RESOLVED, that the American Chiropractic Association considers the attached "Mobile Diagnostic Services" statement official policy:
The American Chiropractic Association (ACA) has fielded concerns raised by members and third party payers, as to the advisability of entering into a rental lease agreement with a Mobile Diagnostic company to perform testing and measurement on: certain nerve electro-diagnostic testing procedures, functional capacity studies, and more recently range of motion and spinal ultrasound studies among others.
It is not the intention of ACA to provide legal or clinical recommendations, however, we feel an obligation as the largest professional association representing doctors of chiropractic, to comment on this practice arrangement and the potential impact it may have on the quality of patient care.
There are instances of mobile services and use of diagnostics by doctors of chiropractic that are fully within their scope of practice and are medically indicated as documented by the treating provider. The ACA supports the profession acting within their state law who are trained to perform and assess these services as clinically indicated.
We caution the chiropractic community when entering into a rental or lease agreement that is or could be perceived as placing financial gain over the best interests of the patient. The ACA Code of Ethics Policy clearly advises:
| "As primary obligation of the doctor of chiropractic the exercise of clinical judgment and practice [is] solely for the patient's benefit. In the view of this association, the receipt of any form of remuneration for a patient referral runs directly counter to this primary obligation and tends to adversely impact upon the relationship between the chiropractor and patient." |
Ask Yourself These Questions
- Does the patient need the services(s) and can I clearly document the medical necessity for each and every test?
- Do I as the treating provider have an obligation to determine the extent of all testing and services?
- Am I being induced to order tests from the mobile diagnostic facility?
- Does every test or combination of tests yield an outcome that is beneficial for the patient?
- Do I know if services are being performed or interpreted by a certified, licensed professional with clinical education and knowledge of the tests and analysis according to state regulations? And, are the qualifications and licensure of the person writing the report available to you and are they state compliant?
- Do I have a clear line of authority and supervision over the technician performing the testing?
- What assurances do I have that the equipment is in good operational order, is reliable, and may not present harm to the patient?
- Does the test in question meet "generally accepted" requirements relative to its purported use?
- Am I liable for any harm to the patient?
- Have I received any kickbacks, gifts or funds for patient referrals?
- Have I been advised to bill for the technical component on equipment that I do not own?
- Have I personally analyzed the test report(s) to determine they are patient specific and give me a clear picture of the patient results?
- Have I ordered tests or referred the patient for services that are for my financial gain and may not be in the best interest of the patient?
- Are there any state laws that may influence my decision or that require specific compliance requirements?
- Have I spoken with my attorney or malpractice carrier about all potential liabilities?
Your thoughtful consideration on the full ramifications of a rental and/or lease agreement on electro-diagnostic testing or other patient referral services will protect you and the image of the chiropractic profession. More information can be found at:
ACA Ethics Policy Addendum:
http://www.acatoday.com/content_css.cfm?CID=719 (Ratified by the House of Delegates, September 2004)
