Practice Management – The American Chiropractor

Compass Health Brands® Acquires Leading Therapy Modality and Consumables Provider, Richmar®

Acquisition Provides Strengthened Position in the Rehabilitation Market, Both Domestically and Abroad

Cleveland, Ohio, September, 2017 – Compass Health Brands, a leading provider of medical devices used for homecare, rehabilitation, and pain management, today announced the acquisition of Richmar. Terms of the purchase are not being disclosed.

Headquartered in Chattanooga, Tennessee, Richmar is a leading developer, manufacturer and marketer of a comprehensive range of high quality devices and consumables used by therapists, athletic trainers, chiropractors, and other healthcare professionals to treat patients with musculoskeletal conditions resulting from degenerative diseases, traumatic events and sports-related injuries. Its products include Winner EVO electrical stimulation, combination, and ultrasound; Hivamat deep oscillation therapy; Hydratherm heat therapy products; Ionto+ iontophoresis and Superstim/Multistim stimulation electrodes; LidoFlex™ lidocaine patches; GelShot ultrasound coupling discs and several laser and light therapy items.

Compass Health and Richmar have both established strong positions in the rehabilitation market. Richmar has a 50-year legacy in the industry and is well-known for its quality manufacturing. Each have complementary products in the rehabilitation and pain management markets and, when combined, will offer a broader go-to-market approach through multiple sales channels. This dynamic combination is expected to provide improved value and service by rapidly utilizing the existing capabilities and product portfolios of both companies.

“We are delighted to welcome the Richmar team to the Compass Health Brands family,” said Stuart Straus, President and Chief Executive Officer of Compass Health. “The combination of our brands, teams, and resources will allow us to develop more innovative products to better care for the needs of patients and caregivers while also enhancing our customers’ business success. This strategic fit, both in the U.S. and overseas, is absolutely compelling and we look forward to further enhancing and satisfying the current Richmar distribution partners.”

“We are excited to be joining Compass Health Brands,” added Chad Morgan, President of Richmar. “Being part of such a rapidly accelerating organization will bring significant opportunities for continued organic growth and product innovation in the market segments we serve.”

Compass Health Brands’ acquisition of Richmar follows on the heels of the company’s purchase of both the ProBasics and Meridian Medical brands. The new addition of Richmar further diversifies and strengthens Compass Health Brands’ extensive and ever-growing portfolio of innovative healthcare products that promote consumer independence and quality of life.

About Compass Health Brands

Compass Health Brands manufactures and distributes a broad range of innovative and high-quality homecare, rehabilitation, and pain management products that enable consumers to live healthier, more independent lives. The company’s therapy product line includes electrotherapy, ultrasound, clinical devices, topical analgesics, conductive garments and braces, hot/cold therapy, and therapeutic pillows. Its home medical equipment line includes bath safety, personal care, durable medical equipment, support surfaces, pressure prevention, mobility, pain management, respiratory, health aids, and medication compliance. Compass Health Brands markets its products to both professional and consumer sectors. Professional brands include ProBasics, Meridian Medical, Roscoe Medical, and InTENSity, and are sold through a professional independent dealer/distributor network. Consumer brands include Carex, AccuRelief, Apex, Bed Buddy and TheraMed, and are sold through drug store chains, drug wholesalers, mass merchants, and grocery retailers. For more information, visit www.compasshealthbrands.com.

How to Avoid Associate Lockdown

:dropcap_open:I:dropcap_close:t’s no secret that only a small percentage of new grads opt for the challenge of chasing their dream and building a practice right out of school. In fact, as the leader for a company specializing in practice start-ups, I see it every day. The sad reality is that there are far more new doctors out there who are capable than those that actually attempt the endeavor. But for those that do buckle down and dig in, the end result can be very rewarding.

For that reason alone, I’m very outspoken about new graduates seizing the opportunity of launching their own practice. However, it’s my unfortunate observation that many new grads “default” to taking an Associate position due to some common fears, frustrations, and uncertainties. Some of those are justified, but many are certainly not. I use the term “default”, because, in a high percentage of the situations, it is simply not the preferred choice or original planned path.

It is clear to anyone in our profession (who actually pauses to assess it) that this common re-active approach results in many unhealthy and poorly orchestrated Associate D.C. employment scenarios. An otherwise excited, passionate and well-educated D.C. winds up in what we call “Associate Jail”. What’s that? It’s the endless cases you have probably heard of (or been in) when a doctor is captive to their circumstances … stuck in a place difficult to get out of. Not learning. Not earning. It can be very tough to endure and causes undue stress, loads of frustration, costly financial challenges, and perhaps worst of all, significant delays in your professional growth and achievements.

Even with all this said, I do suggest some consider an Associate position. Business ownership is not for all. For the sake of this article, let’s say you have considered your options, put aside the inaccurate fears instilled by supposed “experts”, and still ultimately chose to inquire into the idea of an Associate position. A thorough pursuit of establishing such a role that will be mutually beneficial for you (employee) and the owner doctor (employer) is a must.

Too many new grads jump on the first “job opportunity” that comes along. This proves detrimental in a high percent of cases, and seems to be the “norm” for Associate positions in our profession. In this article, I want to share some questions I suggest you ask as you explore the path of an Associate position.

:dropcap_open:Too many new grads jump on the first “job opportunity” that comes along.:quoteleft_close:

First, why does the owner D.C. even want an Associate? Do they really “need” one to see a higher volume of patients, cover more hours, or deliver better care? Is there some other plan? Or do they just “want” someone who will handle some of the work they prefer not to do? There is no “wrong” answer, but it would sure be nice to know this from the start.

