Rhode Island Naturopathic Physician Continuing Education

• Name and describe the different types of sleep apnea.
• Describe the three levels of Apnea-hypopnea index AHI.
• List five symptoms of sleep apnea.
• List two treatments for sleep apnea.

• Describe the physiological response of aerobic exercise on the respiratory system.
• Describe the effect of running on the viscera and the diaphragm.
• Describe the response to inspiratory muscle fatigue on the body.
• List one device than may increase endurance of the respiratory muscles.

• Describe the anatomical structure of the diaphragm including innervation and blood supply.
• List four causes that may damage the innervation to the diaphragm and effect normal function.
• Describe the factors involved in Intensive Care Unit Acquired Weakness.
• Be able to describe the pros and cons of early mobilization in the ICU.

• Outline the most commonly encountered neurological complaints of pregnancy that a D.C. might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Modify normal practices, techniques and methods to accommodate for the biomechanical changes of the pregnancy patient
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• This contains all courses with the educational objectives listed from Chiropractic and Pregnancy 201 through Chiropractic and Pregnancy 207

• Outline eight commonly encountered complaints of pregnancy that a DC might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Understand the various causes of each complaint and how to address these causes
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• Outline the most common herbal and homeopathic remedies that may be useful to a DC who cares for pregnant patients
• Differentiate between helpful remedies and those contraindicated for use during pregnancy
• How and when to successfully integrate these palliative therapies to relieve common complaints of pregnancy
• Recognize the basics of homeopathy, why and how it works, how to administer remedies and proper use and storage of remedies
• Generalize the use and need for these remedies to accommodate the special needs and concerns of the pregnancy patient

• Outline necessary dietary requirements for the mother to be
• Differentiate between safe and unsafe exercises that can be recommended to the expectant mother
• Give examples of safe exercise practices to the pregnant patient
• Identify the normal and customary weight gain during a healthy pregnancy
• Offer dietary recommendations and healthy food choices to the pregnant patient

• Identify the most common birth trauma(s) to a newborn
• Assess the biomechanics of the pregnant pelvis
• Recognize how certain maternal pelvic misalignments can lead to increased incidence of various birth traumas
• Modify adjustive techniques and methods to better care for the pregnant patient
• Reduce the prevalence of certain birth traumas due to distortions and misalignments in the maternal pelvis

• Identify the most common medical tests and procedures performed on pregnant and laboring women
• Recognize the risks of these tests and procedures
• Assess the benefits of these tests and procedures
• Effectively explain these risks and benefits to the pregnant patient
• Assist in the preparation of a well thought out and defined birth plan for the pregnant patient

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Identify the various causes of a breech presentation and how to address these causes
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Outline commonly encountered misalignment and/or subluxation patterns that present with a twin breech presentation
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Identify the correlation between a misaligned pubic bone and an occiput posterior presentation
• Draw a parallel between a superior pubic bone misalignment and round ligament pain
• Develop a pregnancy care plan based on exam findings and presenting complaints

• Utilize the Official Disability Guidelines for Low Back Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of low back pain.
• Use the CCGPP Guidelines for the treatment of low back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment low back pain.

• Utilize the Official Disability Guidelines for Neck Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of neck and upper back pain.
• Use the CCGPP Guidelines for the treatment of neck and upper back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain.

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• Utilize the Official Disability Guidelines for Shoulder Pain
• Apply the Official Disability Guidelines for the chiropractic treatment of shoulder pain
• Illustrate sensitivity and specificity of orthopedic tests for the shoulder
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain

• Utilize the Official Disability Guidelines for Headaches.
• Apply the Official Disability Guidelines for the chiropractic treatment of headaches.
• Use the CCGPP Guidelines for the treatment of headaches.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for headaches.

• Interpret compliance advice and regulations directly from the Federal Office of Inspector General (OIG)
• Identify and become compliant with other requirements from the state level through third-party payer contractual obligations
• Review existing policy and procedure for compliance, including OIG compliance, HIPAA compliance, and other federal and state programs

• Apply guidelines for accurate coding and compliant billing practices
• Install monitoring to ensure standards are met
• Self-audit for compliance purposes
• Create internal policy and procedure to improve compliance

• Identify risk areas in the claim adjudication process and apply learned knowledge to prevent missteps
• Discuss federal, state, and payer guidelines that govern billing activities
• Avoid behaviors that violate the carrier contract and ensure compliance with regulations
• Evaluate provider contracts and payer policy for complete clarification on claim process

• Utilize self-auditing methods to identify high risk areas of patient finance in the office
• Develop systems for accountability and transparency in patient accounting
• Apply appropriate fee schedule measures to ensure validity in account posting
• Address federal and state guidelines for discounting to ensure compliance

• Apply the process for setting your fees legally and compliantly and according to Federal regulation
• Know the policies of ALL your carriers to be compliant
• Properly administer desired discounts without running afoul of the Federal and State regulations
• Implement legal hardship discounts, if desired, using the Federal guidelines to appropriately verify hardship

