Category: Other Articles

:dropcap_open:W:dropcap_close:hat is the chiropractic profession’s position when it comes to treating scoliosis? What have our chiropractic universities taught us? Are we only treating subluxations and not the scoliosis? Are we adjusting for symptoms and not trying to correct the scoliosis? Why does the scoliosis patient live if there are extreme subluxations? 

 

Scoliosis is an abnormal curvature of the spine diagnosed as being more than a 10-degree Cobb angle. Horizontal vertebral body baselines are drawn on the superior and inferior aspects of the most tilted vertebra, and a perpendicular line is drawn to intersect. This angle is measured and that is the Cobb angle.

 

The standard medical treatment is to watch and wait from 10 to 25 degrees, brace it at 25 degrees, and perform surgery at 40 degrees.

 

Doctors of Chiropractic are frequently the first opportunity for patients to receive a scoliosis screening and it should be part of the chiropractic examination, especially with children from 10 to 15 years old. 

 

The Scoliometer is an inexpensive tool to do this measurement and is more accurate than the Adams test.  

 
:quoteleft_open:Some cases of scoliosis respond well to standard chiropractic treatment and some do not.:quoteleft_close:

It has been stated that scoliosis affects 4.5% of children1,  12% of female college students2,  25 – 30% of the general population3,  and 68% of the population over sixty years old4.In 2000, an estimated 2.7 million patient visits were made to American chiropractors for scoliosis and scoliosis-related complaints5. Charles Lantz, DC states, “Full-spine chiropractic adjustments with heel lifts and lifestyle counseling are not effective in reducing the severity of scoliotic curves.” 6 

 

Some cases of scoliosis respond well to standard chiropractic treatment and some do not. When they don’t respond, are we obligated to refer scoliosis patients to an orthopedic surgeon for bracing or surgery?

 

CLEAR Scoliosis Institute is the only organization in the chiropractic profession dedicated to finding an effective alternative to waiting, bracing, and surgery.

 
What are the options?

• Do a scoliosis screening on all your patients. Scoliosis accelerates at 11.7 years of age.7 The Adams test is ineffective8 because once the rib hump is present, the scoliosis is above 30 degrees. Use a Scoliometer and check posture, stance, and gait.

• If there is a scoliosis, do not adjust the “high side of the rainbow.” Do not perform posterior to anterior thoracic adjusting.9

• Monitor the scoliosis. Perform the Scoliometer test on every visit. Re-exams and x-rays should be done every three months.

• ScoliScore is a saliva based genetic marker test that will predict within a 99% certainty if an existing scoliosis will progress.10 It is applicable to a scoliosis from 10 to 25 degrees and for a child 9 to 13 years old.

• Communicate with the orthopedic physician about the case and your treatment plan and goals.

• Consider referring the patient to a CLEAR certified scoliosis doctor. This doctor will evaluate the patient and establish a treatment plan to reduce and stabilize the scoliosis. The CLEAR doctor will then work with the referring doctor to co-manage the patient.

Doctors of Chiropractic should be the spinal experts. Instead of referring the patient to an orthopedic doctor for bracing or surgery, consider an inter-professional referral to a CLEAR scoliosis doctor.

Chiropractic first, drugs second, surgery last!

References

1. The etiology of Adolescent Idiopathic Scoliosis Am J Orthop 2002 Jul;31 (7) :387-95 Ahn et al, New Hampshire Spine Institute
2. “Scoliosis screening of 3,000 college-aged women. The Utah Study – Phase 2”, Brigham Young University, Provo, UT, Francis RS. Phys Ther 1988 Oct;68(10):
3. Chiropractic Technique: 1920, BJ Palmer
4. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Schwab F et al. Department of Orthopedic Surgery, Spine Service, Maimonides Medical Center, Brooklyn, NY, USA. fschwab@ worldnet.att.net Spine (Phila Pa 1976). 2005 May 1;30(9):1082-5
5. Ref: Christensen MG, Kerkhoff D, Kollasch MW: Job analysis of chiropractic 2000. Greeley, Colorado: National Board of Chiropractic Examiners; 2000
6. Effect of Chiropractic intervention on small scoliotic curves in younger subjects: A time-series cohort design. JMPT 2001 Jul-Aug;(6):385-93, Lantz CA, Chen J.
7. Maturity Assessment & Curve Progression in Girls With IS J. Sanders et al, Journal of Bone & Joint Surgery, 2007
8. J Pediatr Orthop. 1995 Jul-Aug;15(4):535-8.
9. Posterior to Anterior Thoracic Spinal Adjusting in the Scoliosis Patient Is Contraindicated By Spinal Biomechanics Dr. Dennis Woggon, BSc, DC, CLEAR Institute, http://clear-institute.com/docs/PosteriorAnteriorThoracicAdjusting.pdf
10. “Prediction of scoliotic cobb angle with the use of the Scoliometer” Spine, 1996 Jul 15;21(14):1661-6
11. www.axialbiotech.com

Dr. Dennis Woggon is the Founder and Director of the CLEAR Scoliosis Institute. You can find additional information at www.CLEAR-Institute.org. Dr. Woggon can be contacted at [email protected].

:dropcap_open:W:dropcap_close:e are all familiar with the National Board of Chiropractic Examiners (NBCE) and the existence of National Boards parts I, II, III, IV and P.T. for students in the doctor of chiropractic program. However, no such assessment has existed for general employees in chiropractic offices that aid in the performance of physiotherapy modalities on patients until now. Standards of excellence in chiropractic now extend to our chiropractic assistants.

 

Concerns surrounding chiropractic office employee training escalated from what is known as “incident to” concerns, which stemmed from the interests of third-party payers who were being billed for services performed by office employees that did not have documented training. In 2008 the American Chiropractic Association (ACA) and the Federation of Chiropractic Licensing Boards (FCLB) asked the postgraduate subcommittee of the Association of Chiropractic Colleges (ACC) for recommendations surrounding chiropractic employee training to help address this issue. 

 

The request was prompted by the above-stated “incident to” issue regarding untrained staff performing billable modalities. But even more important were the concerns of the FCLB surrounding patient protection, safety and office liability. From 2005-2007 alone, NCMIC reported that 5.1% of chiropractic claims stemmed from burns to the patient—clearly a result of modality use. It is important to note that the majority of these reports may fall under the vicarious liability category, which means that the supervising DC is liable for the actions of their employees.

 

Since the time that the issue was brought forth, the FCLB has been working diligently to find a solution. They have implemented a Certified Chiropractic Clinical Assistant (CCCA) application process as well as guidelines that are now in place; the very first CCCA examination was scheduled for March 1, 2013 and is now available online.

 

The creation of the CCCA application and test process is a “win” for the profession on a multitude of levels. Not only does it increase patient safety, it also promotes credibility within our profession and provides a tangible process for third-party payer criteria.