That question leads to the next point: get clarity about your potential role. Don’t assume that, because you are a doctor, you will do just “doctor things.” The term “associate” means different things in different offices. Will you be seeing patients, and if so, in what capacity? Will that include doing consults and exams? Or covering for the employer when he/she is out of office? Will you have your own patients and do everything? Or will you only be a marketing D.C. responsible for bringing in new patients? Maybe you will simply serve as a therapy assistant or “glorified C.A.” I’ve seen each of these scenarios, and as you might expect many of them leave the Associate very unhappy and frustrated.

I’d like to have you ask this: Was the employer ever an Associate? If so, what was their experience? This might give you an idea of their personality type, and establish whether or not they will be sensitive to your position in your working relationship.

Next, you may know what you want out of an Associate position, but ask them about their expected outcome. Where is this working relationship going? What does it look like after a year, or two years, or further down the road depending on your desires.

Establish your potential employer’s experience in the role you are counting on them to fulfill – mentor, trainer, etc. After all, you are probably banking on them teaching you a bunch, right? You want someone who will lead you and prove to be a great example. So, ask how many Associates they have had. Are you going to be an experiment? Do they have a training plan or agenda set, and can you see it? This will indicate “if” they really plan to make time for that teaching aspect.

Along with that, ask if the potential employer has an office manual. This will demonstrate if the office has systems in place. Is there an ongoing coaching plan? So often there is a barrage of half-organized training when the Associate arrives in order to hand-off what the employer doesn’t want to do. Then, the training stops before any leadership, management, marketing or other business sense is really taught.

:quoteright_open:The majority of the colleges are making a good attempt to deliver more and more business acumen to their students.:quoteright_close:

Find out how much they value growth. Ask them who their coach is. What sort of continuing education or training do they do for themselves? This can be a telling factor about their work ethic and desire to create something bigger and better with you there. What is their vision for the future of the practice? And, how does an Associate (you) fit into that?

Finally, make NO assumptions about how you will be compensated. As in so many relationships, money is often the “nail in the coffin” for a frustrated Associate D.C. Inquire about the total “compensation package.” Don’t just ask about the salary. What about bonus opportunities? How about malpractice insurance? Can you write a check for such a payment (sometimes quite large) before you ever see a patient? Who will handle that? Other things that may be discussed or negotiated include continuing education, practice building seminars and coaching, benefits, and retirement.

The list goes on and on, but you will never know for sure … unless you ASK! When you are bold enough to ask these questions up front, you will likely realize that many potential employers are simply not ready for that role … at least not up to your standards. If that’s the case, move on! Just say “next!”

As a result of being part of the business curriculum at a couple of chiropractic colleges and speaking at several others, I have made an encouraging observation. The majority of the colleges are making a good attempt to deliver more and more business acumen to their students. They realize more students need more business to succeed in practice. As this happens, we expect more and more new grads will choose to go into business on their own right from the start.

So, don’t be one to “assume” you have to take 2-3 years to fill an Associate position. It’s not all it’s cracked up to be. However, if you do feel that is best for you, ask questions like those above. Interview the potential employer as much as they interview you. After all, you have worked hard for that D.C. behind your name. Don’t settle for anything less than high potential, positivity and prosperity!

Dr. Bart Anderson of HealthSource Launch U (HSLU), a specialized training & coaching program for D.C.s working to start, build, and succeed quickly in a practice they own. To date, HSLU has been involved in the launching and/or owning of over 100 combined practices. Dr. Bart speaks at numerous chiropractic colleges on a regular basis. To learn more about Launch U go to www.healthsourcelaunchu.com. Or call 888-550-3816 or e-mail him directly at [email protected]

Five Ways to Manage Clinics that Have Several Employees

:dropcap_open:I:dropcap_close:t is important to be proactive rather than reactive when addressing potential problems within your practice that occur when more than two or three people work in your clinic.

The greatest asset in a chiropractic practice is the staff. Unlike other assets, staffing is a dynamic resource in terms of productivity. The need to create the right operating environment for high productivity should be a top priority for all doctors; unfortunately, many end up losing the potency of their staffs and do not prioritize developing their staffs. These are not necessarily bad intentions or motivations, but they should be sanctioned as actual business goals. Management is obliged to integrate this with the staff in an inclusive and developmental approach to unify your practice.

Here are a few ways to establish a growing and motivational environment with your staff:

Inclusive Decisions and Directives

A common model in a chiropractic practice is a doctor-directed environment where only the needs of the patient direct the reaction among the staff. This creates a passive approach among the staff where decisions are held back until the doctor approves or disproves the action. To avert this negative approach, any development in skill, treatment methods, and patient management should be made with the staff’s full participation. This does not strip the managerial team of their authoritative rights, and it empowers them to focus on strategy while mid-level decisions are conducted according to business management goals.

Communication and Team Effort

The diversity of skill among your staff is the very reason why there is measurable success. In human resourcing, division of labor accounts for the largest degree in efficiency, the ability for all to work in a team. The passive presumption that skill diversity is categorized in levels of importance reduces the ability to communicate within the team. For instance, the most critical staff members are the doctors. Critical staff members may be at a high level of importance, but they are only effective with supporting staff for administration of the treatment, documentation, and accounting among other skill diversities. A better approach would be to regard each member as critical to the overall success of the establishment.

Transparency in Operations

Staff attitude is governed by the attitude of the doctor or management staff. This is predicated by privileged access to business operations and performance. Informing the staff with current business performance information is one way of establishing a positive attitude. This gives each staff member the confidence to respond toward the success of the business; for instance, transforming the staff into marketing agents or rewarding staff members for bringing in the greatest numbers of referrals because they believe in chiropractic to deliver results.