Hour 1

• Discuss the Inflammatory Cascade
• Identify the mechanics of concussion that results in inflammation
• Describe the neuro-chemical cascade of concussion

Hour 2

• Perform physical exam protocols in inflammation as it relates to concussion
• Perform Neurological exam protocols in inflammation as it relates to concussion
• Perform Chiropractic exam protocols including incorporating AK exam
• Apply Chiropractic exam protocols in inflammation
• Utilize advanced examination protocols in inflammation

Hour 3

• Perform structural treatment protocols to treat inflammation related to concussion
• Utilize phytonutrient protocols to treat inflammation related to concussion
• Use specific therapeutic protocols to resolve inflammation with literature citations

Hour 1

• Discuss the Selye Stress Response
• Discuss the mechanics of concussion that results in the inflammatory response
• Describe the cortisol cascade response associated with concussion

Hour 2

• Perform physical exam protocols in the stress response
• Perform Neurological exam protocols in the cortisol cascade
• Apply Chiropractic exam protocols in the cortisol cascade
• Utilize advanced examination protocols in evaluating the stress response

Hour 3

• Perform chiropractic treatment protocols to treat the stress response
• Utilize nutritional protocols to treat inflammation related to the stress response and concussion
• Use evidenced based therapeutic protocols to address the cortisol cascade associated with concussion with literature citations

Hour 1 and 2

• Describe the components of the core and the function of the core.
• Describe the function of the diaphragm as it relates to posture, muscular relationships and stability of the spine.
• Describe the function and structure of the superficial muscle system of the body.
• Describe two concepts of spinal stability. 

Hour 3

• Demonstrate how to determine the length of quadratus lumborum and erector spinae. 
• Demonstrate how to evaluate Transversus abdominus function
• Demonstrate how to facilitate the core and initiate a core training program

Hour 4

• List three pathologies related to less than optimal core function.
• Describe three postural strategies that the patient may develop when the core is in dysfunction.
• Describe how weakness of the abdominals can alter diaphragm contractions.
• Explain how respiratory fatigue can alter core control.

• Develop an appreciation of the impact of culture group, minority group and racial group on the health care relationship
• Increase sensitivity, knowledge and skills to promote effective intercultural interactions
• Identify the professional's own cultural identity/judgments /biases and their impact on their behavior and how they are perceived by clients and patients
• Recognize cultural variables that appear in verbal and non-verbal communication
• Examine the influence of culture in our patient population
• Differentiate the provider's culture

• Examine the historical background of the various Latino/Hispanic groups in the U.S.
• Develop the skills needed to care for people from Spanish speaking parts of the world
• Increase our understanding of the cultural traits of Latino/Hispanic groups in the U.S.
• Summarize specific traits of various Latino/Hispanic groups
• Recognize how we can narrow the gap between us

• Develop an appreciation of the impact of culture group, minority group and racial group on the health care relationship.
• Increase sensitivity, knowledge and skills to promote effective intercultural interactions.
• Identify our own provider culture/judgments /biases and their impact.
• Examine characteristics of Asians, Blacks and Middle Easterners.
• Summarize how to care for patients of these three ethnic/racial groups and how to narrow the gap between us
• Develop an understanding/plan of how to reach out to these populations.

• Develop the skills for medical documentation record keeping for proper patient care and adherence to insurance protocols
• Summarize informed consent, Evidenced-based care, Medicare guidelines and NCQA guidelines
• Identify common treatment procedures and modalities used in a chiropractic practice And recognize contraindications to them
• designate specific items to consider when interpreting and/or taking plain film X-rays
• Summarize the value of laboratory and diagnostic testing.
• Recognize the importance of patient communication skills in order to assist in the diagnosis and treatment of patients
• Modify procedures and forms to prevent the possibility of a legal malpractice action against the doctor

Hour 1

• Utilize improved patient communication skills with Medicare Patients 
• Apply appropriate risk management procedures to enhance patient communication
• Identify the four elements of legal malpractice and recognize the key components to avoid a malpractice action  
• Utilize key components of good documentation and record keeping
• Integrate the legal requirements of informed consent in your informed consent process 

Hour 2

• Summarize why doctors are held to higher standards
• Discuss the Do’s and Don’ts of record keeping
• Use the 21 NCQA guidelines for appropriate medical record keeping and integrate the 3 key components of Evidence Based Practice (EBP)

Hour 3

• Assess Medicare’s mandatory Electronic Health Records (EHR) requirement        
• Discuss key items related to the Office of Inspector General (OIG) reports regarding Medicare and chiropractic services
• Summarize Executive Order issued by the White House titled reducing improper payments and eliminating waste in the Federal Programs

Hour 4

• Determine what triggers an audit and key items to consider if audited
• Utilize a step by step approach to meet all Federal Medicare Documentation guidelines 
• Summarize Medicare’s guidelines for necessity of chiropractic care and its covered services
• Prepare treatment plans per Medicare’s regulation requirements
• Recognize Medicare’s policy requirements pertaining to x-ray/diagnostic reimbursement
• Determine if ordering vs. referred services meet Medicare’s policy when performed by a chiropractic physician