 

Just as importantly, it provides professional credentialing and validation for the important work that our CAs do every day with our patients, something that has been missing for many CAs. Certification will increase patient-care standards and satisfaction, improve interactions and increase the CAs self-worth for the job they perform for you. Ultimately, certification will further streamline your office operations and cut down on office turnover.

 

Start by visiting the FCLB website at www.fclb.org for information about the CCCA program application process and for links to approved programs such as www.CCCAonline.com. The FCLB application fee includes eligibility determination, records management, the examination, and a photo ID badge. Plus, with Internet-based testing, the process is extremely affordable and convenient.Online training programs in particular make high-quality training affordable and convenient. Proof of training or equivalency is required as part of the application process. At www.CCCAonline.com, learners can engage in a streamlined, 24-hour training program that meets or exceeds FCLB guidelines in every area of study.   

 

Invest in your office today by validating your CA. Full price for training is an affordable $339 for the entire 24-hour program. Plus, www.CCCAonline.com has special discount programs available for Congress of Chiropractic State Association (COCSA) members, participating colleges and other organizations. Ask your local COCSA chapter for your specific discount code. Not a member? If you have received this article through The American Chiropractor Magazine, you can still enjoy a discount. Have your assistant use AMCHIRO as your discount code. When this code is entered during the registration process, it will automatically provide a $15 discount off the regular price of the program through July 31, 2013.

 

Learners can expect text, images and schematics, dynamic video lectures and robust, customized, experiential, inter-activities in a thorough, 19-module program. Plus, an extensive note packet of nearly 200 pages is included and can be downloaded, printed and studied offline. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an email at [email protected]. 

 
Laurie Mueller, DC served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010, served as the ACC Post Graduate subcommittee chair for six years, peer reviewed for the Research Agenda Conference and wrote the informal role determination study that aided in the development of FCLB’s guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solution and subsidiary www.CCCAonline.com. She is a clinician, an educator and an expert in online educational pedagogy.

:dropcap_open:B:dropcap_close:eing a chiropractor is fulfilling for me because I know I am helping people. I am helping a runner find her stride again after an injury. I am helping a father pick up his kids again without pain. I am helping a senior adult stay active and continue to live a healthy lifestyle. I am sure you have also experienced the joys of being a chiropractor and you have witnessed the benefits of chiropractic care. Let’s discuss ways you can encourage your patients to live a healthy, chiropractic lifestyle.

 

As healthcare providers, we have the important job of making sure we listen to patients, administer the proper care and relieve patients’ pain so they start to feel better again. Our goal is to help them perform as optimally as possible and it involves teamwork between the doctor and the patient. We guide patients in healing, while they must, in turn, do their home care and perform any exercises we recommend. 

 

Once patients are out of pain and discomfort, they may feel as if they have their life back again. We encourage them to perform their everyday activities like exercising, playing golf or going places with family. We are extremely pleased when our patients begin feeling better, and eventually they tell us they feel “normal” again. But our responsibility to the patient does not end there.

 

I believe in the importance of a relationship with my patients – one that is deeply rooted in trust and understanding – on the first day I meet them. I explain and educate them on their ailment, the treatment and what they are expected to do outside the office to help get them better. This expectation I have of patients taking care of themselves follows them throughout their lives, even after we have stopped active care. 

 

As much as we hope that our adjustments hold forever and our patients continue to feel better, the reality is that, inevitably, the body will need check-ups every so often. Life circumstances often arise that can cause your spine and other joints of the body to become stressed and thrown back out of alignment. 

 

It’s imperative to talk to your patients about the significance of regular spinal check-ups – just like they benefit when a dentist cleans their teeth or a mechanic changes the oil in their car. Regular chiropractic maintenance can help patients avoid major problems before they happen. Unfortunately today’s medical world has taught patients that they should only seek the care of a doctor when they are in pain. They don’t realize that healthcare providers can help them maintain a healthy lifestyle if they would take care of themselves and regularly visit a chiropractor.

 

Help Patients Do Homework 

We have to help patients take care of themselves through proper nutrition and exercise. This includes talking to them about their diet and how much exercise they do. You may feel like you are stepping across a line into their personal lives, but you are not. It’s your job to find out why they feel the way they do, just as if you were taking a clinical history or list of symptoms. Understanding how a person eats and whether exercise will tell you a lot about a patient’s health. 

 

If while talking to a patient you discover that she doesn’t like to exercise because she’s embarrassed to work out in front of others. This is when your job title may change from chiropractor to cheerleader. Educating your patients on the proper exercises will empower them to achieve their goals (core workouts for a new mother who wants her body back, etc.). Giving positive feedback with facts about their health is always a good place to start. 

 

:dropcap_open:Having an honest discussion about the physical effects of stress can go a long way toward helping a patient change his/her behavior.:quoteleft_close:
Besides what they eat and how they work out, there is another important factor in deciding our patients’ health: lifestyle stress. Ask your patient about his day and how he likes his job? You will find out more than you might expect. You could discover that he is stressed over a work project that has been making him work long hours and causing stress at work and home. You will see that this stress will have an impact on his physical self. You can determine where he carries stress in his body and help correct that with an adjustment.

 

You can’t change someone’s personality. But you can make a difference by talking about the important link between stress and a patient’s health. Explain that being stressed causes physical problems that you can help to alleviate, but the only person who can control the stress is the patient. Having an honest discussion about the physical effects of stress can go a long way toward helping a patient change his/her behavior.

 

One of the questions patients ask me is, “Why can’t you just put me back in alignment and it stay that way? Why do I have to come back every so often?” It’s clear what the answer is and how we can respond to our patients’ similar questions. The reason why chiropractic adjustments do not hold forever is because you go out and live your life. 

 

When you think about it, almost every single job or daily activity can have an effect on the alignment of the spine and extremities. Even though we encourage patients to exercise to stay healthy, it can cause stress on your body that needs to be addressed. The body reacts by moving out of alignment and your muscles spasm, which causes swelling, pain and discomfort to return. Does that mean patients shouldn’t exercise? No. Stress is a normal part of life; the point is that patients can do something to keep it from negatively affecting their body and their health!

 

Some patients are able to hold their adjustments longer than others. Certain patients may only come in for an annual check-up, because they exercise and do things that keep them strong. Other patients may come back every two weeks, because their daily routine is so physically demanding that they are thrown out of alignment quickly. It all depends on genetics, the commitment to home exercises, and lifestyle. You will work with your patients to discover the optimal frequency they should be for coming back to the office for spinal tune-ups.

Dr. Kevin Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him, and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or [email protected].

 

:dropcap_open:M:dropcap_close:ost people who want to burn fat and lose weight assume going to the gym and doing traditional aerobic exercise like jogging on the treadmill is the best way to see results.  But recent research is proving long distance cardiovascular exercise is NOT the fastest way to burn fat and lose weight.  

