July 12, 2001
Supercedes: The use of High Tech Equipment in a chiropractic office (dated 5-22-91)
The Massachusetts Board of Registration of Chiropractors ("Board") has today voted to adopt the following Policy Guidelines. These policy guidelines are intended as a recommended protocol for the profession to follow. The guidelines set forth below do not have the force or effect of law, as would a Massachusetts General Law or a Board rule or regulation. However, the Board utilizes these and other guidelines as an internal management tool in formulating decisions that relate to issues of chiropractic practice.
The Massachusetts Board of Registration of Chiropractors, after reviewing the most recent scientific evidence, including but not limited to information supplied by equipment manufacturers and independent researchers, has adopted the following guidelines regarding the use of advanced technology in the practice of chiropractic.
- For purposes of these policy guidelines, the term "advanced technology" includes, but is not necessarily limited to, the following equipment and/or procedures: Paraspinal Electromyography (Paraspinal EMG), Electronic Muscle Testing, Sonography, Thermography, Videofluoroscopy, Plethesmography, and Electronic X-Ray Analysis.
- All advanced technology used in a chiropractic office should be certified as meeting the currently applicable federal standards for such equipment. The appropriate federal safety certificates for each such piece of equipment should be conspicuously displayed on the equipment itself or elsewhere in the office.
- The protocols for the proper use of any type of advanced technology should be based upon appropriate, generally-accepted professional standards concerning the purpose and intended use of such technology, and the manufacturer's instructions concerning its operation. In determining the appropriate, generally-accepted professional standards concerning the purpose and/or intended use of a particular type of advanced technology, the Board recognizes chiropractic colleges accredited by the Council on Chiropractic Education (CCE), and independent research organization(s) recognized or approved by the Foundation for Chiropractic Education and Research (FCER) or a similar organization, as acceptable sources for such standards. The Board would not consider the manufacturer or any entity that serves within the manufacturer's distribution network as an acceptable source for such protocols.
- A physical examination of the patient, utilizing standard diagnostic and testing procedures, should always be performed before ordering the use of any advanced technology. Standard testing procedures may include, but are not necessarily limited to, palpation; neurological, orthopedic, vascular, and/or musculoskeletal studies or tests; radiographic imaging; and inspection of all available diagnostic studies that the patient had previously undertaken. In all circumstances, appropriate standard examination procedures should be exhausted before advanced technology is used, and the results of the standard examination procedures should indicate that the use of additional advanced technology is both appropriate and clinically necessary for proper diagnosis and/or treatment of the patient.
- If the clinical information that could be ultimately obtained from the use of advanced technology would be the same as what could be typically determined from a standard testing procedure(s), then the use of the advanced technology would be considered clinically unnecessary by the Board. Advanced technology should be used only if it will contribute significant clinical information which is both reasonably necessary for proper diagnosis and/or treatment of the patient and not reasonably available through use of standard diagnostic or testing procedures.
- If advanced technology is used as the exclusive means of documenting a particular diagnosis or evaluation, the chiropractor's treatment records should demonstrate that the same advanced technology was used for all patients with an identical diagnosis or evaluation, regardless of payment source, and that all such patients were charged a similar fee for it. If this cannot be demonstrated, then the chiropractic physician may, at his or her option, utilize the advanced technology, but should not charge for it.
- The use of advanced technology for the purpose of performing uniform patient screenings, pursuing or defending against an impending legal action or insurance claim, or simply for the doctor's own edification would be considered clinically unnecessary by the Board. Nevertheless, in such instances, advanced technology may be used and the patient may be charged for the cost of this service if utilization of that advanced technology does not pose a material risk to the patient and there is documentation in the patient's treatment record that the patient has specifically requested the service.
- The use of a computer drawing or analysis of x-ray films does not typically give a diagnostic or pathological finding which would not already be observable to the viewing doctor. Therefore, the clinical information that would be obtained from such computer drawings or analyses are presumed by the Board to be of questionable value in the diagnosis or treatment of the patient. Since the doctor can readily obtain the same information by carefully viewing and analyzing the x-ray film directly, any advantage afforded by computer drawings or analyses would be considered by the Board to have been performed solely for the doctor's own benefit and therefore would be regarded as not clinically necessary to the patient. The doctor may use such drawings or analyses, but the patient should not be made liable for the cost of this additional service unless there is documentation in the treatment record that this service has been specifically requested by the patient.
- The use of advanced technologies, such as Paraspinal Electromyography (paraspinal EMG), Electronic Muscle Testing, Thermography, Sonography, Videofluoroscopy, Plethesmography and others not specified, would generally be presumed to be clinically unnecessary if: (a) such procedures are being used during the initial trial phase of a condition, and (b) the relevant information available from these tests could typically be determined through standard testing procedure(s). Furthermore, the use of advanced technology of any type would be considered clinically unnecessary if the ultimate potential benefit of using the advanced technology would have no significant effect on the overall outcome for the patient when compared to the outcome obtained without utilization of the advanced technology. This is not meant to imply that these procedures are always invalid in a chiropractic setting, but rather that the Board believes that use of these procedures is of limited potential benefit to many patients in many situations.
The Board reserves the right to modify this policy and/or promulgate a regulation(s) as new scientific evidence is made available. This policy guideline is not exclusively limited to the particular advanced technologies that have been specifically named in this guideline.