Category: Practice Management

Q: There is a lot of confusion about medical integration these days.  It can be a frightening thing for some, due to some negative national publicity.  What is the latest on chiro-medical integration?

A:  There are two seemingly divergent trends that are affecting the practice of chiropractic today.  The first trend is consolidation.  Approximately 30 percent of medical physicians remain in private practice.  The group medical practice has become the most common model for the practice of medicine.  This trend is now becoming the common tendency in the practice of chiropractic.  Chiropractors across the country are finding safety in numbers.  They understand that consolidating services in the form of joint practice is a more cost-effective, stable manner in which to deliver health care to the maximum number of patients.

The trend of consolidation is very visible in the increasing prevalence of multidisciplinary practices across the country.  One-stop shopping, where patients can receive multiple types of health care services at the same location, is an important trend to recognize.  A decade ago, multidisciplinary practice was a luxury and an interesting adjunct to a chiropractic practice.  Multidisciplinary practice is no longer new, is no longer radical, and is no longer a luxury.  The trend of multidisciplinary practice consolidation extends beyond the combination of physical medicine services under one roof.  Multidisciplinary practices in the future will include multiple healing modalities, including nutrition, therapeutic massage, acupuncture, and other disciplines.

This trend is most appropriately referred to as diversification.  Multidisciplinary practices provide a consolidation of location along with a diversification of services delivered at that location.  This highly coordinated, cost-effective manner of delivering patient care will become the primary paradigm for the practice of chiropractic in the decade ahead.

Diversification of services to include active care, diagnostic testing, multiple specialties, including sleep medicine, psychiatric medicine, podiatric medicine and other alternative healing modalities, is the vehicle in which healthcare will be delivered in the future. 

Dr. Mark Sanna is the CEO of Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and multidisciplinary practices throughout the country.  He can be reached at Breakthrough Coaching, LLC, by calling 1-800-7-ADVICE.

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas is being dealt with sequentially in The American Chiropractor.  By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

6. Multitask for Better Business:

Doctors need to multitask.  Irrespective of the size of their clinic, a doctor must be a businessman as well as a practicing healer.  A clinic needs a budget, a market analysis with projections and goals, and statistical breakdowns by department.

• Budget: The clinic director needs to devise a quarterly plan showing expenditures, revenues and renewal expenses (fixed and variables).
• Market Analysis: This will devise a structured fee schedule for all services according to zip code driven usual and customary fees.
• Projections: From the budget, money and allowances need to be set aside for marketing and any other ventures.
• Goals: Timely goals (daily, weekly, monthly, quarterly and yearly) must be set.  These need to be reasonable and attainable.  Unrealistic goals are ludicrous.
• Statistical Breakdown: (by department)

Billing: January ’04 = $60k     Goal-January ’05 = $80k
New patients: January ’04 = 30     Goal- January ‘05 = 40
Collection: January ’04 = $40k     Goal -January ’05 = $50k

The bottom line is, you must have a well-structured business plan to succeed.  The best part is that it’s not difficult, and, as a multitask professional, it should be easy.  A great venture to start off the New Year.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email [email protected] or visit www.dahan.com.

We’ve headed into a new year and, with that, we’re offering some great advice from the experts! We’ve asked ten of them to answer what they feel are the most important questions to help you advance your practice. From focusing in on who you are as a doctor to over-all advice to the entire profession, these experts have the answers to help guide you through 2005 and beyond.

Tip #1 – Dr. Larry Markson / The Masters Circle

Q: What should I DO to get more new patients and what should I DO to get them to comply and stay longer?

A:  I have been answering that question in person, on the phone and from the stage for 25 years or more, and every other “authority” on practice building has been “doing” the same thing.  Yet, in my opinion at least, the same question will be asked until the end of time.

Why?  Because there is no good answer to a bad question—it is never about what to DO that makes a person successful and happy, it is always about WHO to BE!

You see, all of the “do’s” often are not effective until you take a look at the “who”—who you are as a person and who you are as a doctor.  Simply stated, “Who you are determines how well what you DO works.” It is the WHO, not the DO!

Success is a result of who you BE—your securities and insecurities, your belief systems, your ability to communicate, to influence, to be decisive, to change, to motivate, to organize, to make people like themselves better.

Success is, in fact, very personal.  It is about your clarity, your congruency, your determination, your guts and audacity to be different and to stand for principles that separate you from tasks and procedures (the doing part).

To grasp this concept, I offer the following in evidence.  Three DC’s participate in a Health Fair. Are their results the same?  When one doctor purchases another’s practice (same staff, hours, fees, procedures), doesn’t the volume shift up or down?  Why does one doctor collect 100% of their fees and another 50?  Why do partners in the same practice have different volumes and results?

Because it is not what you do, it is who you be that is responsible for attracting the people, places, circumstances and events that contribute to your success.

