is complaining of leg pain and is unable to get up. A diabetic staff member passes out from hypoglycemia. These are just a few examples of unexpected medical emergencies that could happen in a medical office.

Deciding to go from a private practice to a group practice is a significant step in a chiropractor’s career. It's a decision laden with considerations, from professional growth opportunities to financial implications, and of course, your malpractice coverage. Here are some key points to consider from a professional liability insurance standpoint if you are planning to join a group practice.

When a doctor does not refer a patient to a specialist for additional care, further diagnostics, or for treatment that only another physician can provide, they may be considered liable for negative consequences if the patient suffers as a result.

When a doctor does not provide a referral in time or at all, the patient may suffer serious complications, including:

A new patient comes to you for an initial visit. You perform a chiropractic adjustment based upon the patient’s complaints and much to your surprise, the patient develops increased pain or has an adverse reaction to treatment and must be referred to another provider for further workup and treatment. While this scenario doesn’t happen often, it can and does happen. And when it does, it can lead to a lawsuit against the chiropractor.

As a practitioner, you have most likely experienced an unexpected outcome in your care and treatment of a patient. It does not mean you are a bad doctor. It happens even with the most experienced doctor, but it can be very distressing for you and your patient. How can you protect yourself from risk and maintain a healthy doctor-patient relationship in the event of an unexpected outcome?

Start at the Beginning
First, prepare your patients for the possibility of an unexpected outcome. At the beginning when you’re developing a treatment plan with your patient, discuss the risks and benefits of your plan, including the most likely complications or side effects. Include a discussion of any risk factors that the patient may have that might affect the success of your plan. With medically complex patients, discuss the treatment challenges and the fact that they may require treatment from a team of specialists/healthcare professionals.

Chiropractic is a very “hands on” profession. As such, chiropractors are at higher risk for allegations of sexual misconduct by their patients. Therefore, it is of utmost importance that chiropractors appropriately educate their patients regarding chiropractic treatment and maintain healthy boundaries with their patients. 

The use of marijuana (cannabis) for medical purposes has been steadily increasing over the past few years and is becoming more widely accepted in the medical community. Polls show the public is largely accepting of marijuana use and research studies indicate that it has potential medical benefit.

Start with Informed Consent
As a practitioner, you use your knowledge, experience, and medical judgment to determine the best course of treatment for your patient. However, adult patients (and those having decision-making authority for others) have the right to choose to follow or refuse to follow your treatment plan. When a patient refuses a necessary treatment, what can practitioners do to protect themselves and their patients?

If you’re thinking about retirement, it’s prudent to start planning well in advance. If you are a solo practitioner, will you sell or wind down your practice? If you are in a group practice or employed, what are your obligations regarding providing notice of retirement? What are your state licensing board’s requirements regarding retirement? How will you retain your medical and business records? How will you notify your staff and patients of your plan to retire? What do your contracts with health insurers require when you retire from practice? Do you need to purchase professional liability insurance “tail coverage”? 

Review all contracts pertaining to your practice and consider seeking the advice of an attorney who specializes in business and/or healthcare law, your professional liability insurance carrier, your state board, and your state association for advice regarding these questions and the many other issues that arise in the retirement process. 

Here, we will discuss a few issues related to retirement from a risk management perspective.

All physicians know a medical record must be maintained on each patient. Why? Medical record documentation is required by state and federal laws. Proper documentation is important for continuity of patient care and necessary to receive reimbursement for services rendered. The patient’s medical record is a legal record of the care you provide to the patient and is a valuable tool in your defense should a medical malpractice lawsuit be brought against you.

Introduction to Integrative Medicine
Integrative medicine is an approach to wellness that is growing in popularity in the United States. It is patient-centered and combines conventional medicine and complementary medicine to treat the person as a whole. It addresses many factors, including the physical, emotional, social, spiritual, and environmental influences on a person’s health status. Integrative medicine focuses on the broader concepts of health that promote a person’s overall health and future well-being. Reviews and clinical studies have shown positive outcomes for patients and providers who participate in integrative medicine programs. 

