MAC Virtual Toolkit for May 18, 2020

Tomorrow, May 19th, is National ChiroCares Giving Back Day! This national observance spearheaded by the MAC, partnering with ChiroCongress and the Foundation for Chiropractic Progress, is designed for chiropractors across the state of Michigan and the nation to participate in different events that give back to their local communities during the global COVID-19 pandemic.

The MAC is encouraging Michigan DCs to participate in a virtual food drive through Feeding America to benefit a local food bank. Every dollar raised can provide at least 10 meals to families in need through the Feeding America network of food banks. The MAC has numerous resources to help you get involved, including sample social media posts, website banners, and more.

For more information, see the MAC’s three previous emails on National ChiroCares Giving Back Day, dated May 14, May 11, and May 8.

On Friday, the Small Business Administration (SBA), in consultation with the U.S. Department of the Treasury, released the Paycheck Protection Program (PPP) Loan Forgiveness Application and detailed instructions for the application.

The form and instructions inform borrowers how to apply for forgiveness of their PPP loans. SBA will also soon issue regulations and guidance to further assist borrowers as they complete their applications.

Click here to view the application and instructions. The press release announcing the release of the application can be found here.

The MAC is reviewing the application and relevant analysis and will have a full report ASAP.

Source: Small Business Administration Press Release, “SBA and Treasury Release Paycheck Protection Program Loan Forgiveness Application,” May 15, 2020

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 below).

We expect that Governor Whitmer will issue additional guidance and/or Executive Orders on this topic, 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.

MAC FAQs

MAC Telehealth Information

Volunteer Information

Phone Screening Tool

COVID-19 Patient Screening Questionnaire (see website for workable file)

SHRM: Sample Notice of Temporary Layoff or Furlough Due to Coronavirus

MAC Matters: (NEW 4/29/20-5/8/20)

May 8, 2020 (New Executive Orders, Virtual Toolkit)

May 6, 2020 (MAC Sample Preparedness and Response Plan)

May 5, 2020 (Khaldun Guidance)

May 1, 2020 (Five New Executive Orders)

April 29, 2020 (CARES Act Provider Relief Fund Update - Track Funds)

Telehealth:
- Does Telehealth work in Chiropractic Offices During the Pandemic - Dr. Evan Gwilliam, The Chirocode Institute
- The Swiftly Changing Telehealth Environment - HANDOUTS - NCMIC, Dr. Tim Bertelsman
- Telehealth 201: Making it Work in Chiropractic Practice - Links - ChiroHealthUSA - Dr. Scott Munsterman

ChiroHealthUSA Library

COVID-19 Risk Management: HHS Payments, Employment Law, and Re-opening
Hosted by Kristi Hudson, Dr. Scott D. Munsterman, DC FICC CPCO, Dr. Steve Conway, DC, JD

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, the federal government, 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.