For more information on Dr. Larry Markson, The Masters Circle, visit www.themasterscircle.com, or phone 800-451-4514.

Tip #2 – Dr. Pete Fernandez / Fernandez Consulting

Q: My practice is on the brink of bankruptcy. What can I do to avoid it?

A: That’s the most common practice problem I’ve been asked about in the past 12 months. All of the doctors had a large patient volume (250 to 400 per week), few new patients per month (10 or less), and small monthly incomes ($1,000 to $12,000).

They also:

• only accepted patients who agreed to one year treatment plans. 
• discounted their fees by approximately 50%.
• were adamant about not treating patients for pain.
• were positive that they would finally make money if they increased their patient visits by another 100 to 200 per week.
• were determined not to change what they were doing.

Their “my way or the highway” attitudes eliminated those patients who chose not to pay for a year’s care, and drove off the type of patients who are a practice’s biggest referral centers (called retro-flectors, in psychology).  The only patients left were easily compliant—patients who don’t refer much—thus, very few new patients.

These doctors didn’t understand that a 50% discount of fees made it impossible to meet their overhead expenses.  And, they failed to recognize that a practice’s overhead increases proportionately with increase in patient volume (extra CA’s, etc.).

Their answer was to drop their hard-headed “I’m right and I’ll prove it” attitudes, and be open minded to different, common sense practice procedures.  In other words, be willing to change.  Those DC’s who refused to change, failed.

To use the words of my good friend, Mark Victor Hansen, “If you keep believing what you’ve been believing, then you’ll keep achieving what you’ve been achieving.”   If your practice isn’t what you want it to be, it’s time to make some changes.

For more information, email [email protected].

Tip # 3 – Dr. Daniel H. Dahan / Practice Perfect

Q: What would you say is the most important accomplishment for a chiropractor?

A:  There is nothing more gratifying then having patients refer friends and family members to your practice.  Indeed, the highest compliment anyone can pay your center is to promote your services to the point of actually producing new patients.  Doctors, by nature, are passionate about their work and love to give.  Hence, what can be more fulfilling than to build a practice largely on internal referrals?  However, aside from the doctor’s ability to diagnose properly and treat with fervor, following is a list of “ attributes” necessary to achieve that goal.  To make it easy to remember, use the following mnemonic: “ DEAL WITH ME”.

D= Devoted to the patient’s health care needs
E= Enthusiastic each day to spread goodness
A= Appreciation for the privilege to heal
L= Love each individual genuinely

W= Warmth to be infused in each treatment
I= Intense: The trademark of your personality
T= Tenaciously resolve to heal everyone
H= Humane and caring, the only way to act

M= Motivate, inspire and persuade more people to come to you.
E= Enjoy the benefits and the right to be successful

I must admit that I have not found anything to be more true, in my last 16 years of guiding over 4,700 doctors, than these focused and factual directives.

For more information, call 888-67-DAHAN, 888-673-2426 (toll free), or visit www.dahan.com.

Tip #4 – Dr. Maurice A. Pisciottano / Pro-Adjuster

Q: How effective is your documentation?

A:  All practitioners seem to have their own ideas as to what constitutes effective documentation. It is paramount, in today’s healthcare and insurance arena, that medical necessity be established for each treatment procedure rendered, in order to have those completed procedures become reimbursable. For documentation to be complete, treatment needs to be recorded.  However, the rationale for the treatment must also be present in order that a clear picture exists that the treatment was not only done, but that it needed to be done in order to achieve a specific, pre-planned functional outcome.  It is important to understand that medical necessity is not something that the doctor decides about his treatment validity. It is an already-established standard for healthcare.  Medical necessity precedes all treatment.  It is the process of determining what will happen from the examination of the patient through their release.  It is a pre-determined “roadmap” of the rationale for your treatment, how it correlates to the patient’s diagnosed condition, and the expected outcome as a result of doing that treatment.

For more information, call 724-942-4284 or visit www.pro-adjuster.us.

Tip #5 – Dr. Dallas Humble / Dallas Humble, Inc.

Q:  What is anti-aging and how does it fit into the chiropractic model?

A:  Anti-Aging is a new specialty in the health field. The public is demanding more methods that are focused on looking better and feeling better than ever before. You do not stop the aging process, but you can slow it down. Age related diseases are in the focus of the fight against aging. The chiropractic profession is in a great position to take advantage of this trend.

Q:  How can anti-aging benefit a practice?

A:  Simple. The answer is new patients. Patients pay for what they want as opposed to what they need. With the baby boom generation aging, this trend is becoming more the rule rather than the exception. If the chiropractic profession wants to thrive in the upcoming years, this is the way to do it.

Q:  Give us one way to attract new patients?