 

If you’ve been spending hours on the treadmill and not seeing any results, it’s because long distance cardiovascular exercise can decrease testosterone and raise your stress hormone levels like cortisol1. Increased levels of cortisol stimulate the appetite, increase fat storage, and slow down or inhibit exercise recovery.

 

A recent study in Psychoneuroendocrinology showed evidence of long-term high cortisol levels in aerobic endurance athletes.  Researchers tested levels of hair cortisol in 304 endurance athletes (runners, cyclists, and triathletes) and compared to non-athletes.  The results showed higher cortisol levels with higher training volumes 1. 

 

The Journal of Sports Sciences found that long periods of aerobic exercise increased oxidative stress leading to chronic inflammation2. 

 

If you want to see results fast without the negative benefits of cardiovascular exercise your best option is burst training3. Burst training (aka interval training) combines short, high intensity bursts of exercise, with slow, recovery phases, repeated during one exercise session.  Burst training is done at 85-100% maximum heart rate rather than 50-70% in moderate endurance activity.  

 

Similar exercise methods to burst training include High Intensity Interval Training (HIIT) and the Tabata method.

 

With burst and other types of interval training you are getting the same cardiovascular benefits as endurance exercise but without the negative side effects. 

 

Essentially, burst training is exercising like a sprinter rather than a marathon runner.

 

One of the major benefits of burst training is that it can be done in the comfort of your own home with no or minimal equipment.  An example of burst training would be going to a track and walking the curves and sprinting the straight aways.  Or getting on a spin bike and cycling hard for 20 seconds then going easy for 20 seconds then repeating that effort for between 5 to 40 minutes.

 

Burst (or interval) training isn’t necessarily new. Elite athletes and Olympians have known this secret to exercising and have been doing interval training for years. The research proves that anybody – not just elite athletes – can do interval training and achieve amazing results.

 

Research from the University of New South Wales Medical Sciences found that burst (interval) cardio could burn more than 3 times more body fat than moderate cardio. The researchers studied two groups and found that the group who did eight seconds of sprinting on a bike, followed by 12 seconds of exercising lightly for 20 minutes, lost THREE TIMES as much fat as other women, who exercised at a continuous, regular pace for 40 minutes 4.

:dropcap_open:The reason burst training works is because it produces a unique metabolic response in your body.:quoteleft_close: 

The reason burst training works is because it produces a unique metabolic response in your body. Intermittent sprinting causes your body to not burn as much fat during exercise but after exercise your metabolism stays elevated and will continue to burn fat for the next 24-48 hours!  

 

Also, chemicals called catecholamines are produced which allow more fat to be burned and this causes increased fat oxidation which drives greater weight loss. The women from the study lost the most weight off their legs and buttocks.

 

Another study published in the Journal of Applied Physiology, April 2007, researched eight different women in their early 20’s. They were told to cycle for 10 sets of four minutes of hard riding, followed by two minutes of rest.

 

After two weeks, the amount of fat burned increased by 36 percent, and their cardiovascular fitness improved by 13 percent 5.

 

Key Benefits of Burst Training:

If you want an incredible burst training program to follow check out www.burstfit.com.

 

Dear Dr. Axe, In the last 6 weeks I have lost 37 pounds. I have incorporated your exercise regimen with burst training. I’ve also been working on incorporating as much real food as I can in my diet. Lost 4 inches in my waist during these last 6 weeks. It has been so invigorating to do things properly and healthy and get super results! I’m a 5’9” male and six weeks ago I was 276 pounds, 47” waist. Today, I am 239 pounds with a 43” waist. Thanks for all the valid exercise and nutritional information!    Sincerely, Jeremy H.

 

 

:dropcap_open:A:dropcap_close: funny thing happened at the office …

 

One Florida afternoon I was doing my utmost to provide excellent service for the client sitting across from me.  I’d chided her for months, every time we met, about her ongoing reliance on Mayo Clinic doctors for health care that was costing her a fortune and wasn’t doing any good.  Today I was pleased to learn that she was paying attention, finally. She’d been consulting a natural wellness practitioner whom I’d recommended and reported that she was noticing a difference.  I mentally patted my back.

 

BUT …  and there’s always a but … because she was now going the alternative care route and incurring out of pocket cost, the question she posed to me that afternoon was “Is there an insurance plan that covers these treatments?”   I replied, “That is a very good question, my friend.  Let me check into it and get back to you.”

 

That was 1998.  The concept of insurance that covered alternative wellness care seemed brilliant.  I began an exhaustive search across the country and back, to find any insurer anywhere that would cover natural treatments for a diagnosed illness, beyond the usual minimal coverage for massage, chiropractic visits, and infrequent acupunture.

 

The result of my search?  Zilch !  Not even one insurance plan existed.  I found one union self-funded plan in California that covered more natural wellness modalities than insurance did, but you had to be a union worker living in California to participate.  My search came to a dead end.  And tremendous disappointment.  Why not, I wondered. Why didn’t such a plan exist?

 

I  began formulating in my mind what an insurance plan should look like, if it were to cover natural and alternative health care treatments.  This came easier for me than it might have for an agent with a typical health insurance background, for two reasons:

 

1) One consequence of my going ‘above and beyond’ for clients was making enough ruckus to get the attention of people other than front line customer service stiffs, who answer the phones at Big Insurance.  I was tolerated by staff members involved in the meat – underwriting, actuary, claims, etc.  I ended up absorbing health insurance’s inner workings.

 

2) I had a long time aversion to traditional western medicine and, at the time, a 17-year history of successfully self treating my own family’s occasional illnesses via nutritional methods.

 
The two backgrounds gave me the basis for what was to become Aegis Insurance Solutions. As time passed, the idea became more than a daydream … I jotted notes whenever a brainchild manifested, and began organizing them.

Meanwhile, as the turn of the century arrived, I watched health insurance deteriorate from a once utile product into an increasingly unaffordable, increasingly gutted, barely recognizable shell of its original format. Premiums climbed at an alarming pace to keep up with skyrocketing claims experience.

Health care costs, escalating at 500% of normal inflation, threatened to bankrupt the country. Actuaries predicted that health care would gobble 1/5 of the country’s entire GDP by the year 2013, if trends didn’t change. Health care surprised even the actuaries by beating projections two full years, usurping one in every five dollars spent in the U.S. by the end of fiscal 2011. How is that even possible ?

Well, for starters, over the last decade traditional medical care providers have driven claims costs (translate insurance premiums) through the roof with outrageously priced, ineffective treatments. Add to that prescription drug prices which increase quarterly, since Congress lifted the ban on television drug advertising in the late 1990s.

