32 I Spring 2018 www.anjc.info Legislative Update Chiro Assist TECHNIQUE Council Legal Q&A S C H O L ARSHIP WI N N E R S It will soon be a reality. New Jersey will have the Licensed Chiropractic Assistant (LCA) as a registered healthcare credential – a credential that will enable the LCA, working under the direct supervision of a licensed DC, to provide active as well as passive modalities to our patients. The significance of this new professional degree is enormous considering the amount of time the LCA will save the individual doctor, opening our schedules to do what we do best: diagnose and treat. Beyond increasing our individual offices’ capacity to attend to more patients, the LCA will be able to legally provide timed therapeutic modalities for reimbursement. The current options for a DC in New Jersey to bill out for timed procedure codes (i.e., ultrasound, therapeutic activities, group exercise instruction, gait re-training, etc.), would be for the DC to perform the procedures themselves or to hire a physical therapist. The former is a huge capacity blockage, while the latter is a huge expense for the everyday practitioner. This is where the LCA can really help us grow our practices, improve our services and take some of the work load from us – a perfect relationship. The paradigm shift in chiropractic is to introduce active care as soon as possible in the treatment plan and to progress the patient as they improve. In the acute phase of care this may be simply instructing the patient in home-care stretches, and spinal or extremity hygiene techniques for ADLs. Whereas in the sub-acute and rehabilitative phases of care, the LCA can teach and follow up with the patient in exercises for stabilization, endurance and strength. For the offices that treat a high percentage of athletes, perhaps your LCA is a personal trainer or exercise physiologist: adding an additional level of care to address the needs of that population. The bottom line is that your individual options are vast, depending on your patient population. For doctors who are new to active care, it can be introduced in your office without expensive equipment or an additional exercise room. Effective and space-saving active care equipment such as elastic resistance, stability balls, foam rollers and massage sticks can be used in your current treatment rooms. For doctors already performing active care, simply be sure your LCA understands your personal exercise protocols. Regardless, since the LCA is working under your direction, communication is paramount – both the DC and LCA need to understand the exercise progressions and active care treatment goals you prescribe. While the LCA program does incorporate both didactic and hands-on instruction for active care principles, the treating DC needs to be cognizant of the exercise principles as well. Again, since the LCA is following your instruction, the treating DC needs to be informed of the exercise progression for all phases of care. Take the time to attend the ANJC Regional Meetings, take some additional courses in rehab, and watch well-referenced YouTube videos. As with all new services, take the time and put in the effort to learn the essentials so you can integrate active care effectively. An additional benefit of the LCA is as a tableside assistant for the treating DC. Taking daily SOAP notes, handing you the activator, SOT blocks, IASTM tools, G-5, Purell, paper towels, reflex hammer, pinwheel, getting something from the front desk or the next room, the list is endless... these all open up your time to adjust and examine. Imagine your extra time at the end of the day if you save just one minute per patient. Another, and for some doctors the most important, additional benefit of a tableside assistant is it will reduce your non-essential dialogue with your patients. You will find the conversations will revolve more around their condition and chiropractic and less about the weather or your last vacation. As Doctors of Chiropractic our primary job is to diagnose and treat. Any procedures we can delegate to our staff will enable us to have a more productive and less stressful practice. In the case of having an LCA perform your active care procedures is the added benefit that we can bill for those codes. Services you oversaw but did not have to perform. The LCA and active care for the everyday doctor: perfect together! This article only focused on the role the LCA can play regarding active care and tableside assisting for the DC. Full details on the LCA credential and LCSA’s exact legal capabilities as an assistant throughout the office is the topic for additional articles. Be sure to watch your emails for updates from ANJC HQ as the LCA program moves forward. This is an unparalleled opportunity for chiropractic in NJ. Donald DeFabio, DC, DACBSP, DABCO, is in private practice in Berkeley Heights and is the team chiropractic doctor for a local university. His exercise protocols can be found on his YouTube channel. He conducts Relevant Rehab, hands-on seminars to teach the keys of successful integration of active care into the everyday chiro- practic office. The LCA and Rehab: Perfect Together By Dr. Donald C. DeFabio ANJC Council on Physical Rehabilitation and Performance Chairman