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COVID-19 Resource Page

CHIROPRACTIC IS ESSENTIAL

With the Governor’s “stay-at-home” order Doctors of Chiropractic can continue to provide care to their patients. Governor Walz issued Executive Order 20-20 that requires, beginning on Friday, March 27, 2020 at 11:59 pm through Friday, April 10, 2020 at 5:00 pm, all persons currently living within the State of Minnesota to stay at their place of residence except to engage in the Activities and Critical Sector work. The executive order excepts healthcare and public health workers listed in the CISA Guidance. It is the interpretation of the MCA that chiropractors and chiropractic clinics are included as healthcare providers under the CISA Guidance which lists health care “Caregivers” and “Workers in other medical facilities” that include “Clinics”.

The MCA recommends doctors of chiropractic only see acute, neuromusculoskeletal patients through April 10th. In addition, we recommend you DO NOT see wellness/maintenance patients in your clinic at this time. This is to support Executive Order 20-20 while keeping those who can benefit greatly from chiropractic care out of Urgent Care and/or the Emergency Room.

Doctors of chiropractic can see patients via telehealth services. The MCA is currently in the process of developing a webinar and updating our member resources regarding telehealth services.

During this time, MCA remains committed to our community of doctors to help you care for your patients and staff. We have never been more acutely aware that many chiropractors operate as solo practitioners or small businesses who may feel more isolated than large group practitioners.

In addition to providing information updates, the MCA believes it is just as important that we serve as a bridge to remind members that our chiropractic community is strong and that we are here to help in any way we can.

COMMON QUESTIONS:

The following information addresses the most common inquiries received by the MCA office at this time. We are continually monitoring the situation and will provide updates as we receive more information. 

  • Essential services”: Whether services of chiropractic physicians are deemed to be “essential services” that may remain open in the event that the government declares that all businesses close. The MCA believes it is too early to answer this question because at this time we do not know which governmental branch may make such a declaration or what the guidelines will be. If and when a “close order” happens, we will carefully review and update this information.
  • Closing of offices: At this time, the MCA recommends that doctors use their best professional judgment, applying relevant guidelines, such as those of the CDC and the White House Coronavirus Task Force, to determine whether to close offices. 
    • The MCA recommends closing any office that does not have staff or resources to maintain strict CDC disinfecting protocols, social distancing, and other prevention tools 
  • Offices remaining open:
  • The following recommendations are based on current CDC and MN Department of Health guidelines, closures and executive orders. All chiropractors are subject to and must follow all federal and state laws, rules and regulations regarding public health both at the state and federal level.

    It is our recommendation you only to see acute, musculoskeletal patients through the end of March. The reasoning behind this is to support "flattening the curve" while keeping those who can benefit greatly from chiropractic care out of Urgent Care and/or the Emergency Room.

    It is our recommendation that you, any patient or staff member not come into the office and enter a 2-week self-quarantine if anyone they have been in contact with exhibits any of the following symptoms:

    • Fever (+100.4)
    • Cough (Productive or Non-Productive)
    • Bronchitis or Respiratory Infection
    • Sore Throat
    • Shortness of Breath
    • Digestive Complaints, including Vomiting or Diarrhea
    • Severe fatigue not associated with travel, myalgia and/or arthralgia

    It is our recommendation that you, any patient or staff member not come into the office and enter a 2-week self-quarantine if their history includes:

    • Respiratory or pulmonary disease
    • Smoking, current or past
    • High blood pressure & anyone currently on an ACE inhibitor or other medications(s) related to high blood pressure
    • Immuno-deficiency
    • Chronic illness or compromised immune function, including chronic colds/illness this winter
    • History of heart disease
    • Diabetes
    • GI disorders (Crohn's, colitis, etc.)

    It is our recommendation that you enter a 2-week self-quarantine if you or anyone you know:

    • Have any symptoms of COVID-19
    • Are waiting to be tested for COVID-19
    • Are waiting for test results for COVID-19
    • Have tested positive for COVID-19
    • Have traveled on an airplane in the past 2 weeks

    Your employees, staff and patients/practice members are an extension of you. Whatever you do, say, email or post on social media is ultimately your responsibility and leaves you & your practice liable. While MCA values patient and community education, including the important role of chiropractic in health and wellbeing, please pause and think before speaking and/or responding in person/on email/via social media as your words and actions may not be perceived by everyone the way you intended. And unfortunately, when the general public is in fear, innocent misperceptions can result in a malpractice accusation or complaint to the MN Board of Chiropractic Examiners. If you would not say something publicly, on National TV, do not say it at all. Remember that you are bound to HIPAA. Reporting to the media or discussing that a patient could be positive, or a carrier of COVID-19 is a HIPAA violation.

