Add a Nurse, Make Big Bucks
A key lynchpin in the ongoing chiropractic stem cell scam is the nurse practitioner. Without them, most of these scams couldn’t exist. So let’s explore this phenomenon of how nurses ended up facilitating unethical chiropractors in violating FDA guidelines and scamming patients. Let’s dig in.
What is a Nurse Practitioner?
One of the things I push on my weekly Facebook Live show, “You’ve Got the Power” is that patients need to learn how to become educated consumers of healthcare. Why? Because there are countless built-in traps in the healthcare system that most consumers never see coming. The nurse for a doctor switcheroo is one of them.
An NP (Nurse Practitioner) is someone who has been to a 4-year nursing school and then takes a 20-24 month add-on program to become a nurse practitioner. Compare that 6 years of training (4 years nursing school+2 years NP school) to the average specialist physician who has 4 years of college, 4 years of medical school, a year of internship, and then often 3-6 years of residency and fellowship and we have a HUGE training disparity between seeing an NP and the average specialist MD. Meaning the average physician specialist has more than twice the training of the average NP.
So if NPs have a fraction of the training, where do they fit into the healthcare system? They are called “mid-levels” or “physician extenders”. The idea was that they could allow a physician’s time to be stretched further. Or they could be deployed to rural areas where they could practice independently as part of a larger health system where the physician specialists back in the city would be referred to if there were more complex patients.
To gain this authority to practice independently, nursing organizations made huge legislative pushes beginning in the early 2000s (1). They successfully argued in about half the US states that because there was a predicted rural family physician shortage, NPs would fill that gap. The problem? That never really happened. According to a 2015 report, the vast majority of NPs were practicing in urban and suburban areas and not in rural communities (2).
Exploiting NPs for Profit
There’s a new trend that’s been happening for about the last 5-7 years. Chiropractic practice management groups have been adding NPs to chiro offices to add much higher reimbursing medical services and procedures. How does that work? This past week, I received an email from David Singer, a consultant I have profiled before on this blog:
There are THREE ways to expand a practice:
1) More New Patients.
2) More Treatment by Your Office for those patients.
3) Provide New Services by a Nurse Practitioner that does not require you to deliver any of the treatments.
Option 1 & 2 require you to work longer and harder.
Only option 3 would allow you to work less hard, have more freedom, enjoy life more, and earn more income while providing miraculous results for the people that need your care. While doing this all naturally and holding to your Chiropractic principles.”
Once you click through, this is what you see:
“Learn how to easily and inexpensively hire a Nurse Practitioner (as little as 1 day a month) that can deliver the following types of new service centers for your clinic:
* IV Vitamin Therapy
* Ozone Therapy
* Regenerative Medicine
* PRP (Platelet Rich Plasma)
* Orthopedic Joint Treatments
* Reversing Arthritis
* Peripheral Neuropathy
* Hair Growth
* Face Lift
* And much more.”
So any chiropractor can contract with Dr. Singer who will teach that individual how to get more money out of patients by adding medical services through a nurse practitioner.
The Practical Problems of Adding NPs to Chiro Offices
There are some very real problems when adding a mid-level medical provider to a non-medical office. For example, note that a good number of the services as described by Dr. Singer involve procedures. That means that a few critical things need to be dialed in:
- Procedure rooms
- Resuscitation equipment
- Physician back up
Training is key in this situation. Many physicians won’t teach NPs to perform these regenerative medicine procedures due to a lack of basic training. Hence, the training that they do get is often watered down. For example, the Interventional Orthobiologics Foundation and others won’t train NPs to perform regenerative medicine procedures.
A procedure room is a dedicated space where procedures can safely happen. These are specially built rooms with sealed floors, oftentimes radiation shielding in the walls, and stocked with specialized equipment. Most of the timers, these costly rooms don’t exist in chiropractic offices.
Resuscitation equipment is critical. Things like oxygen, intubation supplies, medications, etc… need to be readily available. Are they in the average chiropractic office? Nope.
Physician backup in an emergency can be critical. You have a nurse operating on patients with half or less education than the average physician. When the proverbial stuff hits the fan, everyone needs to pitch in. Is medical backup available in these chiro offices? Not usually. In fact, my research has shown that even when a medical director is named, he or she rarely steps foot in the chiropractic office and is certainly not there enough to establish and more importantly, make sure standards are adhered to.
Why are NPs Allowing This?
This is the billion-dollar question. Why would an NP allow their license to be at risk by performing these procedures in a chiropractic office? All it would take is one bad result exposing all of the stuff that was supposed to be dialed in at that office, but which wasn’t, to lose a license.
First, don’t allow yourself to get a regenerative medicine procedure by a nurse in a chiropractic office. That might seem simple, but many of the websites for these clinics are slick and don’t even mention or profile providers. That should be your first tip-off that something is wrong. The website should be gushing on the expert qualification of a physician. If there is none of that or all you see if an NP, I find that a reverse address look-up is helpful. Meaning, find the address on the “Contact Us” page and then Google that address. More often than not, instead of XYZ Regenerative Medicine Institute as was advertised on the website or Facebook, you’ll see that this is first and foremost a chiropractic office.
The upshot? I suspect that none of the state legislators that approved independent nurse practitioner practice acts ever thought that this would mean NPs offering medical services in suburban chiropractic offices. As a consumer, you need to take a good look at who is performing your procedure and where. Run a reverse address lookup and if it’s a chiropractic office, then find another provider with the training and expertise needed to perform these procedures safely using best practices.
(1) American Association of Nurse Practitioners. Historical Timeline. https://www.aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp/historical-timeline Accessed 7/19/21
(2) Rural Health Research Center. Assessing Rural-Urban Nurse
Practitioner Supply and Distribution in 12 States Using Available Data Sources. Policy Brief #143 • August 2015 https://depts.washington.edu/uwrhrc/uploads/RHRC_PB143_Skillman.pdf Accessed 7/19/21