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MAC Review of State of Michigan Guidance on “Non-Essential” Procedures
May 5, 2020
Below are the Executive Orders discussed in this email: Executive Order 2020-17 puts temporary restrictions on non-essential medical and dental procedures. For purposes of this order, “non-essential procedure” means a medical or dental procedure that is not necessary to address a medical emergency or to preserve the health and safety of a patient, as determined by a licensed medical provider.
Executive Order 2020-70 is the latest “Stay Home, Stay Safe” order, which requires the suspension of
activities that are not necessary “to sustain or protect life,” currently set to expire May 15, 2020.
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On May 3, 2020, Michigan’s chief deputy health director, Dr. Joneigh Khaldun, issued a guidance letter to essential health care providers as they plan for the reengagement of patients in need of services. This guidance on non-essential services is necessary because State of Michigan Executive Order
2020-17, which bans “non-essential medical and dental procedures” remains in place, as does Executive Order 2020-70, which includes the prohibition of in-person work that is not “necessary to sustain or protect life.” In her guidance, Dr. Khaldun states that the wording found in Executive Order 2020-17 is “intended to be flexible, preserve clinician judgment, and encourage consideration on an individual basis of which patient services can be safely delayed without resulting in a significant decline in health.” She further states:
“EO 2020-17 gives providers broad discretion to apply this standard.” She also lays out a series of guidelines and principles to consider as clinicians provide needed patient services. Based on Dr. Khaldun’s suggested guidelines and principles, the MAC highly recommends the following: - Chiropractic physicians, as “Essential Critical Infrastructure workers in healthcare/public health,” still need to utilize clinical judgment regarding what chiropractic care is necessary under the requirement to “sustain and protect life.” However, chiropractors will want to follow Dr. Khaldun’s guidance to “encourage consideration on an individual basis of which patient services can be safely delayed without resulting in a significant decline in health.”
- Along with determining what care is needed
to help keep patients from the dangers of going to emergency rooms because of pain and other serious issues, and/or away from dangerous opioids, chiropractors need to also recognize that “procedures or visits that were not time-sensitive several weeks ago may now be, based on clinician judgment,” as stated in the guidance.
- Your clinical judgment is key to how your care will keep patients safe and healthy.
As always, be sure to properly document that the care was necessary to keep patients safe and healthy, or that a delay in services would result in a significant decline in health,” as per Dr. Khaldun’s guidance. The MAC also continues to HIGHLY RECOMMEND THAT DOCTORS FOLLOW SUGGESTED CDC PREVENTION AND SAFETY PRECAUTIONS (information is available on our website).
We expect that Governor Whitmer will issue additional guidance and/or Executive Orders on this topic possibly as soon as this week, so stay tuned for more information as it becomes available.
Related: Can My Office Provide Massage Therapy Services?
The MAC continues to recommend that chiropractic offices not provide massage therapy services unless the chiropractor deems it necessary for the care of the patient under the broad directive of the recent Governor Order and Dr. Khaldun’s guidance. Seriously consider whether massage is an essential service to help you “sustain or protect life” or “to prevent a significant decline in health.”
Another consideration: We have been told by several malpractice carriers that you may not be covered if you continue to utilize massage in your practice, based on the directives found in the State of Michigan “stay at home” orders. Whether Dr. Khaldun’s guidance changes this equation is up to you to determine by discussing it with your carrier. Again, that is not officially in a government order, but is our best recommendation at this time.
Please remember: The MAC is not a regulatory body, not for chiropractors and certainly not for massage therapists. We do not have the authority to legally order you to stop providing massage therapy services – only the state and/or federal government has that authority. Nor do we have the clinical judgment to ascertain, after careful consideration on an individual basis, if your patients require massage therapy services.
The MAC also recommends that every Michigan chiropractor familiarize themselves with the guidelines and principles outlined in Dr. Khaldun’s guidance, which should be “considered as clinicians… plan reengagement of patients in need of medical services.” Again, her guidance can be found here.
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Disclaimer: The Michigan Association of Chiropractors is a professional association advocating for the rights of chiropractors and their patients across the state of Michigan. We are NOT a state agency or regulatory body. We are merely informing our membership regarding what they are allowed to do during this difficult and confusing time. The information we provide during
this pandemic is derived in conjunction with our governmental relations and legal experts, developed after examination of all official releases of information from the State of Michigan and in consultation with said experts and representatives from state government. Please refer to our emails and website for the latest information, free from speculation and the rumors currently circulating in the wake of official state actions. Rest assured that we will continue to advocate for the profession at the highest levels, with the health and well-being of you and your patients, as well as the overall stability of the health care system, foremost in our efforts.
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