    It is our recommendation that you and your practice/office:

    • Alert your patients/practice members of the above guidelines
    • Waive any fees/charges for late cancellations or no-show appointments effective immediately through the end of March 2020
    • Designate different days and/or times of day for pediatric patients that is not when any elderly patients would be seen in your office
    • Remove the toys from treatment rooms/office play areas. Disinfect any toys before and after patient contact
    • Remove all magazine from reception area

    It is our recommendation that you do the following regarding Record-Keeping & Documentation

    • Chart that you are being proactive in protecting and identifying individuals who may present to your practice with possible exposure, refusal of entry into your office and recommending a 2-week quarantine for the individual
    • Report suspected individuals as necessary to the MN Department of Health
    • Chart that patients/practice members were questioned with regard to recent travel and exposure to illness including COVID-19 and that the patient denies recent travel to any current region or country of outbreak nor having been exposed to anyone at risk to their knowledge
    • Chart that the patient denies any of the following symptoms listed above
  • Advertising and marketing caveat:
  • Due to the lack of research and the severity of COVID-19, it is negligent to make any claims for treatment or cure. There are currently no therapies, medications or over the-counter products proven to treat or cure COVID-19. This includes promoting chiropractic care or other healing modalities that are not substantiated by peer-reviewed journal articles (such as PubMed or JMPT), the WHO and the WFC.

    MCA strongly recommends that our members exercise extreme care when writing blogs, newsletter, patient emails and anything sent out on social media. Regulators are on high alert for the exploitation of the pandemic and may view as grounds for license suspension any claim that certain treatments can prevent or cure COVID-19 until more is known about the virus. For example, it would be misleading and prohibited to advertise that adjustments or natural remedies can cure or lessen this illness. Please refer to the Advertising Rules by the Minnesota Board of Chiropractic Examiners (MBCE) for further information and specific details.

The MCA is making available to our members a template letter for our doctors to provide to their patients regarding the COVID-19 virus (coronavirus). The letter explains the steps you are taking in your offices to protect your patients.

Example Communication to Patients

RESOURCES:

Minnesota Specific:

CDC/WHO/US Chamber:

American Chiropractic Association:

MASSAGE, ACUPUNCTURE, PHYSIOTHERAPY/REHAB RECOMMENDATIONS:

Based on the current MN Department of Health Guidelines and the Executive Orders 20-04 and 20-08 by Governor Walz (regarding closure of specific facilities), it is the recommendation of MCA that offices consider the safety of staff, patients & their community. 

The MCA would like to clarify that if you provide massage therapy, physiotherapy/rehab, or other therapeutic services  for acute, musculoskeletal injuries/symptoms, the services must be performed within a practice where the primary focus is the provision of chiropractic services, to prepare the patient for chiropractic services, or to complement the provision of chiropractic services. 

CLARIFICATION OF MASSAGE IN CHIROPRACTIC CLINICS:

In response to inquiries the MCA has received about providing massage, the MCA requested clarification from the state of Minnesota. The state responded “If it is medical massage, it is exempt.  It really should be for medicinal therapeutic reasons.” As our request was specific to chiropractic, we interpret “medical” as being interchangeable with “chiropractic”.

Accordingly, based on this clarification from the state, providing massage either directly or through a supervised qualified professional is allowed in a chiropractic clinic if the doctor of chiropractic determines it is a necessary part of the treatment plan to treat an acute, neuromusculoskeletal condition. This is a clarification of an earlier MCA recommendation that doctors of chiropractic only see acute, neuromusculoskeletal patients through April 10th. In addition, the MCA recommends that chiropractors DO NOT see wellness/maintenance patients in your clinic at this time. This is to support Executive Order 20-20 while keeping those who can benefit greatly from chiropractic care out of Urgent Care and/or the Emergency Room.

CDC WEBINAR FOR CLINICIANS

The CDC presented a one-hour live webinar for clinicians on March 5th. It is now available at no cost on-demand here. The presenters reported on important updates, including recommendations for office protocols for control of the spread of the virus. The experts recommend similar protocols for other infectious diseases, such as influenza. Aside from the obvious standards for the physical facility and staff (sanitizing surfaces, handwashing, etc.), if a patient presents to the office with symptoms, the patient should be separated from others in the waiting area and masked to prevent the spread of droplets. The CDC also discussed how to determine which patients to refer for testing. CDC recommends using professional judgment to assess the presence of the following factors in presenting patients:

  • Epidemiological factors such as being in close contact with a diagnosed patient or having been in an area of known community transmission
  • Symptoms including:
    • Fever
    • Acute respiratory illness – cough, shortness of breath, difficulty breathing
    • Myalgia
    • Fatigue
  • Persons over 65 years of age
  • Persons with underlying conditions and comorbidities

Physicians are to use their best judgment in assessing patients and refer those for testing as appropriate. Due to the general scarcity of testing kits, the CDC currently recommends that physicians should refer “persons under investigation” (PUI) to state and local public health laboratories in their areas. Additionally, the CDC states that “Healthcare providers should immediately notify their local or state health department in the event of a PUI for COVID-19.”


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