A:  Target obesity. People are more overweight now than ever before. Every DC should have a weight loss plan within his/her office that can assist the patient in reaching their optimum weight. I advocate the Internet to do this. With technology the way it is, you can educate the public in a way that has never before been possible. I train doctors to market and offer an Internet-based weight management business for their patients. The attraction is nothing less than phenomenal and the benefits to the practice bottom-line will make you smile.

Dr. Dallas Humble is the President of Dallas Humble, Inc,. and a co-author of The YoungSlim Lifestyle. For more information, visit www.dallashumble.com or call 1-800-282-1947.

Tip #6 – Greg Stanley / Whitehall Management

Q: What do you feel indicates a healthy growing practice the most?

A: If I’ve learned one lesson about practice management in 25 years on the consulting front lines, it’s that there is no more important indicator of your practice’s prospects than your monthly direct patient referrals. It tells you how well you’re u meeting your patients’ expectations. There are really only two kinds of chiropractors, those that understand this and those that don’t. The ones that don’t will spend a frustrated 41 years in practice, constantly in pursuit of enough new patients to survive.

The doctors who suffer from low monthly referrals actually believe that they are cursed with the gift of only being able to attract patients that just don’t get it. Patients that are only interested in pain relief.

If you’re getting less than 15 direct patient referrals each month, your offering of service, price and convenience only qualifies you to appeal to less than half your potential market place.

If your monthly direct patient referral number exceeds 25 and you’re not growing, you can bet that your problems are delivery-related as opposed to demand-related. Monthly patient referrals are the “North Star” of practice management: Unchanging and worth setting your course by.

For more information, contact Greg Stanley, Whitehall Management; phone, 623-934-2108; or email [email protected].

Tip #7 – Dr. Timothy Gay / Ultimate Practice Systems

Q:  How we can utilize staff and chiropractic assistants for new patient referrals?

A: Every day in your office, your staff may be missing many new patient opportunities. The single most important thing that your staff has to think about is education of the current patients and listening to their needs. The patient that understands the reason “why” they continue to come in for chiropractic care is the patient that will be referring their family and friends. Chiropractic assistants need to be educated by the doctor as to the importance of patients staying on schedule and minimizing idle chit chat. Patients and staff build the relationship based upon the patient’s results and the services that they receive. A well educated and caring staff can help you build an internal referring machine, simply by giving out appropriate information and staying focused on the patient and what they truly need. The simplest technique is to educate and ask!

Dr. Timothy Gay can be reached at 866-797-8366, or [email protected].  For more information on Ultimate Practice Systems, visit www.ultimatepracticesystems.com.

Tip #8 – Dr. Eric Plasker / The Family Practice

Q:  To be successful and financially independent, does a chiropractor need insurance?

A: Managed care, personal injury, and workers comp are slashing fees across the board.  Rather than be insurance-based or cash-based, we think it is important that a chiropractor be care-based.  Set up all of your systems, procedures, communication, financial policies, and education to build value for people receiving chiropractic care and they will pay for that care regardless of insurance.  Bundle the expected insurance payment into the cost of the total care you recommend for a person or family and the patient will then commit to the care and pay their portion.  Chiropractors worldwide, who have made this transition, have doubled their collections by adding this lifetime care base to their practice. 

Q:  Is wellness care profitable?

A:  Wellness care is high profit chiropractic.  You can provide wellness care without giving the care away.  People pay full price for wellness books, bottled water, fitness equipment, nutritional supplements, massages, and numerous other products and services by the billions, and they will do this for chiropractic as well.  One thing is clear, however, if you don’t teach wellness and have a solid financial system to support wellness, then you can’t expect people to respond.  Teaching wellness and mastering lifetime care wellness-based systems is the single best investment a chiropractor can make in their practice.  You just have to be committed to the path.

For more information, call 866-532-3327, Ext. 118, or visit www.thefamilypractice.net.

Tip #9 – Dr. Mark Sanna / Breakthrough Coaching

Q: What is your best advice to the profession?

A: The following quote appeared in the Millbank Quarterly of the Medical College of Wisconsin, in a report by Richard A. Cooper and Heather J. McKee, Chiropractic in the United States: Trends and Issues. “Having crossed the chasm into the reimbursed world of health care, chiropractors must now prove their quality, effectiveness, and value.  The profession is buttressed by satisfied patients and sympathetic politicians and by the general longing for someone who will listen and be supportive.  But, as our aging nation struggles to define the health care system it can afford, it is uncertain whether this will be enough.”  The practicing chiropractor is ill-equipped to meet the challenges this report describes.  We must accomplish the following if we desire to meet the opportunities this report presents:

1. Practice with a standard of care based upon an empirical evidence objective, and document the functional improvements chiropractic care delivers, and how this impacts the quality of life.
 
2. Master the arts of coding and compliance to effectively communicate the value of chiropractic to interested third parties.