Unifying Purpose

Everyone needs to play their roles in the establishment of the business objective and goals, and the doctor and/or management need to connect the dots for all of the staff in regards to participation toward the business’s goals. This gives each of them purpose—a drive for the intent of establishing the success of the business. Human beings are purpose-centric, so the drive of most doctors is to relieve patients of suffering and enhance the quality of their life experiences. Should this be a unifying purpose for the business, then all the staff must relate to it, no duty should be routine or be labeled as mundane, and it must connect to the organizational goal.

Incentives

Benefits rewarded for remarkable performance is a good incentive towards an effective and efficient team. These benefits could include medical insurance, dental insurance, bonuses, gift cards, or paid holidays or personal days. This would appear as a great cost, but if one believes in the staff, which is the recommended approach, then one would not hesitate to invest in them as part of the business success.

Summary

Admittedly, managing multiple staff members requires a unique model of operation, but it should not be at the cost of large staff turnover, reducing performance rate, non-inclusive routine tasking, poor communication, or other causes springing from a lack of staff development and building. The purpose remains for the patient, but the quality of service administration lies with the staff members, who, without deliberate efforts by the doctor to grow and develop them, will inadvertently lead to poor patient administration and care.

How to Develop an Entrepreneurial Mindset

:dropcap_open:W:dropcap_close:hen you first envisioned yourself as a chiropractor, you were probably focused on the opportunity to help people who were suffering from pain. However, most chiropractors realize quickly that the lessons they learned in school aren’t enough to gain success in the real world. Chiropractors also need business knowledge and entrepreneurial spirit if they hope to run their own practices.

Of course, an entrepreneurial spirit isn’t simply born overnight. That’s why it’s so important to start developing your skills as soon as you’ve finished school. With training, passion and commitment to the field, you can develop an entrepreneurial mindset that will help you achieve success. Use the five following strategies to train yourself to think like an entrepreneur.

Shift Your Thinking

First, it’s important to recognize that you’re not actually trying to start a chiropractic practice. You’re attempting to open and run a small business. Before you can begin seeing patients, you need to complete tasks like finding an office, setting prices, hiring staff and assistants, marketing your services and working out terms with insurance companies. Whether or not you’re interested in the business side of your operation, you can’t avoid the logistical half of the job. Until you can think of your practice as a business, you’ll have a tough time turning a profit.

Consider Unique Marketing Approaches

As a chiropractor, you’ll be working closely with your patients. Your success will hinge largely on the quality of the relationships you can build. Fortunately, many of the latest trends in marketing focus on the importance of personal connections. Instead of relying on traditional advertising methods like mailers or television commercials, think outside the box. Use new media like social networking or a blog to spread the word about your practice. These approaches help you reach new customers while also helping you to hone your entrepreneurial skills.

Set Yourself Apart

Entrepreneurs know how to set themselves apart from the crowd, so you should focus on finding something that makes you unique. Whether your practice specializes in a particular healing method or whether you offer a follow-up care package, it’s essential to find a way to differentiate yourself from the competition. As you begin to think about your practice as a business, consider how you want others to think of you. These qualities and impressions can help you solidify a brand for your practice.

Manage and Delegate

Business owners understand that they can’t operate alone. Similarly, you’ll need to work with other people to create a successful chiropractic practice. Many inexperienced chiropractors suffer from an inability to delegate tasks to other people. Because they are used to relying on their own skills and knowledge, it can be tough to allow others to get involved with the practice. However, you can reduce substantial waste in your practice by hiring a small staff and delegating particular duties to each person. Best of all, you’ll free up a significant portion of your own time so that you can focus on your patients and the other most important parts of your practice.

Dream Big

Finally, remember that no dream is too large for a true entrepreneur. The entrepreneurial mindset is marked by passion, hope and big goals. Set targets for yourself and reward yourself for the small successes you achieve on the way toward your larger dreams. In school, most people learn how to fit their dreams into traditional archetypes. As you set out to build your own practice, you’ll have to train yourself to think in a less restrictive way if you hope to achieve true success as a chiropractor.

Pay Now or Pay Later…Expanding into Three Clinics and the Cost!

:dropcap_open:G:dropcap_close:ood staff will do. Imagine you were planning on building a health care empire. Would you have time to be so picky about hiring new staff that you would delay months just to find that perfect staff member? Would you have time to constantly turn over your staff? This process is costly, decreases morale, and ultimately slows you down from achieving your goal. Hire people who have the basic qualities that any employee should possess. Beyond that, it is your responsibility to see to it that they are trained properly to serve their purpose. Great companies tend to create a noticeable culture amongst their employees, and the company’s expectations and standards are built into that culture. A new employee working with such a company should quickly understand what is expected of them regarding work ethic, punctuality, detail, and customer service. Once these basics are in place, training on their job specifics is simply a function of planning and time. Be patient, have fun with them, encourage and guide them, and redirect when necessary. Remember, you are building an empire and you don’t have time to lose them and start the process over. A word of caution: If your hiring standards are too high, and so few will do in order for your company to be successful, you should reconsider your practice model. Subway was recently named the most profitable fast food chain, with locations in 85 countries, 150,000 employees, and total annual sales of 9 billion dollars 1. The simplicity of Subway’s business model has been the key to their success. If they relied on only hiring that one-in-a-million staff member, they never would have grown to the top so quickly.