Benefits of Integrative Medicine
Complementary therapies are not used to replace conventional treatments. They are used in conjunction with conventional medicine to enhance and complement treatment. Complementary therapies include diet therapy, herbal supplements, probiotics and vitamins, biofeedback, hypnotherapy, meditation, yoga, acupuncture, chiropractic, reflexology, and therapeutic massage. Integrative medicine practitioners include professionals of many disciplines, including medical doctors, nurse practitioners, doctors of osteopathic medicine, naturopaths, chiropractors, mental health professionals, mind-body specialists, massage therapists, and acupuncturists.
Many patients can benefit from integrative medicine, especially patients with chronic or complex medical conditions such as cancer, chronic pain, depression, diabetes, hypertension, fibromyalgia, and many other conditions. Complementary therapies may help people living with such conditions to achieve better appetite, improved cognitive functioning, pain relief, reduced anxiety, and improved sleep.

Risks and Challenges Related to Integrative Medicine
While there are many benefits to integrative medicine, there are some risks to be aware of. Integrative medicine often involves care from multiple practitioners. This may involve multiple appointments for the patient to keep. Providers may disagree on the plan of care since complementary therapies and traditional Western medicine have different philosophies. Some complementary therapies have side effects or interact negatively with conventional treatments.
As a medical provider, it’s important for you to be aware of the benefits and risks of any complementary or conventional therapies a patient is receiving. Complementary therapies should only be used if proven to be effective, safe, and appropriate for a person’s individual health status. Open communication with your patients and their providers is crucial to optimize patient outcomes and maintain a good physician-patient relationship. 

Get More Resources and Information to Stay Educated
It is critical to educate yourself on the various integrative medicine options. The National Center for Complementary and Integrative Health website has resources for healthcare providers that includes an A-Z listing of various health products and practices, including information about the safety and effectiveness of the products and practices. It also includes evidence-based resources, such as research results and clinical practice guidelines, which will help prepare you to discuss complementary health approaches with your patients. 

If you are not insured with OUM, fill out our online form to get a no-obligation quote.

“OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.

What Workplace Bullying Looks Like 
Bullying is harmful, targeted behavior that may be directed to one person, or a group of people. It might be spiteful, offensive, mocking, or intimidating. Bullying can range from being overtly obvious, such as yelling, to subtle, such as using condescending language. It is a repeated behavior that manifests from a real or perceived power imbalance and is often intended to control, embarrass, undermine, threaten, or otherwise harm the targeted person or group.

Understanding What Leads to Common Malpractice Claims
The most common allegations in chiropractic malpractice claims are related to these three things:

While most healthcare providers are compassionate and want to provide optimal care to their patients, everyone has biases and knowledge gaps that may hinder the provision of quality healthcare. These biases and knowledge gaps can lead to:

• Barriers to care
• Miscommunications
• Misdiagnosis
• Lack of trust

If you missed Part 1 of this article, read it here!

Occasionally, there is good news about compliance and risk. Good news came to every licensed healthcare practitioner in the nation on January 5, 2021, when the HITECH Act was amended with the new HIPAA Safe Harbor Law (HR 7898). This change created safe harbors under the law, but only if acted upon by the healthcare professional to protect themselves and their practice.

Finding yourself in a situation where a patient is unhappy with their treatment and asking for a refund, what should be your response? For example, you may feel that your work is satisfactory, and you are unwilling to provide a refund to the patient considering all the time you spent on their care. Or you may be seeking a quick resolution to the situation. In this article, we’ll take a closer look at how to handle patient refunds.

What is the Role of Empathy in Healthcare?
Empathy is the ability to understand and share the feelings of another. It combines intellectual perspective with emotional understanding. Empathy is a skill that has not been historically emphasized in medical schools. However, it plays a crucial role in healthcare.

You’re a very busy chiropractor. With so much to do in a limited amount of time, you may only think about malpractice insurance once a year—at your renewal. You may even say to yourself, “I provide the best possible care to my patients and my records are impeccable. I’m not going to get sued, so why do I have to pay for malpractice insurance?”