3. Finally, we must accept that only through combining our philanthropic efforts can we reach the level of financial commitment necessary to impact legislative regulation, reimbursement, and widespread public acceptance. Contribute wholeheartedly to your local and national organizations and to the only unified marketing campaign endorsed by every chiropractic leader in the nation, “The Campaign for Chiropractic.”

For more information, contact Breakthrough Coaching at 800-7-ADVICE.

Tip #10 – Dr. David Singer / David Singer Enterprises

Q:  How do I get more new patients?

A:  New patients, for almost all practices, come from referrals. Referrals, as a basis of practice growth, is certainly a point of stability. Therefore, to grow, no matter the changing insurance climate in your community, you need to market your practice to build your referral base.  The easiest procedure to do this is to add in-office workshops.

In-office workshops are the easiest of all new patient procedures to introduce into a practice.  This can be in the form of a twice-a-month class for all new patients, or a once-per-month special workshop on weight loss, women’s hormone problems, natural solutions to arthritis, fibromyalgia, fatigue or allergies, etc.

A class for all new patients results in more new patients, if they bring guests. The logical and successful system to get guests there is to teach a method, such as trigger point massage, shiatsu, stretching, etc., that would require them to bring a partner.

A special workshop on weight loss gets new patients, if patients bring guests.  Charge a nominal fee for the workshop, but make it free for those who bring guests, and you will get guests there.

At the end of the workshop, simply give the new patients a free consultation and schedule them for it that night.

For more information on David Singer Enterprises, call 800-326-1797, or go to www.davidsingerenterprises.com.

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed. Each of these areas is being dealt with sequentially in The American Chiropractor. By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

5. Steps to Successful Marketing in the Chiropractic Office

A successful marketing plan needs to have the following components:

• A Budget
• Direction
• Time Limits
• A Designated Person in Charge
• Clear, Concise Statistics of All Results

Budget: Delegate a certain amount to be spent. That money should be marked and disbursed, irrespective of the initial results.

Direction: A comprehensive distinct plan needs to be laid out; i.e., newspapers, coupons, TV, etc. A successful directive must include diversification.

Time Limits: A marketing plan should yield a minimum expected return (result) by a given date and needs to be cancelled or changed if expectations are not met.

Person in Charge: The designated individual should have knowledge of multiple marketing processes and be prepared to make alternate decisions.

Statistics: To make a professional resolution of any change of plan, detailed statistics need to be kept and analyzed thoroughly. Predictable projections need to be met at 50%.

Marketing is the most important venue by which any business can grow exponentially.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email [email protected] or visit www.dahan.com.

Q: You have often said that the chiropractic practice of 15 or even 10 years ago no longer can exist. Why do you feel this way?

A: The rules of the game have changed. It’s as though, for over 100 years, we’ve been playing according to the rules of basketball and that, within the last five yhears, they have changed the rules to the rules of football. Think about the equipment that a basketball player uses. Chiropractors are out there on the playing field dressed in a pair of silk shorts and the team facing them is suited up in football gear. They’re wearing helmets, shoulder pads and mouth guards and chiropractors are wearing silk shorts!

The rules of the game have, indeed, changed. The business we are in is no longer the sweet, soft, gentle business that it was in the ’80s and ’90s. It’s a tough world out there. Those of us who have been in practice for more than a decade will certainly agree with this sentiment. Those chiropractors who are just entering the profession will soon be confronted by this reality on a daily basis. In order to survive and achieve the practice success that they deserve, chiropractors must fundamentally change the rules of the game with which they run their practices. It will not be enough for them to drill, rehearse, and become expert in the skills of basketball anymore. They’re goingo to have to change their gear, leave their silk shorts in the locker room and suit up with shoulder pads.

Q: What can the average chiropractor do to bring about the necessary changes in his/her practice and still survive?

A: In the past decade, the chiropractor was a jack-of-all-trades and, unfortunately, many times a master of none. The practice of the future will require the chiropractor to take on a greater entrepreneurial and administrative role than ever before. While the chiropractor of the past decade focused primarily upon patient care, the chiropractor of the future will focus primarily upon the effective orchestration and delivery of multiple types of service, at one location, in a cost-effective manner. This mean sthat the chiropractor must surround him- or herself with highly effective coaches and consultants to support this endeavor. In the past, this meant possibly utilizing the services of an attorney and an accountant. In the future, it means outsourcing all of those functions that are not directly in line with the chiropractor’s role of healer, administrator and entrepreneur. Employing professional coaches and consultants, such as a practice management consultant, a financial planner, a diagnostic testing firm, a billing specialist and a marketing specialist, allows the chiropractor to most effectively assume his or her new role.

A graduate of Palmer Chiropractic College in 1996, Dr. Craig Hennequant has been spending much of the past four years working with chiropractors nationwide to help them become more evidence-based and improve their documentation and care management. In his interview with The American Chiropractor (TAC), Dr. Hennequant describes his findings and the future of chiropractic.