Slow down to speed up. Commit early to training an associate D.C. as a future clinic director. Most clinic owners resist this step, since it usually decreases profits in the short term. Of course the associate D.C. isn’t as good as the owner, and they make more errors. However, if you are patient and dedicated to the training process, the return is substantial because it allows you to replace yourself in the business. It frees you up to spend the bulk of your time working on the business, not in the business. Is it more important that you perform the hands-on care yourself, or would you rather be responsible for exponentially more patients receiving care because of the practice you have created? Not only are extra patients receiving care, expansion also creates more jobs, and more opportunities for advancement within your company. You win, your employees win, and the patients win. Have you ever heard that learning how to play golf and tennis is a good idea, since both sports can be played into your elder years? Well, learning how to train and manage another doctor to run your clinic successfully follows the same concept. The sooner you learn this vital skill set, the sooner you will be positioned to expand more successfully. Pay for this experience now, and not later. Who knows what can happen later. You have the opportunity to do it now, so get started.

:dropcap_open:Quick response ads and spinal screenings are nothing but short-term solutions.:quoteleft_close:

Branding works, and prostituting does not. Many D.C.s that fancy themselves as marketing savvy will tell you that long-term branding is ineffective and a waste of money. This couldn’t be further from the truth. Quick response ads and spinal screenings are nothing but short-term solutions. They will not positively contribute to your company’s reputation. Think about it: You are sending the message that you need patients, and are willing to give away or discount services in order to get them. Instead, focus on developing the qualities that make your business different. Determine the best platform to send that message. Then, begin establishing relationships with as many community members as possible. Start with the most obvious sources, and go from there. Once you have reached a critical level of branding, multiple sources of referrals will consistently show up. Everything gets easier. Just as more patients attract more patients, more professional referrals attract more professional referrals. How we did it: Our branding started with informational television commercials, none of which offered discounted or free services. In addition, we began building relationships with the primary care providers and specialists in our community. As our frequency of calls increased, we had to form a separate call center which allowed all incoming calls to be funneled to a separate location. Next, we began tracking the calls, and the information that process gave us was priceless. We discovered that many patients were coming from other towns, and when it was time to open a second clinic we already had supporting data to decide on which location made the most sense.

The two step satellite process: We subleased the space of our second clinic, and began a part-time schedule there. We shared staff between the two clinics in order to minimize the transition costs. After maximizing our part-time schedule with services, we then moved to step two: Expanding into our own space within the same building, and offering a full-time schedule. This two-step plan for a satellite clinic allows you to test a new area before committing to a long-term lease, and the expenses that come with staffing and supplying a full-time clinic.

Make a strategic plan. Start with a practice model that allows for a large profit margin. For us, it was the integrated health model. Determine the best fit for you.

References:

The Editors of Publications International, Ltd. How Stuff Works [Internet]. [2007 Sep 15; cited 2013 Feb 7]. Available from: http://money.howstuffworks.com/9-most-successful-fast-food-chains.htm

Tim Gober, D.C. is the President and CEO of The Integration Group, a consulting company specializing in multidisciplinary integration for D.C.s. He is also the owner and founder of The Baltimore Pain Relief Centers. Dr. Gober can be contacted at [email protected]

Small Business Strategy: 4 Vital Tips for Success

:dropcap_open:M:dropcap_close:uch hard work goes into beginning a new business, and we all know that blood, sweat, and tears are the primary ingredients for success. However, it takes much more than that to establish a thriving business. In building your chiropractic business, many other factors also come into play. After many years of running a chiropractic business, my partners and I have come to understand that there are a few elements that are absolutely critical to becoming successful. The following four tips should help you fine-tune your chiropractic business and have your message reaching the masses in no time.

Choose your Name Carefully

First of all, your business will need a name. And not just any name, but something people will remember. A clever, descriptive name is actually a smart business strategy. The name of your business is key. Although it is difficult to come up with a name that is descriptive, yet one of kind, many people have had success with this. For example, Coca-Cola’s name comes from the coca leaves and kola nuts used as flavorings in the original drink. And Google derived its name from the fact that you can find a “Googol” of information from an Internet search engine (a “Googol” is the number “1” followed by 100 zeros.) Put much thought into your name—it is imperative that people can remember it and recommend it to others via the best kind of free marketing: word-of-mouth.

Promote your Practice

Once you have a name, you will need to advertise and market your business. Marketing is of utmost importance. Without it, there will be limited or no growth. Marketing your chiropractic business is necessary from the very beginning, and needs to be a continuing part of your overall business strategy.

Direct mail is one of the oldest and most effective ways to reach your market. You can rent or purchase a mailing list and then mail postcards to announce or promote your practice. Your mailings will go out to areas in the vicinity of your practice. Your postcard can educate the public on various treatments and services while also advertising your name and location.

In addition to postcards and mailings, the Internet is another great way to draw attention to your business. These days, people are constantly online, so having a website for your chiropractic business is essential. The website can be simple and does not need to be fancy or expensive. But even a basic website should look professional, should contain a short bio for each doctor or provider, and should list your services, address, and contact information, including email.

It’s important to remember that marketing does not stop once you have a steady flow of patients. To maintain your clients and continue to grow, you must continue to market your business from within your business. You may consider setting up a monthly theme in your office or a birthday board with patient’s birthdays posted. Periodically emailing your clients with newsletters, updates, and special discounts is another good idea. Offering occasional promotions, discounts or free screenings is a great way to attract new business and show existing patients that you care. The business strategy here is to encourage patients to strike up conversations about your business. Again, the best marketing is word-of-mouth, and it’s free!

