Thursday, September 10, 2015

Who supervises the work of an Acupuncturist?

keywords:  supervision, hospital employment, credentialing and privileging, LIP, Joint Commission, the Hospital Sponsor

Supervision of an L.Ac.  
related topics include:
  • the Hospital Sponsor
  • working as part of a team
  • referring to appropriate providers, red flags, etc.

In hospital practice, the following question, “Who supervises the work of an L.Ac. at our hospital/medical center?” is common.  Here is a good answer and some talking points.

Direct Answer

The supervision of an L.Ac. is limited to administrative review.  Practice review (TCM practice review) can only be done by another L.Ac.  L.Ac.s, therefore, as health care professionals, must participate in the Peer Record Review process.  [Quality Assurance review aka Peer Record Review and the assessment of any scope of practice can only be determined by a supervisor and/or senior clinician with the same license and training (master’s or doctorate degree from ACAOM accredited program and current NCCAOM diplomate status).]

Special case:  L.Ac. Internship or preceptorship:  The supervision of an L.Ac.’s clinical work can be done by another L.Ac. as may be the case during an internship or preceptorship.

L.Ac.s are independently practicing providers with graduate health education* and degree(s).  The state law term is "licensed independent practitioners (LIP)". The Joint Commission uses the term "licensed independent practitioner" (LIP) for this class of provider. **  Acupuncturists should be credentialed as professional health care providers, eligible for a “delineation of clinical privileges”.  L.Ac.s are not primary care providers as primary care physicians or advanced registered nurse practitioners are.  L.Ac.s are LIPs similar to clinical psychologists, physical therapists, pharmacists, and chiropractors. 

Why Peer Record Review vs. practice supervision

Simple answer:  L.Ac.s are health care professionals, not technicians.  Hence, they participate, as other credentialed and privileged professional health care practitioners do, in the peer record review process as well as other professional practice evaluation processes (FPPE, OPPE).

*Graduate health education. Acupuncture education is a graduate master's or doctorate degree program accredited by the ACAOM (which is recognized by the U.S. Department of Education). As of January 2018, the Bureau of Labor and Statistics published the Standard Occupation Code (SOC) for the profession, 29-1291 Acupuncturist, which recognizes acupuncturists as health-diagnosing professionals. [update added 5.21.2019]

**LIP is a state law/scope of practice term. It is not a term that translates well in hospital setting. No professional in the hospital practices "independently". Every professional in the hospital has a chain of command (line of management). 

Review:  Health care professionals (LIPs) vs. technicians

Licensed Independent Practitioners (LIP), a state law term, are health care professionals, not technicians. 
Professional work “requires the exercise of discretion, judgment, and personal responsibility for the application of an organized body of knowledge that is constantly studied to make new discoveries and interpretations, and to improve data, materials, and methods.”[1]

Licensed Independent Practitioners (LIPs), a state law term--Joint Commission recommends these types of providers be credentialed
Can be credentialed. Are NOT privileged.
Has a national provider identifier (NPI)
Does not bill insurance. Does not have an NPI
Able to practice clinically with only administrative supervision
Carries out the treatment plan their supervisor, the provider, creates
Has training and education to evaluate a patient
Cannot sign notes; does not take full responsibility for treatment
Can create a treatment plan
Clinical work is directly or indirectly supervised
Can modify a treatment plan
Does not have ability or authority to evaluate patient
Can re-evaluate patient
Does not have ability or authority to change or modify treatment or procedure
Can adapt treatment procedures

Reads research literature in the field, including evidence-based clinical guidelines and recommendations. Able to discern and incorporate clinically relevant information into current practice

Participates in peer record review, an OPPE process and standard
Does not participate in peer record review
BLS occupational code delineates as “health-diagnosing professional”
Example: 29-1291-Acupuncturists
Group 29-0000 is the major group, “healthcare practitioners”
Group 29-1000 is the minor group, “health diagnosing and treating practitioners”

References for table:

[1] p.7, “Distinguishing Between Professional and Technical Work”, Professional Work in the Medical and Healthcare Group, 0600, Office of Personnel Management (U.S.A.), published September 2017. Retrieved 5.22.2019.

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