TAC:  Tell us something about yourself.

Hennequant:  Well, I think I should start by sharing with you what my mother told me when I graduated from Palmer in October of 1996. She said, “Son, always remember, people don’t care how much you know until they know how much you care”.  Giving my best every day, helping individuals that were on their last hope and making lasting impressions on people’s lives is a rewarding job that comes with great responsibility. In the last five years, I’ve broadened my objectives from not only helping individuals in my practice, but also helping the profession…because I care. I care what happens to our patients, to our doctors and to the profession.

For the past five years, I have been consulting nationwide with chiropractors, medical doctors, insurance adjustors and attorneys. In the late ’90’s and early 2000’s, the company I represented focused primarily on billing and coding; but, in the last three to four years, I’ve done more and more research in documentation, objectification, the Health Care Financing Administration (HCFA) and the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, to help chiropractors get more evidence-based, while improving their documentation and care management.

Most recently, I’ve been traveling as a consultant, representing Myo-logic and Spinal Logic Diagnostics. I am most fortunate to spend quality time teaching and learning from the top people in our profession on a regular basis.

TAC:  There has been a lot of recent concern about the changes in California’s reimbursement and workers compensation laws. Can you share with us what is happening?

Hennequant:  Not too long ago, a senate bill (SB 899) passed that will change the way doctors in California handle workers compensation patients. Specifically, it limited the amount of visits a patient can have with chiropractors and it changed the way the doctors need to examine and objectify the patients’ injuries.

TAC:  What has caused this?

Hennequant:  Looking at the past, we can evaluate a couple of different causes of this. One, the former guidelines didn’t allow for proper checks and balances within the system—which didn’t hold the practitioner accountable for their services. This led to cases in the 20, 30 and 40,000 dollar ranges for chiropractic care.  Now, I’m not going to say whether this was over or under utilization; but I will say that, the majority of time, there was no evidence or objectivity to support such a high level and term of chiropractic care.

TAC:  Do you see what is happening in California as a trend?

Hennequant:  It has already begun to change things. Many states have, by now, capped care or have fee schedules in place and others have changes in the works. I am hearing more and more stories everyday, consulting with doctors across the US, about how their laws are changing for the worse.  Chiropractors are facing a different reality today than 5, 10 or, especially, 15 years ago.  Many DC’s are considering going to cash practices or moving to different states; but I don’t think that is the answer.

We are faced with these changes and problems, primarily, due to our not documenting properly or doing nothing more than orthopedic testing or, at most, taking plain film X-rays.

What is taught in chiropractic school hasn’t changed much in the past 15 to 20 years or longer, with regard to our exam process; but things are evolving dramatically around us.  We are taught orthopedic exams, which are positive about 1% of the time, and are considered subjective in nature.  Too many chiropractors are not equipped with the knowledge to properly u assess a patient’s injury and or illness according to the latest research, guidelines and standards.

TAC:  What can chiropractors do to make a difference?

Hennequant:  We need to have better documentation that is evidence-based, not subjective based.  It is necessary to have orthopedic examination be first, but objective documentation needs to follow, to support our working diagnosis and have more defined care management.  We also have to be more educated in the latest accepted guidelines, research and standards that are widely accepted across the disciplines.

The importance of using proper objectification and care management is paramount; this will prove that chiropractic works, to those beyond our patients and ourselves. This is the only way that we will change the views of the politicians, attorneys, insurance companies and the masses that have the most influence on our future as a profession. We need to show them through an “objective (I understand) system, rather than a subjective (belief) system,” (the latter of which has not been working since the early 1900’s, hence the problems we are now facing).

We also need to make this a habit.  In his book, The 7 Habits of Highly Effective People, Dr. Stephen Covey defines a habit as the overlap of knowledge, skill and desire.  It is evident that we are usually lacking one of the three.  Some lack the knowledge, some the skill, while some lack the desire. Each doctor needs to evaluate which of the three he or she is lacking and improve each until it becomes habitual.

It is also imperative for chiropractors to get more involved with their local, state and international chiropractic associations.  I can’t say enough about what our top organizations are doing.  When you join and support an association, you’re supporting the “life” of chiropractic.  When you pay those dues, you are making an investment in chiropractic that goes toward helping fund research, pay our lobbyists and keep our profession alive. 

TAC:  What are the accepted guidelines that our readers should be aware of?

Hennequant:  HCFA, Croft’s Guidelines, and the AMA’s Guidelines to the Evaluation of Permanent Impairment, 5th Edition, (specifically Chapters 1, 2, 15, 16, 17 and 18) are the most widely accepted standards that we need to understand.  They put us on the same playing field as any other practitioner, no matter the profession.