Manage your Business

Regardless of how well you advertise your business, you will only be as successful as your management practices allow. Before you ever delve into a new business, consider the cost. Literally sit down and make a basic spreadsheet to consider the upfront cost of beginning your business. Consider your operational costs, marketing costs, and the costs of your supplies. Make certain that you have enough capital before you start.

Next, consider your cash flow. You need a steady cash flow to continue to thrive each month until your business is steady. If you need more capital or cash, consider these options: 1) Partnership. A partner can share the cost, but will also share the potential profits. Your partner also needs to be someone with whom you share mutual trust and with whom you get along well. Weigh this option if necessary. 2) Cost cutting. To cut back on initial costs, find employees–perhaps friends or family–who are willing to work for deferred salaries in the beginning. And postpone any and all purchases as long as possible.

Pamper your Patients

Most importantly, your customers, your patients, are your most valuable assets. Without them, your business is nothing. Once you have a client, you must work hard to keep him by exceeding his expectations. It’s much cheaper to keep a client than to attract a new one, so keep clients happy and keep them coming back. Your customers are also your greatest and least expensive mode of marketing. Call them on occasion, just to check on their wellbeing. Get to know them and develop a relationship with them through dialogue in the office. Treat them well and they will spread the word for you.

How to End a Roller Coaster Practice

:dropcap_open:T:dropcap_close:he January 5, 2012 CNN Money article “Doctors are Going Broke” stated, “most doctors in private practice have experienced a 10 percent to 15 percent profit leak which can lead to significant losses in their bank account.” Since 2008, the majority of chiropractic practices are down an estimated 25% or more. Unfortunately, the news gets worse. Higher gas prices and more forecasted insurance cuts will continue to create headwinds for the profession. Since the beginning of time, chiropractors have experienced the proverbial roller coaster practice. This article will provide you with information that will help put an end to the nauseating dips, turns, and uncertainties that a roller coaster practice provides.

You will only get one chance to make a great first impression and that begins with your consultation. Your consultation will literally make or break your practice. There are two reasons, in my opinion, to perform a consultation. (1) To adhere to the standards of care in case you are ever sued. All professions require that you perform the minimally acceptable standards of care. All first-line health providers are required to perform a proper OPQRST (Onset, Provocative/Palliative, Quality, Radiation, Site, and Timing) consultation and proper examination to arrive at a proper diagnosis and treatment plan. Failure to perform either the consultation or an examination will cause an almost guaranteed loss of your case.

Non-performance of a proper consultation and examination also puts you in jeopardy that an insurance company not only will not have to pay you, but can also ask you to refund monies that they have already paid. (2) To determine why the patient is really there. Our patients will tell us that they are there for neck pain, back pain, or sciatica. Please be aware that they are really there because their neck pain, back pain, or sciatica is precluding them from doing something they want to do; or they are afraid that their neck pain, back pain, or sciatica will prevent them from doing something they want to do.

Here is a scary test for you to perform. Go into your clinic after reading this article and ask yourself why Mr. or Mrs. Patient is on your table. If you get answers like neck pain, shoulder pain, or tendonitis, guess what? You missed the boat in your consultation, as you will soon see.

It is very important, especially for those doctors practicing greater than five years, to remember to be “human” and to project empathy and sympathy with each and every patient. Why even make mention of that very basic fact? After you have been practicing for awhile, and you have seen thousands of patients and their problems, it is easy for you and me to take it for granted that this is “just another case”. What I want you to remember is that for the patient, the experience is painful, scary, and upsetting. It is also the most important thing in their life at that time. For us not to give them our full attention, complete with the human caring qualities that we would want to receive, is doing our patients a terrible disservice.

The mechanics to performing a proper consultation are as follows:

Establish rapport
Establish commonality
Praise them for however they came to your office (walk-in, referral, advertisement)
Start with OPQRST
Categorize the disruption of activity of daily living (ADL)
Ask them what would their life look like if _____ went away?
Keep it human and conversational
Do not make it sound or feel like an interrogation
Be 100% present
Do not allow staff to disturb you unless there is an emergency.

In step number 5 above I suggested that you categorize the disruption of ADL. In my experience, I have found that the majority of patients can be classified into the following categories:

Other doctors that I teach have found the above table to be very helpful in figuring out why a patient is “really” coming for help. Typically, the patient has a real problem of job loss, disability, medication, etc. Or, they have a fear that if their problem continues it will lead to a job loss, disability, medication problem, etc.

During the interview with the patient, ask questions about each category and determine if it applies, if it is a real problem, or if they are fearful of the problem. You should always resist the urge to guess why they are really there. You need to know with certainty why they are really coming to you.

A great way to practice and train yourself is to role play with friends and family members. Play the game “why am I really here”? The way the game is played is have your partner choose a problem. It can be neck pain, tendonitis, or whatever they choose. Remember, the pain is precluding the patient, or the patient is fearful that the problem will preclude them from doing an activity of daily living. The object of the game is for you to determine the real reason why the patient is there. The answer will typically be in one of the categories above. Some examples of why the patient is really there that you should come up with are as follows:

The patient is here because she has a fear that her migraines will cause her to become addicted to pain meds like her mother.

The patient is getting adjusted so they can get back to exercise. Exercise is important to the patient because they suffer with depression. Exercise is the only thing that really keeps them from becoming depressed. The real reason that they are here is to give them the best opportunity to ward off depression.

The patient is getting adjusted because they are afraid that if they can’t take care of the house and kids that their spouse will divorce them.

If you are coming up with the patient is here for headaches, you have missed the boat. Go back and keep practicing.

Another good tip is to video and/or audio tape yourself performing practice consultations, as well as actual consultations. Evaluate for present time consciousness (PTC), quality of your questions, rapport skills, empathy and sympathy projection, and excitement. A great metric to use is: would you be happy if a doctor that you went to performed the same consultation in the same way? (Golden Rule)

Performing a complete consultation followed by a solid report of findings will go a long way to helping you ward off a roller coaster practice. It is important to remember that you and I treat patients, not conditions. If we offer treatments that are aimed at repairing disruptions of activities of daily living instead of symptoms, we will stand out head and shoulders above the crowd of other doctors that the patient has seen in the past. You will be the first doctor in the patient’s mind that actually listened and more importantly heard their real complaint. This will lead to more respect, more referrals, and a more solid and enjoyable practice.

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]

What Does It Take to Succeed as an Entrepreneur?

:dropcap_open:M:dropcap_close:aking the decision to open your own chiropractic practice can be both exciting and terrifying. First of all, congratulations on your decision to branch out from the comfort zone you have enjoyed while working for someone else’s practice. Taking a leap into the unknown by becoming your own boss is risky, but that risk is an essential ingredient in your success as an entrepreneur.

As chiropractors, we are more inclined towards the technical aspects of both our work and lives. Having a love for the technicalities of your work is great! This knowledge, as well as your passion for chiropractic philosophy, is what got you through chiropractic school in the first place. To succeed in running your own practice, however, you will need to harness your inner business person – and business involves both risk-taking and creativity.

If you haven’t picked up a copy of Michael Gerber’s book, The E-Myth, I would highly recommend that you do so. Here, Gerber teaches his readers to not fall victim to a common entrepreneurship myth (or, “E-Myth”). This myth tells us that if we know how to handle the technical side of our business, we have an understanding of the entire business.

A chiropractic business is more than just the technical aspect of service. While it is true that the business would not exist without the service, we have to understand how to manage a business and maintain a customer base in order to succeed. In addition to handling the patients and problems that arise in the moment, we must look ahead and plan for the future.

Success tip #1: Know what you need

Your particular skill set is what makes your practice possible, but do you have what it takes to turn your skills into a successful business? You may find it necessary to hire help for administrative duties, reception, and billing. The key here is to keep any overhead expense at a minimum. Try to hire employees who are capable of handling multiple tasks, or find software programs that can reduce and simplify administrative or billing work.

Success tip #2: Manage your staff

Until now, you have only worn one hat – as the chiropractor. When operating your own practice, however, you must also put on the “boss” hat. Though your staff may be trained in skills beyond your particular areas of expertise, it is important that you hire knowledgeable, experienced employees with whom you can work closely and trust. Ask questions and be involved with the business side of your business. It is imperative for the success of your entrepreneurship that you have a solid grasp on what is going on with your accounting books, appointments, etc. at all times. You must also work closely with your staff to ensure good morale and customer service practices. Your administrative staff will likely be the first staff members that your clients will encounter, and first impressions are everything.

Success tip #3: Market yourself

In order to succeed, you must make yourself known! Develop a mission statement that clearly conveys to your potential clients what it is that you can do for them. Reach out to the public through social media (Facebook, Twitter), radio advertisements, mailers… even go door to door. It’s important that you get creative when trying to establish a solid client base. Host an open house, develop special promotions – whatever it takes to get people walking in through your doors.

Success tip #4: Maintain your clients

:dropcap_open:Never become comfortable with the status quo.:quoteleft_close:

Once the people are making appointments, the ball is in your court. This is your time to shine with your technical expertise and ability to help others. Make customer service a priority in order to retain your clients. Again, it is key here that your entire staff is on board with keeping clients happy. From answering phones to answering questions, you and your employees should all represent your practice with eloquence, authority, and knowledge. You will find that the majority of your new business will come from reviews and referrals, so it is essential to your entrepreneurship that you maintain 100% customer satisfaction.

Success tip #5: Educate and expand

Besides recommending you to other prospective clients, happy patients can aid in the growth of your entrepreneurship in other ways. Though you may be taking care of one problem for a client, they may not realize how many other ways you can improve their health and quality of life. It is your job to educate your patrons on the various services and educational products that you can offer to them. This is a mutually beneficial tool that will both increase your revenue and your customer satisfaction.

Remember that of utmost importance in your journey into chiropractic entrepreneurship is your constant passion for your work and your business. Never become comfortable with the status-quo.To keep your practice vibrant and successful, you must always work to improve and grow your business.

Anatomy of a Practice Consultant Buyer Beware: How to Choose the Right One

Disclosure: I am a practice consultant and, after 31 years in the industry, I have been on both sides of the fence. I see and speak to many new consultants in the industry and some are excellent, yet I see many leading doctors down a “slippery slope.” Beyond the emotional choice, too many doctors do not have enough tools to make an informed choice. This document is dedicated to giving doctors additional tools to guide and protect themselves.

:dropcap_open:I:dropcap_close: am trusting, eager, believe in my “gut,” and hungry to take my practice to the next level. Therefore, I will seek counsel from many who are smarter than I and I am willing to pay for their knowledge. That was my mantra for many years and I paid handsomely for answers from consultants whom I trusted to bring me to the “promised land” of practice. At one point, I paid 7 years in a row and many, many $1000s to be guided.

My disillusionment and subsequent enlightenment came when I was assigned a consultant who constantly called me for advice on issues he had difficulties with. It was at that time I realized it was time to find a formula to make better decisions. This was a learning experience that I ignored 10 years later and, again, I spent countless $1000s based upon blind faith that brought me close to total financial ruin because the scheme created did not stand the test of time and I willingly became their guinea pig. They made money and I ended up writing checks to lawyers and carriers.

Most consultants in our profession have either stumbled upon or developed formulas in their private practices and feel they can profit from the profession by putting together a similar program in a “canned” package where the message remains constant. That in itself is not a bad thing…for today. The one constant is that everything changes, and, in today’s healthcare marketplace, those changes are occurring more rapidly than ever. Therefore, consultants need to be able to change and alter their messages to keep up with those changes. In cash practices, states are passing legislation and updating regulations on how you can bill.

Workers’ compensation practices face even bigger challenges as the rules are changing so rapidly that even the carriers can’t keep up with the changes. Many states have adopted evidenced-based outcomes as criteria for care. Others are strictly using ICD as criteria and yet others have a formula that is completely arbitrary. Then there are court rulings regarding labor issues that also have to be dealt with.

Personal injury is even more intricate. Doctors have to deal with internal insurance company rules, which are arbitrary, but have to be dealt with nonetheless. There are the state regulations and laws which do not change rapidly (except in Florida) and then there are court rulings which literally change on a daily basis, redefining how we need to conduct ourselves in our triage and paperwork. After all of those issues, lawyers representing the patients have issues that must be dealt with on a constant basis.

Managed care is usually more straightforward, yet highly secretive at the same time. The rules are clearly laid out, but they hide their fee structure formula behind a metric based upon their actuarial tables and will not divulge them. It usually requires a court order or subpoena to obtain them. On top of that, they have so many ways not to pay you, a fact you often only discover following the completion of a voluminous amount of paperwork. If you are lucky enough to get paid, you get a fee so low that if every patient was a managed care patient you’d close your doors in financial ruin.

If you have a consultant for any of the above financial classes, how well versed are they in the process they are consulting you for? I didn’t ask if they are good at getting you business because it is relatively EASY to get business and make money. The real issue is: Do you get to keep the money that you make?

A few years ago, one consultant created a scheme for cash practices and then exposed all of his clients to lawsuits for acting as insurance companies without the proper licenses.

Another consultant’s advice resulted in almost every client being sued by the carriers for improper corporate structures, costing some doctors millions in legal defense, and in the end many lost their practices. Another consultant strongly recommended the use of certain documentation to overcome the carriers’ objections in payment. One doctor he consulted with did get paid, but 5 years later the doctor was sued by the carriers, retrospectively costing the doctor close to a million dollars. He lost his practice. The consultant, who was not a doctor, walked away to spend the doctor’s hard earned money, never to be heard from during the lawsuit or any time thereafter.

How do you choose the best consultant for your practice?

Here are strong suggestions:

1. What are the qualifications of the consultant?

This is the most important issue; more so than the subject matter of the consulting program. Your consultant will eventually drive your practice. The only verifiable, valid vetting process is through the consultant’s curriculum vitae if he/she is a professional or a résumé for a non-professional. A professional CV is preferable for 2 reasons. First, you want someone who has been where you are and understands the issues from the inside out vs. a spectator who is commenting on a game he/she has no “skin” in. Second, a professional CV is a legal document that cannot be falsified, as that is a felony in most states and can be the cause for loss of license.

2. What is the experience of the consultant?

:dropcap_open:One doctor he consulted with did get paid, but 5 years later the doctor was sued by the carriers, retrospectively costing the doctor close to a million dollars.:quoteleft_close:

Is your potential consultant experienced in the specific field he/she is consulting for and for how long has he/she been one? Too many consultants are only experienced in their personal offices or ancillary fields and that is problematic. Many consultants have figured out a “scheme” to get more patients or extract money from carriers and/or patients without knowing whether or not 5 to 10 years downstream that scheme will stand the test of time and not trigger a lawsuit later in practice or retrospective audits as many schemes do. Remember, your consultant is not responsible for your actions. You have the sole responsibility and, in the end, you alone will be writing that big check for a lawyer to defend you or a refund to the carriers if the consultant is wrong.

3. Is the subject matter being taught in line with your practice goals?

Simply put, are the teaching materials offered sufficient for you to make the changes you need to positively affect your practice?

4. Has the method stood the test of time and done so in your state?

How long has this method been employed and by how many? Is it important that the consulting method be deemed successful in my state? Some programs are universal and not state-specific while others have been altered state-by-state. Time is critical to determine the success of a program, and although some “start-ups” will thrive over time, do you want to be the “guinea pig?” In some cases, the answer is yes, but be very discerning. Remember the adage of “a fool and his money..”

5. Scour the credentials of the consultants and all that work for them.

It always goes back to credentials and not just those of the primary consultant, but everyone in a consulting capacity within their organization. Be alert for telltale signs, such as improper grammar in a signature line. Does he/she sign his/her name Dr. Joe Smith DC? You can’t have a “Dr.” in front and a “DC” at the end. Does he/she consult on workers’ compensation despite having run a cash practice for an entire career? Does he/she consult on personal injury with vast experience in “on the job injuries?” Credentials do not lie. You also might end up with an employee of the main consultant working with you. What are his/her credentials?

6. Schemes

Does the consultant build an entire program around a scheme designed to confuse the carriers or alter usual and customary practice standards for you to make money? Unless the program is based upon accepted clinical and practice standards, which include documentation standards, you leave yourself exposed to huge issues downstream. Creating a scheme of “smoke and mirrors” is big in the “get rich quick” programs, and in the end they rarely stand the test of time, instead resulting in a necessity for lawyers to defend you.

If a program is centered around “busting” something vs. learning how to succeed at a higher level of clinical and business excellence, look at other professions and realize they do not have any of these programs, confirming this is just another “get rich quick scheme.”

7. Testimonials

Testimonials drive business. However, be careful as any business owner can get his/her friends to write testimonials. The key is how many testimonials are offered and is there diversity in the messages? Getting an individual referral to talk to is important, but, again, you will be handed the “cream of the crop” for that person’s business. Certifying success in this instance is more a function of sheer volume from a diverse geographical location.

Budgeting & Planning: Budgeting Includes Short and Long Term Plans

Look Beyond Next Year!

:dropcap_open:W:dropcap_close:e are very excited when we get more new patients. To get new patients, marketing is important, but financial management can be the key to successful marketing. Once you get a new patient, the key is to get them to accept care, which is the importance of a Report of Findings. Remember, no person calls you or your office without a need. The exposure you are getting for your office, for chiropractic, is exciting and the cost is minimal considering the exposure. Once an ad or a commercial is placed, hopefully your phone will ring. The key is for your staff to try to do less phone talking and instead get new patients into the office. My experience has shown me no person can close a patient better than the doctor. The amount of new patients that stay for care is where you can determine the cost effective nature of your marketing.

A good budget encompasses all the financial details of running your practice. Good budgeting goes further and projects how those details will help achieve your and your practice’s larger, long-term goals. The dual purposes of operational and strategic planning lie at the core of your success.

Look Further Ahead

Yes, in order to grow your practice your budget will need to grow. But in today’s marketplace there is no better place to invest your money than in your office. Chiropractic practice budgeting is more than a series of annual targets. The effective planning process considers strategic issues for the coming five or even ten years. This is business goal setting. Where do you want your practice to be in five years? What is your plan?

Before your accountant, manager or administrator can “run the numbers,” you must provide them with your plans, your goals for the coming years. If your budgeting and planning efforts don’t project beyond the coming year, schedule such planning sessions. Otherwise, it’s like building a bridge from one riverbank with no knowledge or concern of what’s lurking on the opposite shore. That’s exploring, not planning.

Strategic questions such as “What do we want to be doing in five years?” produce natural operational questions such as “What will we do next year to put us, or keep us, on that path?” This strategic planning step involves questions about internal (physician goals) and external (competition and other market forces) factors such as:

Do you want to make the practice larger?

If so, how? Should you add physicians? Should you increase your geographic market, perhaps with an additional office? Should the practice introduce new services you’ve referred out in the past?

What competitive threats exist or are likely to develop? How can you react to them or eliminate them?

Budget Mechanics

Next, begin the traditional budget mechanics. Have your manager start using the budget framework to attach numbers to agreed upon ideas and goals. We’ll look at the following different budget components in greater detail in the coming months:

1. Revenue budget. Looking at past data and projecting forward, how much revenue does the practice except from insurance payments? And what about managed care plans, prepaid HMO contracts, patient co-pays and self-pays, receivables on the books and the prospective sale of any assets? Well-researched revenue budgeting explores all likely income sources.

2. Expense budget. The health care services you render cost money to provide. You must meet fixed, variable and “semi-fixed” expenses to keep your doors open and the revenue coming in.

3. Capital budget. Small and mid-size practices (even many larger ones) rarely develop capital budgets. Nor should they. But for larger practices, capital budgeting can be an important part of the overall process and an alternative to borrowing.

4. Profit plan. This integrates the revenue and expense budgets to show net income for the practice. Some groups even start the budgeting process by deciding what take-home pay their doctors should receive and then work back up the line to project the revenue needed to produce that profit.

5. Cash budget. The cash budget details the anticipated cash flowing through the practice. Net charges and actual revenue don’t march in step. Prepaid contracts, workers’ compensation and outside referrals can create a significant short-term difference between what you’re due and what you actually receive. And cash outflows like malpractice premiums and meeting travel may vary significantly from month to month. The cash budget helps keep you on top of your practice’s monthly cash needs.

6. Balance sheet. The balance sheet puts all the revenue and expense data together and projects the practice’s assets and liabilities—essentially a snapshot of the practice’s financial health—at the end of the budget year.

7. Review, revise. After you put the collected information into an initial draft, the crucial review process begins. Are the numbers accurate to the best of your forecasting ability? Are the forecasted results good enough to support the practice and meet the needs of the physician owner(s)? If you project these numbers into the future, will the practice likely stay on track toward achieving its long-term goals? Was anything inadvertently left out?

Project some problems

Consider the financial implications of falling a little short, or a lot short. That raises the issue of whether a budget should represent your best projection of what will likely happen, a “stretch” goal to strive for, or a near worst-case scenario that will still meet the needs of the physician owner(s). We’ll focus on that issue next month when we examine the planning process.

Regardless of the approach you choose, instruct your manager to run some good, bad and middle-of-the-road scenarios so you know what to expect if the unexpected happens. But, if you carefully gather your information, project reasonably and don’t get blindsided by external changes, budgeting shouldn’t provide too many surprises. And that’s the point of the entire process.

Dr. Eric S. Kaplan, a former President COO of a NASAQ traded public company, which included Nutrisystem, Currently he is CEO of Concierge Coaches, Inc., www.conciergecoaches.com, a comprehensive coaching firm with a successful, documented history of assisting doctors create profitable practices nationwide, providing over 30 New Patient marketing Programs. Teaching doctors nationally how to develop a successful business in the health care industry of today. Dr. Kaplan is the best selling author of Dying to be Young, and Lifestyle of the Fit and Famous and Co-developer and President of Discforce and Palm Beach Massage Centers, www.pbmassage.info, the next Generation Chiropractic Practices, massage and Spinal decompression For more information on coaching or spinal decompression, call 1-561-626-3004.