CCGPP on the Proper Use of Guidelines

By Mark Dehen, DC

Chiropractor News: Recently we were contacted about the appropriateness of individual states endorsing one guideline document over another. While we have no control over how any state association, governmental agency or payor uses or endorses guidelines, we would ask that each executive director and each individual doctor consider the proper use of guidelines and how these important documents potentially impact our profession, both from within and without Chiropractic. The main question we all need to ask is:

Will this guideline positively affect reimbursement and/or allow proper treatment of the patients we serve?

If a guideline is developed, but is used by virtually no payor organizations, or does not potentially influence existing guidelines in a manner that benefits our patients, what is the point of having it?

Please remember that CCGPP was formed in 1995 at the behest of COCSA to address ongoing guidelines development and refinement. The main issue at that time, which still prevails today, related to how existing guidelines restricted chiropractic, primarily due to lack of chiropractic input in the developmental stages. Clearly, we needed to work with existing guideline organizations in order to help update their documents to reflect current literature.

Most payors rely upon existing guidelines (ODG, Milliman, ACOEM, etc.) or simply develop their own proprietary guidelines. Most existing documents were, and still are, reliant upon very outdated research. Clearly, we as a profession needed to act. Therefore, CCGPP sought to develop a document based upon the best possible evidence. In the absence of evidence on some issues, CCGPP also developed a low back consensus opinion using a broad spectrum of our profession and professionals outside our profession, using rigorous, internationally established procedures (AGREE, the RAND/UCLA Appropriateness Method User’s Manual) to maintain integrity of the process.

CCGPP will continue to work to develop products that assist our doctors and improve patient outcomes, while at the same time strive to educate nationally recognized guideline developers on the proper applications of chiropractic-related literature.

Please keep in mind the following basic tenants of the CCGPP:
* All guidelines serve merely as background information to assist doctors in the clinical decision-making process.
* A guideline serves as a “compass” for care, not a cookbook for care.
* Guidelines should never be used punitively or as prescriptions for care.
* Each patient is unique and treatment recommendations must be based on the specific factors pertaining to the individual case.
* Guidelines are only one piece of evidence to consider when considering the medical necessity of care. Other pieces of evidence include: research, clinical experience/decision-making, patient values, risk stratification, process of care, response to care, documentation, etc. Again, guidelines are not cookbooks with rigid dosages for treatment, nor do they recommend/dictate the elimination of anecdotal information, personal experience, intuition, etc.

If you have additional questions, please do not hesitate to contact any CCGPP Executive Committee member.

CCGPP — PO Box 2542, Lexington, SC 29071
803-356-6809
www.ccgpp.org

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