You have two choices, you can crack open the CPT Guidelines and AMA Guidelines and get studying, or you can attend a seminar which will bring you up to speed.  Either way, ignorance is not an excuse any longer.  Whether you adopt an understanding or not, you will be affected by this trend if you’re not affected already. Changing to a cash practice or moving to a different state is only avoiding the issue and not helping the profession.  We need to get more educated and objectify as doctors.  We get paid to think and do paperwork, not to see patients. That part is rewarding enough.  It’s OK to be paid for our services, help people, and have a successful practice at the same time.

TAC:  What are some final words of advice?

Hennequant:  We have a responsibility, to ourselves, our patients and the profession, to be evidence-based in our practices.  No matter what technique you employ or how you define “subluxation”, you need to objectify properly and be evidence-based according to the accepted guidelines.  The more chiropractors providing that type of care, the fewer problems we will face in the future, and the more accepted chiropractic will become.

I challenge each and every chiropractor to address his/her weak area(s), whether it’s knowledge, skill, desire or a combination of the three. If it’s knowledge, get to a seminar or open a book or two.  I feel it is absolutely necessary for doctors, at least 3-4 times per year, to get out of the office and go to a seminar.  Usually, it’s not the skill a chiropractor lacks; we get plenty of practice.  It is usually knowledge and/or desire that hinder most doctors that I consult.  Practice, at times, can become monotonous or confusing; and a lack of desire can stem from frustration and a lack of knowing what to do.  Either way, getting out of the office and being recharged with new information, re-kindling that desire to be a  chiropractor, and meeting new people who share the same interest is very therapeutic.

Use evidence-based objectification in your office, like that which is available through companies such as those featured in this magazine.  Many of these systems use all of the above mentioned accepted guidelines, put it all together for you and even write your reports.

Renew your belief in what you do, educate yourself in the latest objectification standards, and prove that chiropractic works and is the leading health care choice in the world.

Dr. Craig Hennequant may be reached by email at [email protected], or call 412-726-8179.  For more information, visit www.myologic.com or www.bulletproofseminars.com.

That Was Then

The old-school way of running a private practice was for doctors to refer patients requiring advanced medical testing or physical therapy services to their colleagues and golfing buddies.  And why not?  Money wasn’t an issue.  Twenty years ago, most doctors were earning six-digit salaries and building up their retirement nest eggs.

Today, business-savvy chiropractors focusing on their future and retirement years will make the smart choice to provide better, more controlled patient care, while taking steps to increase practice revenues and reduce overhead costs—working smarter, not harder, in an effort to grow their practices.  Factors to consider include other medical competition, providing better patient care, creating an additional practice profit center, per patient reimbursement, and future practice trends.

Today’s Competitive Medical Field

Who’s the competition?  In a competitive medical industry, the competition is no longer just the doctor down the street, but the hospitals, medical groups, and freestanding health clinics, such as physical therapy, rehabilitation, and sports medicine centers. In order to aggressively compete with these facilities, chiropractors need to stop referring their patients out for services they can perform in their own offices, where they can oversee the procedures and, more importantly, earn the fees themselves. 

Providing Better Patient Care

By utilizing and working with credible medical service providers that deliver on-site services, private practice chiropractors will gain financially, while improving the care they offer to their patients.

Recent medical breakthroughs in technology allow physicians to conduct, oversee, and grow their practices, utilizing many advanced on-site services, including nerve conduction velocity (NCV) testing, electromyogram (EMG) studies, somatosensory and dermatomal evoked potentials, ultrasound imaging, sleep studies, physical therapy, and magnetic resonance imaging (MRI), to list a few.

Providing patients who require advanced medical testing or physical therapy services with one-stop on-site services not only makes scheduling and receiving services easier for the patient, but also provides that patient with faster testing turn-around times and treatment options. 

Ancillary Services Provide Additional Practice Profit Centers

Health care reimbursements are either going to stay the same or continue to go down and will never be proportionate to the cost of living or the high cost of running a private practice.  Chiropractors who provide ancillary services within the scope of their office will continue to be successful and the doctors who do not will eventually die off, because they won’t be able to afford to stay in practice. 

Maximizing Per Patient Reimbursement

As the expenses of running a medical practice—overhead, staffing, malpractice insurance and marketing—continue to increase, insurance reimbursements have stayed the same or gone down, and the costs of collecting the money have gone way up.

According to the U.S. Department of Labor, Bureau of Labor Statistics, over the past five years, salaries have increased at a rate of one percent per year, which does not cover the cost of living increase, the cost of growing malpractice insurance, or the operating expenses of running a private practice.  Chiropractors who are not looking for new ways to develop their practices by creating an additional profit center and bringing ancillary services on-site are getting eaten up.

For example, in an effort to achieve the same financial result, a chiropractor that does not provide on-site ancillary services may need to treat 100 patients in the same time frame that another doctor, who does utilize ancillary services, treats only 33 patients.  It’s not about getting more patients in your door; it’s about maximizing the reimbursement for the patients you are currently treating.