Insurance companies fought hard to contain costs by eliminating covered services, increasing deductibles and co-pays, increasing premiums, etc. They got tough on network fee schedules and lost significant network provider membership as a result. Meantime, insurance premiums tripled anyway since 1998. And an ever increasing population (near 50 million at last count) goes uninsured. The national healthcare forcemeat, Obamacare, has zero power to tame the monster because it has zero provision for cost containment.

It became painfully evident that something had to be done to reverse health care trends because insurers were literally drowning in costs. Health insurance companies began jumping ship in droves at the turn of the century, realizing there was simply no way to be profitable anymore. And consumers suffered.

Compare consumer choices for health insurance today with the 1990s versions. Insurance agents in that era offered clients a selection of health plans from dozens of insurers. Competition was fierce to provide the best benefit package for the smallest price. Ten years later, the choice of insurers shrank to a half dozen. Benefits vanished, premiums grew unaffordable, employers dropped coverage. Yet Obamacare’s solution is to compel people who can’t afford coverage to buy it anyway, or pay a hefty penalty.

Believe it or not, insurance companies laid the ground work for today’s disaster by unintentionally eliminating personal responsibility for health care decisions and spawning over-utilization of benefits. How on earth did they accomplish all that? By implementing plans in the mid 1980s that covered almost unlimited medical care for minimal co-pays.

One could logically ask how insurers could make a mistake with such profoundly disastrous consequences. It evolved almost overnight, due to fear. Cancer shock-loss claims were increasing at an alarming rate, with no upper end in sight. And despite new admonitions by the American Cancer Society about the importance of early detection via preventive screening, Average Jill refused to undergo screening because she had to pay for it. Insurers desperately needed a plan to encourage early diagnosis, to slow the avalanche of new cancer claims.

So insurers caved and came up with first dollar insurance coverage as incentive for obtaining preventive care. They couldn’t have anticipated how quickly policyholders would develop a new mentality – “Why should I care how much my healthcare costs?” “I pay ten bucks for a doctor visit. Instead of buying Desitin for the baby’s rash, I’ll take her to a pediatrician and get a prescription.”

Insurers inadvertently created an insurance gremlin that mutated into a monster before they had the first inkling of the damage it would do. But that’s just part of the story. Western healthcare practitioners are not without huge blame for the crisis that evolved. They have more than a decade of experience now, gouging insurance companies at every opportunity.

Example – doctors once required annual office visits to reauthorize a patient’s prescription. But when insurance began first dollar coverage, doctors began requiring that patients show up quarterly to get the same prescription reauthorized. After all, the patient had little out of pocket cost – no sweat off his back!

Some doctors identified opportunities to become real estage magnates at the expense of insurers (translate–premium dollars paid by you and me.) They erected labs and free-standing surgical facilities, rather than rent privileges at the local hospital, because they could bill insurance to cover the new mortgages while increasing their net worth. Doctors began ordering endless streams of unecessary tests and performing unnecessary surgeries to generate fees, since patients didn’t have to pay. Buildings got built while dollars poured into coffers like water roaring over a dam.

Because I believe that a higher standard of ethics exists in the natural wellness arena of the healthcare universe, it was a surprise to watch even wellness practitioners make an occasional grab for a slice of the new insurance pie. My own massage therapist charged self-pay clients $65 per hour and historically refused to accept insurance. But now she decided to accept insurance because she could bill $150 for people injured in vehicle accidents – providing the exact therapy I received at $65 per hour. During one visit, she bragged about her newfound wealth.

Make no mistake, I understand a fair charge to cover the cost of generating a bill. Billing and waiting for payment costs money. But charging 130% over the fee for cash clients isn’t fair. After seven years of routine therapy, I was suddenly compelled to find a new massage therapist.

A local chiropractor charges cash patients $35-$65 per (follow-up) adjustment visit, based on ability to pay – admirable. But he bills insurance $120 for the same visit – not admirable, not fair, not ethical. That drives up the price of MY health insurance.

Recently I stumbled into an insurer’s worst nightmare. I used a Groupon to try a local massage therapist for the first time. Massage therapy is so beneficial I’ve opted to self pay for routine visits the past fifteen years. In addition to monthly visits, I make a point to obtain treatment from new therapists often, especially when traveling. It keeps my neck and shoulders from tightening up, after dozing in uncomfortable seats hours on end. (Thai massage is best so far!)

:dropcap_open:Hospitals bill insurance 300-500% over actual cost of providing care and, for some services, even 1000% mark-up.:quoteleft_close:
After my massage therapy was complete (excellent work), I considered scheduling another round. The desk clerk inquired if I’d had massage therapy before. I replied, “hundreds of times.” She asked if had insurance she could bill. I informed her there was nothing wrong with me – no diagnosis. She then lowered her voice to inform me that the doctor could create a diagnosis. I could come in for more frequent massages, paid by insurance. I was astounded.

Not only did she encourage me to cheat my insurer by submitting a fraudulent claim. She was clueless as to the fact that ANY diagnosis affects my future insurability for years, and maybe even permanently. Not just health insurance, but disability income insurance, life insurance, long term care insurance, etc. She could do me lasting harm by falsifying a diagnosis.

Astonishment gave way to disgust. I held my tongue and left, but I won’t go back. Note to self – that practitioner will not be part of the Aegis provider network.

I’ve related how so many allopathic practitioners and even some natural wellness practitioners contributed to today’s crisis in U.S. health insurance. But when we examine the contribution from privately owned hospitals, we discover they are greedier – by light years – than any individual practitioner. Hospitals bill insurance 300-500% over actual cost of providing care and, for some services, even 1000% mark-up. Consider too that these are supposedly not-for-profit organizations !

The federal government allows hospitals 4-5% over cost under existing national health care (Medicare). Medicare determined that a not-for profit entity can cover cost and make a reasonable profit at that reimbursement schedule. Yet, in fiscal 2005-06, a group of seven U.S. catholic hospital systems in the southwest netted a profit of over $2 billion (and all in the name of Christ). No income taxes due, no sales taxes due, no property taxes due – zero taxes on two billion dollars. Hospitals more than make up for stingy government pay schedules by gouging private insurance. And they laugh all the way to the bank, while your insurance premiums spiral and your benefits shrink.

After nearly 20 years of battling the monster that insurers birthed with first dollar coverage plans in the mid 1980s, health insurance companies are still at a loss as to how to even begin to bring it under control, much less how to reverse damage done. They’re fresh out of ideas and have no clue what to do next.

Aegis does! And ironically, the solution is first dollar coverage! Sound ludicrous? It isn’t, when you know what we know. The ONLY solution to greed in traditional health care, to outlandish insurance premiums, to a shrinking selection of insurance plans, is a first dollar insurance plan which promotes natural wellness and alternative treatment. It’s so simple it’s brilliant – the ONLY way to fix the mess is to facilitate good health.