You can practice the best of care, follow every protocol and keep meticulous records, but that still won’t prevent a claim being filed against you. Yes, all those measures may reduce your risk, but ultimately, it’s out of your control and in the hands of your patient. Simply put, claims are filed every day; some are legitimate and others are frivolous. You shouldn’t live in fear of being sued, but you also shouldn’t ignore the fact that it’s a real possibility.

You may believe that if you’re uninsured or “go bare,” you’re less of a target of being sued. You may even think that when your patient’s attorney finds out you don’t have malpractice insurance, he/she will drop the case because there’s less potential for substantial financial gain if the case is won. While this may happen in very rare instances, the fact is that the attorney can still go after your personal assets, livelihood and reputation.

Another factor to consider is that a malpractice claim can be filed against you after you retire. Imagine if you were traveling the world and then came home to find out that you were being sued by a patient you treated before your long-awaited retirement. Everything you worked so long and hard for and all the finances you saved to cover your expenses during retirement could be in jeopardy. However, if you had a claims-made policy while you were practicing and purchased tail coverage after the policy was terminated, but the incident happened during the time the policy was active, the policy may protect you against that claim.

As you can see, a patient can file a malpractice claim against you whether or not you carry malpractice insurance. It doesn’t matter whether you are an actively practicing chiropractor or retired—the threat of a lawsuit is still a concern. This can seem daunting, but there’s a simple solution that can give you peace of mind–a solution that’s not only necessary, but essential to the success of your practice. It’s to continuously carry malpractice insurance while you’re actively practicing and obtain tail coverage when you retire. With malpractice insurance, you can rest assured that you have a team of professionals helping protect you and your practice should a claim arise.

Don’t let one lawsuit take away the practice, reputation and lifestyle you worked tirelessly to build. The price of a malpractice policy is minimal compared to the financial loss a lawsuit can bring. Ask yourself this question, “Can I afford to be uninsured?”

If you don’t have malpractice insurance with OUM, now is the time to obtain coverage. Our team of knowledgeable professionals is readily available and happy to help you. At OUM, we’re with you. Every step of the way.

Contact us today for coverage information. Fill out our online form to get a no-obligation quote.

You’ve seen the term “Administrative Defense Coverage (ADC),” but do you really know what it is and understand why it’s so important to your practice?

An administrative claim is very different than a malpractice claim. For example, ADC provides defense for board actions brought against you, whereas malpractice insurance provides defense and indemnity for liability actions.

So why is ADC important? Because an administrative claim could cost you your livelihood! If your chiropractic license is revoked, you’ve lost your ability to practice. Your professional reputation is irrevocably damaged and your chiropractic career is over. Let that sink in.

Take a look at what our ADC covers. It’s included in your policy at $25,000 per policy period and in the aggregate.

• Administrative disciplinary actions
• MCO de-certification or contract terminations
• Actions brought by government payers such as Medicare or Medicaid
• Actions by state licensing boards
• Investigations involving billing and coding practices
• Meaningful Use audits

At some point in your career, you will be audited. In most instances, the first appeal of an administrative claim will fail. But did you know you could be able to appeal a Medicare claim up to five times? Because we know how devastating an ADC claim can be to a chiropractor’s practice, we will be there for you at each of the five levels of appeal allowed.*

Other actions may be covered, too. Check your policy for complete details. If you have any questions, call us! In fact, when you receive any notice - legal or otherwise - please call your OUM Risk Management Department as soon as possible for a confidential consultation at (800) 423-1504, and press 7. If you are not insured with OUM, fill out our online form to get a no-obligation quote.

In a word, yes. Many chiropractors significantly underestimate how much a breach will cost, and think they can self-insure it. Outlining what will happen in the event of a breach is very useful when understanding the value of cyber liability coverage. Below are a variety of claims scenarios that help illustrate the severity of cyber claims, and how widespread cyber breach activities are throughout the healthcare industry.

Scenario 1
Employees of a large chiropractic group discovered that their email accounts were not accessible. The group’s IT department investigated and discovered that a ransomware attack infected 10 servers and 50 workstations. The group had to close operations for two business days and suffered losses in relation to the event.

Cyber insurance covered a total of $83,050, as follows: