staffmeetingA good football coach meets with his player before the game to inspire them.  This should take place daily.  Lunchtime is halftime; review how the first half of your day went.  The end of the day is post game. Did you Win or Lose?  Review your day, prepare your troops for another day, another game tomorrow.




To create teamwork and comradery, MBA encourages a daily planning session. These daily planning sessions occur before patients enter the office and are 10 minutes or less in length. The purpose is to organize the day, assign any unassigned daily tasks that may have arisen, increase staff communication, improve case management, and encourage teamwork and a good attitude during the day. Suring the session, be sure to accentuate the positive and reserve confrontation, correction, or difficult tasks for weekly staff meetings or private meetings. Since this daily meeting occurs before you see patients, it is imperative that everyone leaves with a positive attitude. As a result, the first topic should be a review of yesterday’s activities, pointing out the good things that have happened and the patients who have had good results. Second, cover goals for now patients, patient visits, collection, and services rendered for the day so that each staff member can keep an eye on the goals throughout the day. Third, review the patient’s charts, paying special attention to any patient who is not progressing well or has other concerns with their treatment of card. Also note any changes in treatment plans and specific patient needs. Toward the end of the meeting the doctor should delegate a “Do It” list to each of the staff members that will lighten the doctor’s load throughout the day and allow him or her to see patients more efficiently.



Finally, the doctor should close the daily planning session with some motivation, encouragement, or praise for the staff. Daily planning sessions can be viewed as a huddle in the football game prior to each play. It organizes and encourages.





Weekly staff meetings are imperative and should be held by every office without exception. Decide on the day of the week and time that will be most logical for the office to meet. Have an agreement that a staff meeting will be held at the same time each week regardless of rushed schedules, absent employees including the doctor, or any other unforeseen circumstances. Most offices have had staff meetings at some time during their history. However, due to lack of good procedure, many offices have stopped meetings on a regular basis. This inevitable contributes to a plateau in the office. Do not adopt the attitude that, “We will have a staff meeting it there’s something to discuss.” Instead,


Adopt the attitude that “There will be a staff meeting each week regardless of the amount of material that needs to be covered.” You will find that once you are in an organized staff meeting, there is always adequate material to cover.


MBA finds the best time for holding a staff meeting is in the middle of the day, and a day at the beginning of the week. During one day of the week the staff will use the first hour to go out on their own and have lunch and will return the second hour to have a staff meeting. Do not combine your staff meeting with a meal. In almost every case this proves to be counterproductive.


Your staff meeting should last no longer than an hour. Good staff meetings cover the following topics in the following order:


1.       A recap of the positive activities that have occurred during the last week or month.


2.       A review of the staff meeting notes from the previous week. MBA suggests that you appoint one staff member to take staff meeting notes. Those notes should be typed up in a positive, friendly way immediately following the staff meeting and posted in the employee lounge or a location where all employees will have an opportunity to view the notes without concern that patients may read the notes. During the week as each employee reads the notes, they initial the bottom of the staff meeting note pate to indicate they understand and agree with the summary of the staff meeting. If the staff meeting notes from the previous week agree, read at the weekly staff meeting and if an employee has not signed the staff meeting notes, they should initial the notes at that time. Those notes should be kept in a file for future reference. Also, any tasks that were assigned and not completed during the week should be reassigned and a notion should be made in the new staff meeting notes.


3.       New business should be handled in the following way:


All staff members are encouraged to keep a file in or near their desk entitled “Staff Meetings.” Throughout the week as questions arise, the employee should jot down the question or concern and place it in their staff meeting file. When you assemble for the staff meeting, everyone should bring his or her file to the meeting. During the new business portion of the meeting, the doctor should start with reviewing all questions, concerns, and new business that he/she has brought to the meeting. After he/she has completed his/her new business, the meeting should progress and each employee presents his or her new business. As this new business is discussed, it is important to complete each cycle. Be sure that as you leave a staff meeting you have discussed the new business and created a plan of action for handling any problems or concerns that may have arisen.




During the staff meeting three major rules apply:


1.       The staff meeting is not a gripe session.



2.       Never present a problem without a possible solution.


3.       All staff members should participate in the staff meeting unless the employee is a new staff member. All members who are present at the meeting should contribute in some way. If a staff member never presents any problems, concerns, or questions to be addressed at the staff meeting, we must decide whether that staff member has value to the organization. Staff members that are always a silent bystander or only complain during staff meetings probably have the same effect on the work being done in the clinic.


After all new business has been concluded, the staff meeting should then be directed toward the monthly goals and the progress the clinic is making toward those monthly goals. If the clinic is ahead, staff should be encouraged and praised and if you’re behind with your monthly goals, the staff and doctor should discuss corrective measures to place them back on track to meet their goals.



If the staff is not totally trained in the philosophy and education of chiropractic/wellness, a case of the week should also be included in your staff meeting.


Again, weekly staff meetings should not be longer than one hour.  Staff meets are not about length of time but quality of service.  A great leader is a great communicator.  Staff, just like yourself, needs to be kept on purpose, kept focused.  They must see the light at the end of the tunnel.  Set goals, bonus your staff, make their job fun.  If you do this you will win at the GAME OF WORK.



Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation’s largest multi-specialty consulting companies. Dr. Kaplan ran and operated five of his own clinics, seeing over 1000 patient visits per week. He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen. He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country. For more information about Dr. Kaplan or MBA, call 561-626-3004.

Ten Easy Steps to a Successful Screening

Chiropractors all over the country conduct health screenings.  Some are successful, some are not.  The ones who are not successful typically fail because they do not properly prepare for success.  The following ten steps will help ensure success the next time you conduct a health screening.

Step # 1–Set Yourself Up to Succeed
Think about your community, the demographics of your public and their characteristic activities of interest.  It is important to lay the foundation for a positive event that has positive results for the participants in your community.  Remember to consider the type of screening and where the majority of the people interested in this screening would frequent.

Step # 2–Review Staff Functions
If you are taking any staff to the event, review what their specific functions will be during the screening process.  Staff members can assist by routing people to your screening area, helping with the patient information or scheduling a follow-up appointment for chiropractic care.  Decide what everyone’s role will be prior to the event to eliminate confusion and present a professional organization to your community.

Step # 3–Interest the Public
Plan to have something of interest in the area of your screening.  You want to catch the attention of your public through a specific piece of equipment, television screen, literature display and/or type of screening featured.  Your screening area must be inviting and easily accessible to your audience.

Step # 4–Introduce Your Survey
Have an information survey available to pass out to everyone interested in participating in your screening.  The survey should be short (no longer than one page) and easy to fill out.  All pertinent contact, as well as medical information, should be included.  Do not forget a signature area for consent to conduct the screening.  

Step # 5–Collect Survey
As you collect the survey, you essentially begin your screening process.  Build a bond with the person.  Initiate easy conversation about the location, family, weather, etc.  Let your personality come through to help the person feel comfortable with you.

Step # 6–Introduce Yourself
Once the individual feels at ease with you, introduce yourself.  Do a little commercial regarding your credentials and practice history.  Weave the discussion of your qualifications around to include some specific questions about their survey.  This will smoothly lead you into conducting their evaluation.

Step # 7–Conduct Evaluation
Carefully conduct the evaluation or screening.  Give a thorough explanation of the cervical, thoracic and lumbar areas that you are screening.  Make sure to use instrumentation and/or a procedure that will add credibility to your screening process.

Step # 8–Include Patient Education
Critical to your screening process is educating the individual regarding the results of their screening.  Align the credibility of your screening to their problem through the education process.  Be sure to include how chiropractic care in your practice will help their specific situation.

Step # 9–Set an Appointment
Ask direct questions to determine the individual’s feelings about chiropractic care.  Determine if an office tour or new patient visit is more appropriate for the individual.  Set the appointment and give directions to your office.

Step # 10–Confirmation Call
Two days prior to the individual’s appointment, call to see if an earlier appointment would work better for them.  If so, you can move the appointment up in your calendar.  One day prior to the appointment, call to confirm the appointment.  Be careful not to put yourself (or your staff) in a position to ask a yes-or-no question.  This could lead to a cancellation of the appointment.

Consider doing a health screening in the near future.  Follow these ten easy steps and enjoy a successful screening event.  Increase your new patients and promote a positive awareness of chiropractic care and your practice within your community. 
hiropractors all over the country conduct health screenings.  Some are successful, some are not.  The ones who are not successful typically fail because they do not properly prepare for success.  The following ten steps will help ensure success the next time you conduct a health screening.graduate of  National College of Chiropractic.

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Generate a Positive “First Impression”

A first impression is a lasting impression.  An individual will receive their first impression of your practice based upon their interaction with your front desk staff.  Whether an individual calls on the telephone or walks into your practice off the street, your front desk staff delivers to them their first impression of your practice.  A person will make their decision to become a patient or to continue to receive care in your facility, or not, based on how they are treated by your front desk staff. 
Individuals clearly formulate an opinion on how the doctor thinks, works, and acts based on their interactions with the front desk person.  It makes no difference if you have a chiropractic practice or a business that deals with chiropractors.  The front desk is the key to getting and maintaining your customers.  
Since they are a focal point of your practice, it is extremely important that you evaluate your front desk staff from a distant and unbiased standpoint.  Take a look at the individuals running your front desk and evaluate them as if you have never met them before. 
Listen when they answer the telephone.  How do they treat the person on the other end of the line?  Do they sound caring and accommodating?  Or are they short and to the point?  How do they treat other doctors, such as a colleague or friend, when they telephone your office?  Ask people you speak with on the phone, “How did the front desk person treat you when you called in?  Did they seem warm and receptive to your conversation?” 
What is the demeanor of your front desk staff when dealing face-to-face with current or prospective patients?  Are they pleasant when answering questions or scheduling an appointment?  How is their enthusiasm for their job, their level of interest in the patient and their personality when interacting with others? 

Just sit back there...I'll call you when the doc can see you...

After you have taken an opportunity to evaluate your front desk staff, carefully consider the results of your findings.  Immediately address any areas of concern and then implement a formal training program.  Your front desk person should receive at least one hour of training per week.  Their training should focus on increasing their skills to become better communicators, handle patient objections and concerns to care, and also include sessions on becoming a better listener, paying attention to detail and duplicating what the patient is asking. 
Another important aspect in the training of your front desk staff is knowledge of your personal information.  The front desk person needs to be trained on your specific skills and abilities.  It is vital that they know your complete educational background, including what chiropractic college you attended.  They should be well versed in answering questions regarding chiropractic care and any special techniques you use in your practice.  It is advisable to periodically have one of your friends, colleagues or a family member call in and ask your staff members to describe the type of work you do as a chiropractor.  Your staff should be able to speak intelligently about your background and current chiropractic efficiencies. 
It is also important to set protocol for the front desk staff to follow under specific conditions.  For instance, what is the protocol when another doctor calls in to speak with you?  How should your front desk person handle this situation?  The front desk person should be trained to inquire what the call is regarding.  It is important to note if the call has to do with a current patient, sending a new patient to the clinic, or a similarly specific situation. 
You should have a protocol established so the front desk person is not put in a position of deciding if it would be okay to call the doctor back later.  The front desk person can not evaluate the importance of the call or the impact it may have upon your practice.  By putting a protocol in place, the front desk staff will know when to interrupt or when to take a message, based on their training of the protocol. 
A weekly training covering all areas discussed here will ensure that you continue to offer the very best first impression to the public.  If the information listed here is consistently followed, the level of “good” public relations that is fostered in your community will increase.  A friendly and well-trained front desk person will go far in providing a caring and professional environment that people would like to share.  It will make a “lasting” first impression! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Practice Management Tips

Q:  Which adjunctive services, if offered, have you found to be most beneficial for chiropractic practices?

A:  The language of reimbursement today is the language of function.  In order to fully participate in the mainstream of healthcare, chiropractors must become proficient in objectively assessing and documenting the functional outcomes of their care.  It is extremely difficult, if not impossible, to track functional outcomes in a practice that operates in the “passive care paradigm” of the 1970’s–in which patients come in, lie down, receive an adjustment, hot pack and muscle stimulation, visit after visit, for forty-plus visits.  The most successful chiropractors today include active care/rehabilitation in their treatment protocol. 

The CPTÔ codes with the highest value are the active care codes:  therapeutic exercises, kinetic activities, neuromuscular rehabilitation, and others.  The reason for the high level of reimbursement these services receive is that they produce a higher quality outcome.  Patients who participate in rehabilitative exercise programs have a lower rate of recurrence of their original conditions, and this is recognized by third party payors.  After hiring a personal coach, the most beneficial service a chiropractor can add to their practice is to invest in low tech (tubing, bands, gymnic balls), or high tech (weight stack machines) rehabilitative exercise equipment.


Q:  What mistakes in practice management do most DC’s make?


A:  The single most effective habit you can develop to successfully manage your practice, after hiring a professional coach, is to establish regularly scheduled practice building hours.  While almost every doctor I speak to has established regular hours for patient care, only a very few have established similar hours for practice building. 

If you search long enough, in every chiropractic office you will find a box filled to the brim with seminar notes.  These notes contain ideas, each one a gem, that has never been implemented.  The single most efficient way to close the gap between idea and implementation is to set aside a minimum of two-to-three hours each week devoted entirely to practice building.  This time should take place in your office and should be uninterrupted. 

Chiropractors have two businesses.  The first business is the patient care business and the second business is the practice building business.  Most doctors attempt to build their practices and polish their procedures in between and around patient care.  Develop the habit of dedicating regularly scheduled time to building your practice.  This habit will allow you to focus your energy and attention on practice growth and will keep you from diverting your attention away from your patients during the time you should be focusing on them.



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.

How Much Staff Do You Need?

As a Consultant, I have had the opportunity to visit clinics throughout the United States.  This is one area of my consulting that is unique.  As the owner operator of 5 clinics that saw in excess of 1200 patient visits per week, it is interesting to see how many clinic’s staff their practices.  Some clinics are overstaffed and some understaffed.  The key is to know which you are.

Clinics of the 2000’s can learn a lesson or two from clinics of the 1970’s.  Most clinics today are overstaffed.  A clinics staff overhead should equal 12% or up to 18% of entire overhead with billing and collections.  The office should run at 50% and never more then 60%.  This is not what I see out there today.  Many doctors hire employees with no set formula in mind.  Doctors like saying, “I have eight employees.”  It is not how many employees you have but how they are utilized and how profitable you are.  Staffing should be equated by number of patient visits as well as collections.  This is also the reason so many clinics have financial troubles.  The first thing I teach my doctors is to understand overhead, how to mange a clinic and how to make it profitable. (See chart)

Use the following guidelines:

          • 0-100 Patient visits per week = 1 full time CA, possibly one part-time after 50 visits.

Front Desk CA

Doctor handles treatment, exams, X-rays, and therapy


          • 110-175 Patient visits per week = 2 CA’s, maybe an additional part-time may be added at 150, to assist with patients or billing.

Front Desk CA

Therapy CA (also traffic control)

Doctor handles treatment, exams, and X-rays

          • At the 150 level an associate doctor may be considered.  He or she will then take on the responsibility of doing the following:
            1. Exams
            2. Taking X-rays
            3. Marking X-rays
            4. Preparing report booklet
            5. Managing therapy or rehabilitation
            6. Diagnostics
            7. Outside marketing


It is only after mastering the above that he or she will be allowed to treat patients. Having an associate can often give you more time to treat and bond with your patients, thus increasing your volume.


          • 175-250 Patient visits per week = 3 CA’s

Front Desk CA

Therapy CA (backs up front desk)

Billing Control CA (backs up both above CA’s)

Associate doctor handles treatment, exams, X-rays



          • 275-350 Patient visits per week = 4 CA’s

2 Front Desk CA’s

Therapy CA

Billing Control/Office Manager CA (backs up all above CA’s)

One of the front desk CA’s at this level assists with billing and collection.


When you get to this level, often one front desk CA answers the phone and does intake.  The second usually sets up patient visits does insurance verification and collects money.  This employee sees the patient as they exit and handles any insurance problems.


          • 350 + Patient visits per week = 5 CA’s

2 Front Desk CA’s

2 Billing CA’s

1 Therapy CA



You can use this knowledge as a motivator for yourself and your staff.  Just knowing that a small increase in patient visits per week will put you at a level that warrants an additional staff member should inspire you to make the push necessary to exceed and maintain that level.  You must maintain this level, though, for four weeks before hiring the additional person.  Let your staff know that increased business can lead to increased staffing.  Many doctors add employees because the staff says they are overwhelmed; that they need help.  The real question is, do they really?  An empirical formula on staff control will lead your staff to more production.  They will know what they must maintain, and what the office must produce to bring on help.

Once the new staff member has been added, you now have a vacuum to fill once more!  Successful people never rest.

Successful doctors throughout the United States have used the recommendations above effectively for years.  Today it is usually insurance that puts a strain on the office.  Many offices utilize billing companies.  Remember, a billing company is nothing more than an outsourced employee.  You must manage them as you would any employee and judge them by their effectiveness.  Before hiring a billing company, ask for doctor recommendations, then call them.  Make sure they do electronic billing and assist in follow up.  A good billing company should provide you with weekly reports.

Some clinics may offer services, which require additional staffing, such as diagnostic testing, rehab services, or massage therapy.  A massage therapist does not equate into the calculations, as they can produce revenue.  It is also their responsibility to assist with therapy and diagnostics when not massaging.  Often they are paid hourly (never by percentage) and are treated as Independent Contractors.

Staff Management

When professionals initially start their professions, they focus on being chiropractors, optometrists, dentists, etc.  But, as their practices grow, they find they must also become managers.  Some feel involvement in management makes them less of a health-care provider.

All careers eventually lead to management and management means managing people.  Skill, hard work, dedication, and technical competence alone won’t get you to the top.  Over-reliance on technical skills and neglect of the people skills leads to the leveling-off effect.  Continued advancement requires people skills.

There are no tricks to being a manager just an awareness to respond to the human needs of your staff.  Basically, you cannot change people.  You cannot put in people what they do not already possess.

Management of people is like placing a string on your desk.  Try pushing the string, notice how it binds up.  Now pull the string and see how it takes your lead and follows you.  Pulling people is tiring, but pushing people is exhausting and fruitless.

Rules to Remember

The following are rules to remember when you work with people:

  1. All people are motivated.
  2. People do things for their own reasons, not yours.
  3. You cannot motivate people.  You can inspire them, thus, they will motivate themselves.  Don’t FIRE employees, FIRE THEM UP.
  4. You can create factors that will be motivational in their environment.
  5. People won’t change for you, but they may change with you.

Good office procedure and clinical competence will help you sustain a certain level of success, but it’s your ability to manage people that will get you into the major leagues. TAC

Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation’s largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

Cheeseburger, Cheeseburger, Cheeseburger

A friend of mine, a chiropractor, was listening to the tail end of a talk I was giving in Florida, and after the talk, asked me to explain this cheeseburger thing to him.  I told Mike, (that’s his name) that the cheeseburger phenomenon is something we coined to explain the product problems that we encounter which causes us to redesign our existing product line.  “Explain,” he said. 

Well it’s like this:  You have fifteen chiropractors on the same block and all of them do basically the same thing.  How most of them try to differentiate themselves is by word speak, technique, marketing, hurt and rescue, and other various strategies.  It’s like when you go in the bathroom and see the poster, “As the twig is bent so grows the tree.”  We call that a symptom of product problems. 

“Product problems?” Mike replied. 

“Yep, product problems,” I said.  “Take that cheeseburger analogy thing, replace the fifteen chiropractic offices with cheeseburger stands.  The owners of the cheeseburger stands try to differentiate themselves by rearranging the items between the buns.  The first guy sticks the meat on the bun first, then the cheese, then the tomato, lettuce, onion and ketchup.  The second guy has a better idea.  He puts the cheese on the bun first, then the meat, next the lettuce, ketchup then onion.  Of course, the third fourth and fifth guys do their own arrangement and all feel like they are unique compared to the other fourteen cheeseburger stands. 

“You know, just rearranging the items on a display doesn’t make a new product.  If it was a new product, the cheeseburger stands would be able to charge much different prices and, like the chiropractic office, it seems to me the prices all are about equal.  Equal price, equal value.  Imagine that.  No real way of differentiation.  In our business, we call this a product problem, and, when it emulates the cheeseburger example, it’s time to look at our product and figure out how to really differentiate from the competition and re-engineer what we offer the customer.

“You call them  patients; we call them customers,” I said to Mike. 

Here’s another analogy.  The patient or customer who walks down the street has a wallet with two twenty-dollar bills in his or her pocket.  The money doesn’t care where it gets spent, but the owner of the money evaluates all their spending options.  Pizza Hut, the department store, overdue bills, a gift for someone special, or the chiropractor, and so on—all are options available to spend the money on.  How all of those products stack up is what we call purchase hierarchy.  Which one of those items or combination of them wins out is based on the value the customer places on them.  This is where the tricky part comes in.  How much value the customer places on it is based on their satisfaction index.  We gauge the satisfaction index by the response the customer has to our product without a “sales pitch”.  The duct tape test.

“The duct tape test?” Mike asked.

“Look at it like we do, Mike,” I said.  “If you place a piece of duct tape across the salesperson’s mouth, (this can be a doctor, CA, etc.) and if the product is not accepted by the customer without the pitch, or the customer cannot be convinced to come back and purchase more product without a pitch, you have to start looking at your product and asking why the customer doesn’t perceive value.”

Now I had Mike right where I wanted him.  “Do you have one of those As-the-Twig-Is-Bent-So-Grows-the-Tree posters?” I asked. 

“Yeah,” he said. 
(Don’t tell me, it’s in the bathroom!)

Dr. Mike was pretty quiet by this time, but I asked if he did things like nutrition, electrotherapy, ultrasound, traction and other treatments in addition to his adjustments. 

He said, “Yes.”

Now for the real tough questions.  I asked, “How many minutes do you apply electrotherapy on the patient during a session. 

He replied, “About 12 minutes.” 

I replied, “Oh the electric aspirin.”  I explained to him that there are dozens of treatment options other than the “electric aspirin” that will really send the customer—I mean, patient—home really feeling great.  How about traction? 

Do you do real traction or just rollers. 
“Just rollers” he replied. 

“Just  babysitting the patient,” said I.

“When you do ultrasound, do you treat only three times the ERA of the crystal or do you paint the wall?” I asked.
This is when Dr. Mike stopped answering my questions. 

“Well, Mike,” I said,  “the good news is you’re a perfect candidate for product repair.  Just imagine, if we fix your product offering in all aspects, the patient satisfaction index will go up and your practice will truly be different than the others in the neighborhood.  In fact, the better your product gets, the more of those tacky posters you’ll be able to remove.” 

“Great,” he said.   “They really make the place look pretty unprofessional.”

My advice to Dr. Mike was the same advice I give to all of the chiropractors I meet in my travels worldwide through my work.  It hasn’t changed for twenty years.  When you fix the product, the sales come.  When you do the same thing over and over and expect different results, you have a problem. 

Think about this example.  If we sent twelve employees from the local McDonald’s to an Anthony Robbins seminar for a weekend, do the cheeseburgers taste different on Monday morning?  Are the Happy Meals any better than they were on Friday?  The fact is enthusiasm is a wonderful catalyst, but you need a new product together with the catalyst to really get all the benefits.  Imagine, if we took those same twelve employees and, in addition to the “head repair” they get with Tony Robbins, we gave them an entirely new improved product.  Instead of just “supersizing” every order, they were turning on all the customers to the “new product line”.

So here was my prescription to Dr. Mike:
When you offer adjunctive therapies in your office, they are only as good as the research behind them.  After that, you need to purchase all of your “non chiropractic” additions from reputable companies and knowledgeable distributors.  The lack of training you get from the salesperson hurts your practice and product more than you will ever know.  Only buy from a company that supports the product with in-office training for you and your staff, and backs it up with clinical data from accepted publications, not anecdotal information.  Remember, the only one that loses is you, because the product you offer the public is not as great as it could be.  Demanding excellence from the people you buy your therapies from will help improve the product you deliver to the patient.  Most importantly, if the claims sound too good to be true, they are.

Second was the most important advice to Dr. Mike.  It was the advice about the risk to his license.  I explained to Dr. Mike that taking the information the salesperson gives them on billing codes was like lending his license out for someone else to use.  It is crazy to take the billing advice the salesperson or manufacturer gives you at face value. 
Improper billing of CPT codes is insurance fraud.  Billing codes for therapies that do not have the effect the codes imply is also fraud.  When a salesperson gives you billing advice, remember to always call your billing consultant to make certain you aren’t creating a situation in which, under an audit, you will have to pay back thousands of dollars you probably spent a long time ago.  Let’s face it, “Whose license is it anyway?”  Do you think that salesperson has as much at risk as you do?

Well, Dr. Mike was mumbling something about, “I don’t even eat cheeseburgers, I’m a vegetarian,” while he walked away. 

But I think he learned a valuable lesson about product and the value the customer places on it. 
As he walked further down the hall, I said, “You know, Doc, your patients will appreciate all the changes you make because, when you fix the cause, the symptoms go away.”

Chris Peetros has spent the past 20 years developing products for the chiropractic profession. Currently, he is the National Sales Manager/Specialty Products Division and Chiropractic Products Division Manager for the Chattanooga Group in Hixson, Tennessee. Chris has spent the past 10 years developing the Ergostyle Adjusting Table product line and his most recent project, the Triton DTS Spinal Decompression System. Chris can be contacted through the Chattanooga Group, Inc. He can be reached at 800-592-7329.