Why does that work? Because making someone well brings an end to insurance claims. Claims become finite, rather than chronic, lifelong, and increasingly expensive.

A good side effect – because natural wellness is nondestructive, the body suffers no damage. Thus it averts potential additional costs associated with treatment of bad side effects that often result from dangerous allopathic methods. Even the most oblivious insurance underwriter understands that if you heal a man, instead of just treating him, you put a finite dollar amount on that man’s claim, which eventually results in reduced insurance premiums.

Increasing numbers of enlightened patients today prefer treatment with more effective alternative methods, but insurance won’t pay. When patients can’t afford self-pay, what are their options? None. They revert back to traditional care that insurance WILL pay for. So by refusing to pay for alternative natural treatments, traditional insurance perpetuates the problem it desperately wants to resolve. More doctor visits, more tests, more procedures, more drugs, more side effects – same routine, same results. People remain ill … claims experience continues to accelerate.

Health insurers not only can’t fix it – they exacerbate the dilemma of spiraling claims experience by encouraging over-utilization through faulty plan design. With the health insurance crisis becoming an unbearable burden on the financial resources of this country, our alternative insurance plan is the only logical, viable, long term solution. Our plan solves ALL current problems in health insurance:

First, we don’t accept bills from practitioners. Every insured pays for his care at time of service, and then submits his own claim for reimbursement. Thus we eliminate the need for our provider members to hire staff to track insurance billing and make it possible for them to charge a universal fair fee for service rendered. Requiring patient payment for service also restores personal responsibility for the cost of the patient’s health care, by making him aware that there is a price for unwellness – that there is indeed a correlation between his personal financial health and his lifestyle choices.

Second, we don’t negotiate fees with our network providers, making membership in our network desirable. This creates excellent choices for our insured members when they need care. We prefer a network replete with the best practitioners, so insureds have access to the very best wellness care. When you’re the best, you’re worth what you charge. Your patient/client gets well – our customer’s claims costs are finite.

Third, we make it financially appealing for our insured members to seek natural wellness instead of consulting traditional practitioners because we want them to get well – not to be in treatment. Because we make it inexpensive for members to obtain natural care and (very) expensive for them to obtain allopathic care, we control the cost of care. In the end, reduced cost always means lower premiums.

Fourth, in the employer group health arena, we actually refund large chunks of premium at the end of a plan’s fiscal year to insured employers whose group health plan design encourages employee wellness. Their claims costs are dramatically lower than employers who fail to differentiate between traditional care and natural treatments. So we offer handsome rewards to employers who help improve the bottom line.

Until now, Aegis has offered coverage only to employer groups. But the winds of change are blowing. In the near future we’ll introduce an individual insurance plan in most states, which covers the full spectrum of natural and alternative treatments. Of course we include coverage for traditional care when it’s required. If you fall off your bike and break your arm, we wouldn’t penalize you for practicing healthy living.

:dropcap_open:I:dropcap_close:f you accept insurance, you are a target of the insurance carriers on many levels. First, you cannot be “Pollyannaish” and think that because you are a “healer” or help people on so many levels you are deserving of the fees you get. That is not part of the equation. Your patient has a contract with his/her insurance company and your claims trigger provisions in his/her contract for you to get paid. Nothing more or less.

 

Due to the fact that this is about contracts and contract law, there are many ways to interpret the language within those contracts. Lawyers hired by the insurance companies have made a “cottage industry” out of using the courts to redefine the agreements to secure additional profits. The carriers have been so successful that they have retained some of the best firms nationally to ensure increasing profits. The carriers are now utilizing “old” technology created for their benefit with a twist to further increase their bottom line at your expense: IMEs and Peer Reviews. 

 

The IME or independent medical examination and peer review processes are necessary and integral steps in maintaining a system of checks and balances in health care billing in order to prevent unnecessary care. Over the last two decades, the system has evolved to where too many doctors who are hired by the carriers through an IME company (middle man) or directly by the carriers are not performing examinations that are remotely close to independent. Two decades ago, some of the facts reported were not accurate, leading to desired conclusions. Today, it is a rarity to see the facts represented accurately, based upon this author’s 31 years in the industry reviewing IMEs and peer review reports nationally and polling treating doctors and lawyers from coast to coast.

 

Over the years, it has been my experience that too many IME companies have handed doctors completed reports, mandated diagnoses, misquoted research and/or given strict orders regarding the scope of care permitted, all prior to the examination. In almost every instance I have encountered, the carrier or IME company has offered to send the doctor more cases if he/she works with them to reach a desired conclusion, whatever that may be.

 

This is one of those scenarios where you need to be ready. This is also where the 5 P’s (proper planning prevent poor performance) come into full effect and you have to ensure that your documentation infrastructure, knowledge base and credentials are strong enough to meet the challenges of today’s marketplace. Basically, if you want to keep your hard-earned money rather than allow a predatory insurance carrier to, in essence, “steal your money” on what could be considered a technicality, misstating the facts or errors of omissions, then you must be prepared.

 

As a profession, we are not prepared to meet the challenges in today’s marketplace to ensure that we get to keep well-deserved fees paid for honest and ethical services delivered. I have been witnessing that fact for almost a decade while working with and teaching doctors nationally. We are simply not prepared as an industry to compete with the insurance industry…yet! 

 

A modest sampling of the profession in early 2012 revealed the following: 

Fact: Right now, the carriers are ordering IMEs and peer reviews, which is nothing new. HOWEVER, based upon the independent medical examiner’s or peer reviewer’s often improper results, the carriers are demanding repayment of claims already paid to you and hiding behind the third party reports (IMEs and peer reviews). We (field doctors) can all agree that MANY of those reports are a work of either fiction, partial truths or outward fabrication of the history, clinical findings or test results and treatments rendered to reach a desired conclusion of non-necessity.

October  08, 2012                                                                                               Auto Claims                                                           P.O. Box 10000                                                           Atlanta, GA 3000-0000 RE: Claim Number:         Date of Loss:                               July 7,2011         Our Insured:         Patient Name:         Policy Number:   To whom it may concern:   Our policy provides coverage for charges incurred for reasonable and necessary medical expenses. An independent medical examiner reviewed the treatment bills, records and rendored his medical opinion that some of the services rendered were not reasonable and medically necessary.   Based on the examiner’s consultation and review and all other information known to date, All Farm Insurance Company will be unable to consider the medical charges in question as they have been deemed not medically necessary.   AllFarm Insurance Company has previously made payments to your facility after September 9,2011. The independent medical examiner deemed any treatment past this date not related, reasonable or medically necesary to the motor vehicle accident  that occured on July 7, 2011. At this time, we are requesting reimbursement for all payments made to your facility after September 9, 2011 payable to AllFarm Insurance Companye as payments were issued in error for services not reasonable and medically necesary.   Please forward reimbursement with the claim number printed on the attachement to : AllFarm Insurance Company PO BOX 10000 Atlanta, GA 00000   Should  you have any questions, please contact me at the number below.   Sincerely,   AllFarm Insurance Mutual Automobile Company

 

One doctor on the east coast just received the above form letter.