The Successful Doctor of the Future

Ancillary health care services have always been out there, but they have mostly been based in freestanding centers.  For example: A physical therapy center on the corner.  Before there were surgery centers, patients were only operated on in hospitals.  As chiropractors became more entrepreneurial and looked for additional ways to earn income, surgery and physical therapy centers became more prevalent within the profession.

Chiropractors of the future will utilize hospitals and freestanding centers as little as possible because they will realize that hospitals and health care center operations aren’t their friends any longer—they are the competition.

Mitchell E. Rubin is founder and chief executive officer of VeridianHealth, LLC, which consolidates his diagnostic testing companies—Diagnostic Testing Centers of America (DTCA), ZT Technical Services, LLC, and HTZ Technical Services, Inc.—under one flagship entity, comprising the nation’s top providers of on-site neurological diagnostic testing and physical therapy services for physicians.

VeridianHealth operates within state and federal guidelines, offering a variety of compliance-driven practice models. For more information about VeridianHealth, LLC, call 1-877-837-4342 or visit www.veridianhealth.com.

“That which is our greatest strength is also our greatest weakness.”  That sounds like a profound quote from some eccentric philosopher.  It’s not.  I just made it up.

But, as far as chiropractic is concerned, I’m convinced it’s the truth. Our offices are full of testimonials from patients who swear that we’ve helped them when no one else had.  Some of these testimonials sound like downright miracles!  So how is that a weakness?

The weakness of chiropractic care

I think it has to do with third party reimbursement.  When someone other than the patient is considering paying for our services, they DARE to ask us to prove that our patient has a problem and that we can actually help them! It’s just not enough anymore for our patients to just tell them how much we’re helping them.  So, now we’re faced with having to prove “medical necessity.” We’re also asked to document like a medical doctor. As a profession, we’ve never been good at that, nor have we really cared!

This is where my story comes in. Several years ago, my bills began to be denied more and more often by insurance companies, because, they said, I did not prove medical necessity.  In addition, the personal injury arena seemed to change right before our eyes.

We just weren’t good at proving that the patient was injured and that what we did had helped.

Toward evidence-based

So, I embarked on a mission.  What I discovered amazed me.  The exam that we all learned in chiropractic college just wasn’t cutting it anymore. As I did more digging, I discovered that we needed to go toward an “evidence-based” model of chiropractic.  We needed to do things in our exams that not only fit with our philosophy, but also were accepted in the medical and scientific community.  Fortunately, I realized that the exam we needed to do was mentioned, in bits and pieces, all over the place.  I found components of the exam in the Health Care Financing Administration’s Evaluation and Management Guidelines, as well as in the AMA Guides to the Evaluation of Permanent Impairment.  Even one of our own, Dr. Arthur C. Croft, discussed the “evidence-based” examination in his Treatment Guidelines for Cervical Acceleration/Deceleration Injuries.  Once I began doing this exam and documenting it the right way, I soon found that my claims were not being denied for lack of medical necessity, my patients were complying more with my treatment recommendations, and they were being sent for IME’s less and less frequently.  The IME thing bugged me so much that I took training and became certified by the American Board of Independent Medical Examiners.  I found out that the IME’s that I’ve seen all these years were bogus.  They did not follow any semblance of objectivity or even an evidence-based exam, and were full of subjective and biased opinions. 

Where does this lead?

There is software and equipment available today to help us demonstrate the efficacy of chiropractic care.  No matter how we may want to treat our patients, our entire standard of care must revolve around the right kind of objective, evidence-based exam.  If we are to prove to the world that chiropractic is as effective as we say it is, evidence-based chiropractic is the way we must do it.  Our examinations must include scientifically accepted, objective methods that test for changes in function.  We must be able to document these objective, functional findings easily and quickly.  We must be able to do this with honesty, integrity and dignity.

And that is how chiropractic will thrive in the 21st century.

Dr. Gregg Friedman is a graduate of Arizona State University and Los Angeles College of Chiropractic.  He is certified in the treatment of sports injuries, is a Fellow in the International Academy of Clinical Acupuncture and is a Certified Independent Chiropractic Examiner by the American Board of Independent Medical Examiners.  He has been practicing in Scottsdale, Arizona, for more than 17 year.  He teaches the Bulletproof Seminar more than 40 times each year all over the country.  For more information about the Bulletproof Seminar, please visit www.bulletproofseminars.com.

Ring.… Ring!

You answer the phone and an investigator with Health and Human Services’ (HHS) Office for Civil Rights (OCR) is on the horn. What you say and do during this phone call could mean the difference between a slap on the wrist and a visit from the OCR’s investigators.

