algorithm for the chiropractic treatment of spine related pain

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Algorithm for the Chiropractic Treatment of Spine Related Pain. Source Documents. - PowerPoint PPT Presentation

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Algorithm for the Chiropractic Treatment of Spine Related Pain

>

Source Documents

bull ALGORITHMS FOR THE CHIROPRACTIC MANAGEMENT OF ACUTE AND CHRONIC SPINE-RELATED PAIN GREGORY A BAKER DC RONALD J FARABAUGH DC THOMAS J AUGAT DC MS CCSP FASA CHERYL HAWK DC PHD TOPICS IN INTEGRATIVE HEALTH CARE [ISSN 2158-4222] ndash VOL 3(4) DEC 2012

bull CHIROPRACTIC MANAGEMENT OF LOW BACK DISORDERS REPORT FROM A CONSENSUS PROCESS G Globe MBA DC PhD C Morris DC W Whalen DC R Farabaugh DC and C Hawk DC PhD JMPT NovemberDecember 2008

bull MANAGEMENT OF CHRONIC SPINE-RELATED CONDITIONS CONSENSUS RECOMMENDATIONS OF A MULTIDISCIPLINARY PANEL R Farabaugh DC M Dehen DC and C Hawk DC PhD JMPT Volume 33 Number 7 Sept 2010

>

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Source Documents

bull ALGORITHMS FOR THE CHIROPRACTIC MANAGEMENT OF ACUTE AND CHRONIC SPINE-RELATED PAIN GREGORY A BAKER DC RONALD J FARABAUGH DC THOMAS J AUGAT DC MS CCSP FASA CHERYL HAWK DC PHD TOPICS IN INTEGRATIVE HEALTH CARE [ISSN 2158-4222] ndash VOL 3(4) DEC 2012

bull CHIROPRACTIC MANAGEMENT OF LOW BACK DISORDERS REPORT FROM A CONSENSUS PROCESS G Globe MBA DC PhD C Morris DC W Whalen DC R Farabaugh DC and C Hawk DC PhD JMPT NovemberDecember 2008

bull MANAGEMENT OF CHRONIC SPINE-RELATED CONDITIONS CONSENSUS RECOMMENDATIONS OF A MULTIDISCIPLINARY PANEL R Farabaugh DC M Dehen DC and C Hawk DC PhD JMPT Volume 33 Number 7 Sept 2010

>

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Algorithm for the Chiropractic Treatment of Spine Related Pain

bull Dictate or recommend the modality of treatmentbull Guide the management of non-painful functional or

structural spinal care (subluxation correction posture correction scoliosis management etc)

bull Apply to wellness carehealth promotion

The scope of this algorithm is for the chiropractic management of spine related

pain

It does not

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

This is a new patient

Patient presents with spine related pain

This is an established patient with a new condition or a moderate-severe exacerbation of a pre-

existing condition

This is an established patient with a mild episode of a previously

treated (usually chronic) condition

Perform New Patient Evaluation

Perform Established Patient Evaluation

Perform Evaluation1 (Often Condition Focused)

Go to Acute Care Algorithm

Go to Chronic Care Algorithm

1

2 3

4 5 6

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope of

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
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  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Patient presents with acute spine related pain

Is ConditionOutside of Scope or

Practice or Skill Set

Refer to appropriate provider facility

Is co-management required

Refer to appropriate providerfacility

Yes No Yes

Yes or No

Begin therapeutic trial of up to 12 visits within 4 weeks

Assess for improvement at mid-

point of trial using any of the accepted

measurement tools

Improvement Evident at Midpoint

Considerbull Modifying treatment methodsbull Additional diagnostic proceduresbull Referral or co-management

Refer to appropriate providerfacility

Continue TrialSymptoms Resolved

Perform Reassessment

Evaluation

Yes

Yes

No

No

Acute Care Algorithm

1

2 3

4

5

6

7

8

910

11

12

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • Slide 65
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  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