AllFarm Insurance Company contends that these payments were made in error based upon the IME doctor’s report. That is not true. AllFarm Insurance Company found a method to turn the “hands of time” backwards and utilized a loophole in the ability to take money away from the doctor to realize a windfall profit…at our expense. When the treating doctor examined the IME doctor’s report, it was fraught with a distorted history, omissions of positive test results and improperly reporting that a complete physical examination was performed when the patient and a witness in the room verified that many of the negative reported tests were never performed.

Solution: The ONLY solution is to be able to effectively rebut the IMEs and peer review reports. The doctor who received this acknowledged that he must fight this in order to keep his money and to ensure that he doesn’t continually fall prey to AllFarm Insurance Company as an easy target in the future. He also realized that in order to fight this request to repay the carrier that he has to be credentialed in the subject matter(s) in contention. In other words, if the carrier is denying care based upon the MRI results, then the doctor must have credentials in MRI interpretation to understand and be able to refute the conclusions. A complete record must also be maintained with appropriate re-evaluations every 30-45 days as prescribed by the Medicare standard, which is followed by most carriers nationally. In almost every case where the IME or peer review rebuttal was overturned, the doctor was credentialed through post-doctoral education (CE courses) in MRI, accident reconstruction, neurology, orthopedics, biomechanics, triaging the injured, sports injuries, etc. The credentials needed should reflect the type of practice you have.

Recently (October 2012), a doctor from Florida told me that as soon as he accurately rebutted a peer review denial based upon the facts of the case, citing the actual facts of the research considered by the peer reviewer, while removing any emotion in the rebuttal, the carrier instantly reversed their decision and authorized more care than he requested. They were afraid that he was going to follow through with his promise (not threats) to expose the illegalities of the carrier’s hired IME hand to the licensure board and state’s attorney general. The carriers are acutely aware of the issues and are concerned that this will become public and cost them. This doctor, in spite of the carrier reversing their decision, will still be going after the peer reviewer (DC) who falsified her report. These doctors need to be taken out of the system and deserve to have their licenses considered by the states for their actions to make money at the expense of the patients that are being hurt. That can only be done with rebuttals that are factual and by utilizing the laws within your state to ensure we all, treating doctor and independent examiner alike, adhere to the same practice and reporting standards. Although third party doctors have different “duty of care” standards in certain states than treating doctors, we all have the same licensure requirement to be factual in our reporting. The lack thereof constitutes both licensure infractions and possible negative legal implications of fraud.

As of now, there are very few doctors nationally that are successfully overturning negative improper IMEs. This is because most doctors simply do not understand the process. To learn more on how to do a proper rebuttal, Google “IME rebuttal” and get educated on how to be successful in defending your practice, your reputation and your money.

In addition, you must, must, must get credentialed. If you have been sitting on the fence, now is the time. MRI spine interpretation has become a critical component to the denials because the carriers’ hired doctors are often “spinning the facts” in the results that have direct impact on the necessity of your care. To be qualified in refuting these issues, get credentialed. Do a Google search for “MRI spine interpretation.” The same applies at every level of your practice.

They’re coming…ARE YOU PREPARED?

What it Means if you’re already using EHR software…and What It Means if you’re Planning to start This Year

:dropcap_open:C:dropcap_close:MS recently released its final rules for Stage 2 Meaningful Use under the American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

At more than 600 pages, the rules are extremely detailed. Initial reactions are fairly positive, and it appears that CMS took into account the comments provided on the proposed rules by groups like the ACA and individual providers.

Here are 9 key takeaways from the newly released rules:

Under the proposed rules, providers were to progress to Stage 2 Meaningful Use criteria after two program years of meeting Stage 1 criteria. For example, Medicare providers who first demonstrated Meaningful Use in 2011 would need to meet Stage 2 criteria in 2013. CMS has now delayed the onset of Stage 2 criteria so that the earliest a provider would have to demonstrate Stage 2 criteria is 2014.

Note: Providers who were early demonstrators of Meaningful Use in 2011 will now meet three consecutive years of Stage 1 criteria before advancing to the Stage 2 criteria in 2014. All other providers would meet two years of Meaningful Use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year.

2. Three-month EHR Reporting Period for Stage 2 in 2014 Only
Those who completed their first year of Meaningful Use in 2011 or 2012 will only need to complete 90 days of Stage 2 Meaningful Use in 2014.

Note: This 90-day Stage 2 timeframe is ONLY for those who successfully demonstrated Meaningful Use in 2011. Then, in 2015, these providers must complete a full year of Meaningful Use. Those who begin Stage 1 Meaningful Use in 2013 will complete their first year of Stage 2 in 2015 and will be required to do so for the entire year. 

 

This Stage 2 90-day timeframe is separate from the first-year Stage 1 90-day timeframe. All providers who begin Stage 1―no matter what the year―will only have to complete 90 days of Stage 1 Meaningful Use their first year.

It should be noted that while Meaningful Use only needs to be demonstrated for three months, you still have the full 12 months to accrue Medicare-eligible allowed submitted charges to maximize your incentive amount.

Although some Stage 1 objectives were combined or eliminated, most of the Stage 1 criteria continue in Stage 2, and some menu-set criteria have become core objectives under Stage 2. For some Stage 2 objectives, the threshold percentages that providers must meet for the objective have been raised.

To demonstrate Meaningful Use under Stage 2 criteria, providers must meet 17 core objectives and three menu objectives, for a total of 20 objectives. For the menu objectives, providers must select three items from a list of six options.

Physicians must report on most all 17 core objectives:

 6. Clinical Quality Measures (CQMs)

All providers are required to report on CQMs in order to demonstrate Meaningful Use. Beginning in 2014, all providers—regardless of their stage of Meaningful Use—will report on CQMs in the same way.

 

Providers must report on nine of 64 total CQMs. In addition, all providers must select CQMs from at least three of the six key healthcare policy domains recommended by the Department of Health and Human Services’ National Quality Strategy, which include:

One of the most controversial rules has to do with providing patients with the ability to view, download and transmit their health information. As such, providers must move forward with a patient portal, such as a PHR like Microsoft HealthVault or an actual portal to their EHR. 

 

This is a significant change from Stage 1, and it will take a significant effort to educate patients and get them to initiate the exchange. In the final rule, CMS lowered the threshold to 5% and added a “broadband exclusion” for rural areas with limited broadband access.

 

Because secure messaging has to be initiated by patients, providers will be challenged to educate patients on the availability of secure messaging as a communication option, and it remains to be seen how feasible that will be. In short, it is feasible but may be a challenge for DCs who are less technically savvy.