First: Answer All Correspondence ASAP: In cases for which OCR suspects an entity of a violation, the enforcement agency will make direct, verbal contact with your organization. Make sure you get in touch with OCR immediately upon receiving their message, advises William Pierce, a spokesperson with HHS. If you receive a message from OCR, contacting them immediately to address the complaint will earn you some good credibility.

Second: Don’t Panic–Just Cooperate: The worst thing you can do if you receive a call from OCR is panic. Sure, it’d be frustrating to receive a call like this; but, remember, OCR knows that sometimes a violation reported by an angry patient really isn’t a privacy rule at all. The agency’s first goal is to determine what violation, if any, occurred.

If a violation did happen, they want to know why. The best thing you can do is answer OCR’s questions as honestly and as fully as possible. After that, OCR will work with you to fix any problems and to ensure that a privacy breach doesn’t occur again. After all, the complaint could’ve arisen from “a simple mistake or error—or it could be a lack of knowledge [about the privacy rule],” says Pierce.

Also, keep in mind that OCR must show “clear cause and motivation” when it submits a complaint to the DOJ. As long as you cooperate with the agency and answer all of the investigator’s questions, you shouldn’t have to worry about any on-site investigations, much less incurring a fine, assures Pierce.

Advice Straight from The Source: Pierce sums up OCR’s enforcement goals with some advice for covered entities: “What [OCR] really wants to do is they want you to know what the rule is—to know what you’re supposed to do—and to implement it. Remember, “The ultimate goal of the privacy rule is to protect an individual patient’s medical record. Everyone shares that goal. Nobody’s working at cross-purposes here,” Pierce says.

Some Real Life Situations

About HIPAA on the Net

Question:  “If a recipient wishes to have results sent to him via e-mail and has signed a consent form for this communication, with the understanding that our office does not encrypt the message, are we still permitted to send this information along to him? Do we have any other responsibilities under HIPAA with regard to this request?”

Answer:  In this type of a situation, it would be advisable to have the patient sign an authorization to disclose protected health information via e-mail, says Laura Scallion, president and CEO of AllSource Technical Solutions, Inc., in Portland, OR. “The authorization should include language that clearly informs the patient that the e-mail is not encrypted and the internet is not secure. If the patient authorizes, it’s permissible to send the results via e-mail,” she notes. These forms should only be given on request, she advises.

The Bottom Line:  You are permitted to send non-encrypted documents containing Patient Health Information (PHI) to patients via e-mail, as long as you first obtain a signed authorization from the patient, explaining that transmissions sent over the internet have vulnerabilities or are not 100% secure.

Can we share?

Question:  “One of our office employees moonlights at a long-term care facility. Under what circumstances can he share PHI with our staff about a patient he cared for at another facility?”

Answer:  Sharing PHI is “not appropriate, unless it’s particularly for treating the patient,” Kirk Nahra, a partner in the D.C. office of Wiley Rein & Fielding, advises. If both facilities have an established treatment relationship with the patient, the employee could provide valuable information that would benefit all parties. However, if he is sharing the information simply because he is aware of it, or for the purposes of gossip, that is inappropriate and violates the patient’s privacy, he says.

If the employee has information about misconduct or abuse of a patient, then he should address those concerns to his supervisor at the facility where the behavior is occurring or, if necessary, to law enforcement. This disclosure is protected under HIPAA’s whistleblower provision.

The Bottom Line:  If your employee is sharing infor-mation about patients for reasons other than treatment, payment or health care operations, that behavior violates HIPAA and must be reported and corrected before it adversely affects your facility. Any whistle blowing should happen internally, unless law enforcement must be involved.

Dr. Eric S. Kaplan is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide.  For more information, call (561) 626-3004.

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas is being dealt with sequentially in The American Chiropractor.  By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

4. The Collection Department: Where it counts!

The Bottom Line:  Every doctor knows that, even with the most accurate and appropriate billing codes, it is in the collection department where the final decisions are made.  Irrespective of the volume of patients or the type of care rendered, regardless of the location or type of marketing, the monthly collections show the “bottom line” of an office.

Consistency and Organization:  The collection department requires constant attention and detail-orientated information.  Data must be gathered consistently and in an organized fashion.  The information must be logged in by patient account and followed up regularly and consistently.  A good collector needs to be aggressive, but understanding, direct, professional, determined and, especially, focused.

Break It Down:  Account audits need to be done weekly and broken down by alphabets (Part I: A-F; Part II: G-M, etc.)  Each week you should be concentrating on a separate section, to insure a comprehensive and thorough knowledge of where the money is.  The collection department needs to be evaluated by its total efforts; goals need to be set up weekly, monthly, and quarterly.  Bonuses are a must and should be clearly spelled out.  Remember, the “best doctor/office” in the world cannot keep its doors open, unless money keeps coming in.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email [email protected] or visit www.dahan.com.