MTB Achieved

Continue up to 12 visits within

4 weeks

Yes

No

Acute Care Algorithm

Do Significant

Symptoms andorFunctional deficits

Remain

Is conditionStable or resolved

Release with home care instructions or

transition to wellness care

Trial withdrawal desired

Functionalsymptom improvements

Has condition deteriorated

Consider co-management

Provide home care instructions and initiate trial

withdrawal

Reassess condition status

Refer

Yes Go to Chronic Care Algorithm

OtherTreatment

Options availableIn this

facility

Additional improvement

likely

Refer

Yes

Yes

No

No

No

No

Yes

13 14

17

15 16

19

18

2021

22

23

24

25

26

27

Yes No Yes

NoNot Sure YesNoNot Sure

>

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Chronic Care Algorithm

bull Minimize lost time on the jobbull Support patientrsquos current level of

functionADLbull Pain controlrelief to tolerancebull Minimize further disabilitybull Minimize exacerbation frequency and severitybull Maximize patient satisfaction

Chronic Care Goals

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
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  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
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  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Patient presents with chronicrecurrent spine related pain

Do the benefits of chronic pain management

outweigh therisks

Refer to appropriate providerfacility or

provide home management instructions

Red flags present Refer to appropriate providerfacility

This visit follows a trial withdrawal and there

is a recurrence or worsening of

symptoms

This is a symptom flare for a known chronic

condition or recurrence of acute

condition

This is a scheduled visit for ongoingrecurrent care for a

patient expected to progressively deteriorate based

on previous treatment withdrawals

Traumatic cause of exacerbation

Treat according to ongoingrecurrent care

plan (1-4 visits per month) Re-evaluate

every 12 visits at minimum

Consider imaging

Mild ExacerbationModerate to severe exacerbations follow

Acute Care Algorithm

Continue

No Yes Yes

No or yes but appropriately managed

Yes

No

No

Yes

Chronic Care Algorithm

12 3 4

7

6

5 8

9

10

11 12

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
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  • Chronic Care Algorithm
  • Slide 51
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  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Slide 42
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  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
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  • Slide 57
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  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
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  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
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  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
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  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
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  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
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  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
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  • Slide 65
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  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
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  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
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  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
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  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
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  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
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  • Slide 12
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
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  • Slide 68
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  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
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  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
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  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
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  • Slide 29
  • Slide 30
  • Slide 31
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  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
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  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
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  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
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  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
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  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
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  • Slide 28
  • Slide 29
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  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • Slide 16
  • Slide 17
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 69
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
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  • Slide 49
  • Chronic Care Algorithm
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  • In Summary
  • Two Items of interest

Treat for up to 6 visits

Has patient returned to pre-episode status

Consider further diagnostic testing

DoesCondition

Worsen upon repeatedattempts towithdraw

care

No YesRelease patientProvide home management

recommendations if appropriate

Consider ongoingRecurrent care plan of 1 ndash 4

visits per month Re-evaluate at least every 12 visits

Red Flags present or other

conditions outside of scope or skill

set

Refer to appropriate

providerfacility

Symptoms

ImprovedAre ChronicCare goals being

Met

MTBPre-EpisodeStatus

OtherTreatment options

Available at thisfacility

Discontinue care and refer to appropriate providerfacility for

opinionmanagement

Treat for up to 6 visits Consider multimodal multidisciplinary care

Chronic Care Algorithm

No

YesYes

YesYes

No

NoNo

Yes

No

13

1415

16 17

18

19 20

21

22

2523

24

>

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
  • Slide 12
  • Slide 13
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

In Summary

bull Spine related pain bull All decisions should take into account provider

experience and patient preferencebull Care is appropriate provided improvement is

demonstrated andor expected

>

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • In Summary
  • Two Items of interest

Two Items of interest

Thera-band System Appeal Letters

Thank you North Carolina Chiropractic Association (NCCA)

81

wwwccgpporg

>
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Source Documents
  • Algorithm for the Chiropractic Treatment of Spine Related Pain
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Slide 11
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  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Chronic Care Algorithm
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
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  • Slide 79
  • In Summary
  • Two Items of interest

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