 

With the goal of furthering interoperability, the proposed rule sought to ensure that providers were exchanging health data with users of other EHR vendor systems and with other organizations.  

 

CMS will require providers to conduct one or more successful data-exchange tests with a “CMS designated test EHR” during the EHR-reporting period. According to CMS, the intent of that proposed rule is to foster electronic exchange outside established vendor and organization networks. 

 

In the final rule, only one demonstration of this cross-vendor organizational capability is required. This will be a one-time test for the whole year and should be an easy criterion to perform and cross off to achieve compliance for getting the incentive.

 

One Stage 2 core objective is to use secure electronic messaging in order to communicate with patients on relevant health information. A secure message must be sent using the electronic messaging function of Certified EHR software to at least 5% of unique patients you see during the reporting period.

 

If you have not yet started Meaningful Use, the most you can now receive is $39,000 (from a previous high of $44,000). But you must begin Meaningful Use by October 2013 to collect up to $39,000.

 

If you start after October 4, 2013 and before October 3, 2014, you can qualify for up to $24,000.

If you do not start by October 3, 2014, you will get zero dollars.

 

Many DCs lament that they need to make more money. Compliance with this program will take several hours of work—most of which can be performed by staff—and  DCs can collect up to $39,000 per provider over the next five years, with $15,000 allowed for just 90 days of effort in 2013 for first-time meaningful users.

 

Ninety percent of Meaningful Use criteria can be performed by staff. More than 4,896 DCs are scheduled to complete attestation for 2012 with over 1485 already successfully paid for  Meaningful Use. Most of those DCs received the maximum amount of $18,000 for their first year of Meaningful Use. This is a golden opportunity to inject more than $2 billion into our profession.

 

Take advantage of something all healthcare providers are implementing anyways: EHR will soon be a standard of practice. You can do it with training, determination, and simply taking your first step.  Choose to do it now and get paid for it, rather than being forced to do it later with no incentive money. You can be a leader or a follower.

Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future Health, the nation’s #1 provider of chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR (electronic health records) and the up-to-$44,000 ARRA incentive program to implement EHR.

Dr. Kraus has served―and continues to serve―on numerous committees and boards, including:

• ACA Computer & Technology Advisory
• ACA Legislative Commission
• ACA Quality Assurance and Accountability Committee

He lectures to state associations and at industry events regarding EHR and the relationship to documentation, and he presents monthly webinars on how EHR usage will impact doctors of chiropractic. For more information, visit www.FHeConnect.com/1074 or call Toll Free 1-888-919-9919, ext. 652.

 

“Make a positive impact on each person you interact with daily.”

:dropcap_open:T:dropcap_close:hat is a difficult task, but it is one that the late Kirk Lee, DC, accomplished with grace and poise. Dr. Lee will be remembered for more than just his work in the chiropractic profession—which is significant—but also for his positivity that lit up every room he entered. His presence and cheerful attitude could make a bad day turn good and a good day even better. He was more than a chiropractor, an instructor and a writer; he was a loving husband, doting father, proud grandfather and beloved friend. Dr. Lee will be missed by all who knew him, and his legacy of practicing kindness will live on through those who had the pleasure of knowing him.

 

Dr. Lee was known for his chiropractic expertise in the field of sports injury. He wrote countless articles on the topic, especially those related to running. He was a seminar speaker for Foot Levelers, Inc., for more than 15 years. He brought not only knowledge and experience to these seminars but also his warmth, humor and compassion. He conveyed more than words on a PowerPoint slide to his students; he taught them by his actions how to find the good in every situation, in every person, every day. His optimism and gratitude cannot be forgotten. He always found a way to make someone laugh or charm them with his sense of style or brighten their day with a kind word. He knew that being a chiropractor was more than being a healer and used his profession to help others not only with his hands but also with his words and actions.

 

He did not do just what was expected of him; instead, he exceeded expectations by always doing more than required. He served on multiple boards, clubs and chiropractic associations, usually in a leadership role. As a graduate of Palmer College of Chiropractic, Dr. Lee was a member of the post-graduate faculty at both Palmer and Parker and was the former president of the Michigan Chiropractic Society (a precursory organization of the Michigan Association of Chiropractors (MAC)). He received numerous awards for his dedication and diligence to chiropractic, including “Chiropractor of the Year” in 1998 and the MAC “Pioneer Award” in 2010 for continued service to the chiropractic profession on the state and national levels. 

 

Dr. Lee is survived by his wife, Terri Jo; his two daughters, Elexis and Elyse; one grandson, Dylan; and one grandchild on the way. 

 

We felt the best way to remember Dr. Lee is to hear how he affected those who had the pleasure of working with him and calling him friend:

 

“The supportive members, dedicated leadership, and loyal staff of the Michigan Association of Chiropractors are deeply saddened by the loss of our dear friend and colleague, Dr. Kirk A. Lee. Although our grief is all encompassing, we are comforted by our fond memories of Kirk and our sincere appreciation for all he contributed to chiropractic. 

 

“First and foremost, he lived for his family. He was a wonderful, involved father and husband who put his wife and girls above all else. His love for his profession, his friends, and his colleagues was clearly evident to all who knew him. His volunteerism with his state associations and national speaking engagements is unmatched, and his accomplishments too numerous to list. He is remembered as one of the most important architects of our merger, and one of the most effective association leaders ever to serve in our state.

 

“We are blessed with memories of his kindness, honesty, unbelievable work ethic and love for his profession. Always positive and ready to share a laugh, Kirk was a true friend to all who were lucky enough to know him. We will always remember his cheerful ‘Hi, Honey’ when he called the MAC office and his ability to warm our hearts. Many will also remember his stylish flair, including his fancy suits, bow ties and suspenders.

 

“Although he is no longer in our vision, he will always remain in our hearts and minds. We love you Doc. May you rest in peace.”

 

— The Michigan Association of Chiropractors

Reflections from Foot Levelers Staff Members

“Dr. Lee was a very humble and generous person. I never heard him utter a bad word about anyone or anything. He really did care about people and put others’ needs ahead of his. He would gladly stay after a seminar to talk to the doctors attending. We were honored to have him as a featured speaker in our speakers’ bureau for more than 15 years. He was an expert in sports injury, but he taught doctors so much more. He was a true gentleman and will be missed.”

:dropcap_open:A:dropcap_close:s a chiropractor I use lumbar braces on my patients a great deal. I experience wonderful success in my therapeutic results as well as very strong financial re-imbursement, especially from Medicare. I believe that every chiropractor should be a certified DME provider for Medicare; it just makes good sense.

 

In the use of good quality lumbar bracing that is approved by Medicare (the only ones I will use) it is important to document in the patient’s chart why the brace is given and its effectiveness.  A physician must and should expect good results and the chart should reflect those results.

 

I happen to like using functional testing to establish the need for and the effectiveness of any procedure I deliver. This is especially true in lumbar bracing. The “Get up and Go” test delivers on both points. This test paints a picture of the patient’s functional status (for example: stability) that medical reviewers or even laymen can understand. There are many other ways to document but this particular test is especially effective.

 

In the Journal of Rehabilitation, Research, & Development¹ the authors, James C. Wall, Phd. et al., explain at length “The Timed Get up and Go Test.” Other great sources are an article in the Journal of American Geriatric Society², written by authors Podsiadlo and Richardson, as well as an article in the Arch Phys Med Rehabilitation³, courtesy of authors Mathias, Nayak, and Isaacs.  

 

For the purposes of a chiropractor or therapist testing a patient here is how the test is conducted:

The total time it takes a patient to perform the task should be 10 seconds or less. Any time over that is abnormal, with any time over 20 seconds being very significant.

1. Wall JC, Bell C, Campbell S, Davis J. The Timed Get-up and go Test Revisited: Measurement of the Component Tasks. Journal of Rehabilitation Research & Development. 2000 Jan;37(1):109-114.
2. Podiadlo D, Richardson S. The Timed ‘Up and Go’ Test:  A Test of Basic Functional Mobility for Frail Elderly Persons. Journal of American Geriatric Society. 1991; 39:142-148. 
3. Mathias S, Nayak USL, Isaacs B. Balance in Elderly Pateints: the ‘Get Up and Go’ Test. Arch Phys Med Rehabil. 1986;67:387-389. 

:dropcap_open:L:dropcap_close:et’s face it; there is much uncertainty that plagues not only our profession, but the world economies at large. Add into the mix $65 co-pays, decreasing insurance reimbursement schedules and the new Obama-Care Health Law, and it’s no wonder chiropractors are losing sleep.

This article will walk you through the uncertain economic maze and give you clear-cut strategies you can utilize so, no matter what happens to insurance, you will be in a profitable position to deliver great chiropractic care to your patients.

In this economy it is imperative that your attention turns to “the business of chiropractic”. Before you hang me in effigy, please understand that running a business and turning a profit is not bad or evil. If you want to do pro-bono work then by all means do so. Remember that your electric bill, rent bill and every other bill you have will come due each and every month. If you do not have the funds to pay your bills, you will go out of business and not be able to take care of anybody. So, like it or not, you are going to be forced to at least earn enough money to pay your bills. Since you have to earn money anyway, why not maximize your return on investment and earn as much as you ethically and legally can?

The first key to running a successful business is to understand basic business principals. You should be able to generate and interpret the following reports: profit and loss statement, balance sheet, cash disbursements book, and the creation of budgets. If you are not familiar with these accounting reports then my suggestion is to enroll in some basic business classes to acquire these needed skills. Another good way to become familiar with these reports is by using accounting software. There are several excellent programs that will create the reports for you, but as my father always used to tell me, “Numbers must mean something;” therefore, you must be able to interpret what the numbers mean.

The next recommendation is to keep meaningful statistics on your practice. If you fail to keep good records, how can you possibly determine if your marketing efforts are working? I recommend that you keep monthly and year-to-date stats of the following: month worked, days worked, new patients, office visits, avg. people per day, services rendered, income collected, PVA, average income per visit, and accounts receivable.

Now that we have the foundation for running a business we need to turn our focus to creating a practice that will run in an insurance or non-insurance environment. This step is imperative for our profession’s continued success. In my opinion, the handwriting on the wall regarding insurance reimbursement is not looking too good. Let me cite a couple of insurance examples to make my point:

In October, 2011 the North Carolina Bar Association Health Benefits Trust started charging a $65 co-payment for specialists on their Blue Options Plan 4 insurance plan.

In May, 2013 Florida passed a new No-fault law. The new bill provides strict and rather biased definitions of what constitutes medical treatments and covered injuries. Accident victims now must seek medical treatment within a narrow 14-day window from the accident and only from specified licensed medical physicians. Acceptable treatment providers include emergency services determined by a physician, osteopath, dentist, physician’s assistant or registered nurse practitioner. Chiropractor visits are limited to $2,500 and can only be sought after a referral from an acceptable health care provider.

Remember, as one state changes, other states follow suit. How far behind do you think your state is?  Do you know what the definition of a $65 co-payment is? The answer: A CASH PRACTICE.

What I have been teaching my clients and what I hope to teach you, the reader, in this article is how to insulate yourself and your practice against these insurance changes that are coming very quickly down the pike.

:quoteleft_open:If you fail to keep good records how can you possibly determine if your marketing efforts are working?:quoteleft_close:

All consumers will pay for something that we feel has value. If we sincerely believe that our purchase will help enrich our life, we will spend money on it. Our patients and potential new patients are no different. If your care will solve their problem and enrich their lives they will be able to find the money to afford your care. When a patient tells you that they can’t afford your service, what they are really telling you is, “YOU did not create enough value to allow me to give you my money.”

Let me give you an example. When was the last time that a homeless, destitute person came to your office seeking care? 99.9% of you will answer never. The other .1% will answer maybe once in my whole practice career. Why don’t homeless, destitute people come to our offices seeking care? The answer is because they know that they cannot afford our service. Any patient that walks into your office knows that they will incur an expense of some kind. Whether that expense is in the form of a co-payment, full payment, premium increase, etc., they know and understand that payment of some kind will be required. Once they walk through your doors it is up to you to create value to enable them to want to stay and have you fix their problem. If you master the skill of creating value for your patients, it will not matter to you if insurance pays 0% or 100% or anything in-between. Your patients will know and understand and want to pay you for your service.

You may utilize the following checklist to help insulate yourself if insurance reimbursement goes away:

The final piece to the puzzle is to be prepared. All of healthcare, including chiropractic, is going to go through some tremendous changes in the next few years.  Living in fear or denial will not help you or your practice. If you believe that insurance reimbursement is going to deteriorate further, you must begin to do things in your practice differently NOW. When change is inevitable it is imperative that you institute and adopt the changes as quickly as possible. Proactively making necessary changes instead of reacting to change will allow you to stay ahead of the curve and remain profitable. If you don’t know where to begin or what to do, ask a colleague who has achieved what you want to achieve.  If you don’t, have a friend or colleague who can help you seek professional help from a practice management firm.

Dr. Paul S. Inselman, President of Inselmancoaching, is an expert at teaching chiropractors how to build honest, ethical, integrity-based practices based on sound business principles. From 2008-2012 his clients practices grew an average rate of 145% while the general profession was down 28%. His 26 years of clinical experience coupled with 10 years of professional coaching has allowed him to help hundreds of chiropractors throughout the nation. He can be reached at 1-888-201-0567 or [email protected]