The Professional PI Practice – Know the rules, and do it right

As a consultant, I find more and more doctors turning to Personal Injury.  Why?  The great bank robber Willie Smiths was once asked, “Why do you rob banks?” 
His response was, “That’s where the money is.” 
As regular insurance is becoming more difficult to collect, more and more DC’s are turning to PI.  Why?  Again, that is where the money is.  This is a bad place to put your practice solely in.  The key is to diversify.  PI should be part of your practice, but not 100%.  Otherwise, you will be put into a position of failure, if regulators make changes.  New York already has PI limits; more and more states are looking into changing the current model.  It should be your job to work with national and sate representatives to bring back equality in our profession.  However, many of you will continue to do PI.  If you do, know the rules and do it right.
First and foremost, don’t just beg attorneys for patients.  Attorneys refer to doctors that are thorough and whom, they believe, will add value to their case.  Remember, their income comes from the settlement.  The larger the settlement you can help the attorney procure, the more valuable you are to his team.  He/she is out to make a living.  Provide him/her with great reports, know how to do impairment ratings, know how to document your file.  Be professional.
If you’re going to travel the auto insurance route, you had better know how to navigate around potholes. Follow these tips for circumventing billing roadblocks when filing auto insurance claims for motor vehicle accidents (MVA’s):

Your Manual for Billing Auto Insurance

  • Keep good records.  Save all relevant information from patients, insurers and other professionals involved in MVA’s.  Get pictures from the accident, and do a thorough consultation.  Get copies of and other doctor or hospital records.  Save your e-mails especially, because you can make copies of conversations and keep them in the patient’s chart.  Keep track of key phone numbers, contact names, and dates of conversations, and mark your information in the computer with special codes so you can run reports on them.
  • Establish a hospital contact.  Many patients go to the hospital first.  When working with my MD/DC clinics, we know who is on staff at the hospitals.  We let them know we specialize in SOFT TISSUE INJURIES.  We provide these emergency room doctors with information that is viable to them.  The key is establishing yourself as the expert.  In addition to establishing good communication with agents, attorneys, the insurer’s claims department and the patient, you should look for a hospital contact to find out useful information regarding auto or health insurance, especially from inpatients whom the contact can visit.  Remember these contacts take time; be patient.
  • Fill out your insurance claims completely and send them immediately.  Send a copy of your initial exam to the attorney as well as the insurance company.  I NEVER CHARGE FOR THIS INITIAL REPORT.  Get the insurance form filled out as completely as possible.  Contact auto insurance as quickly as possible, since there’s usually a medical maximum on the policy.  The first claim in gets the money, so out-kick competitive submissions with speedy filing.  Know if there are limitations and know your state laws in regard to billing.
  • If health insurance is involved, prepare for denials.  Don’t be surprised if you have trouble billing health insurance after the patient’s auto insurance tops out.  If you’re lucky enough, health insurance will pay the claims.   When you bill health insurance for the remaining amount, you need to obtain a letter from the auto insurance stating that auto insurance has maxed out, and be prepared for health insurance denials.  One medical office reports that it can rarely get an HMO or PPO to extend the filing deadline when a patient’s auto insurance is exhausted.  So, the office bills the health insurance from the start, using the ICD-9 code for MVA’s.
    One way around this problem is to notify the HMO or PPO before you do any billing,  When you encounter an MVA that involves an HMO or PPO, make sure you get the referral from the HMO or PPO, because the MVA will most likely top out quickly.


Buckle Up for Patients
Involved in Auto Insurance Lawsuits


Strap in tight.  Your automobile accident patient’s legal proceedings can mean a long, bumpy ride for your office, even if you’re not directly involved.  Avoid financial dents by practicing these safety tips:

  • Immediately talk to the lawyer or paralegal on the case.  They will be very honest with you about whether they think there is a good lawsuit.  This information will give you a good idea about your patient’s future financial situation.  Often it is the paralegal that runs the case.  It is the paralegal that often refers the case.  The paralegal is a good person to educate.  Are you able to educate the paralegal on the value of the case?  If you answer NO to this, you need to attend more seminars.  Kaplan (no relation) and Croft are two excellent ones in regard to PI.
  • Provide medical records when requested in a timely fashion in order to protect yourself.  In many states, like Florida, if your claim is not filed in a timely manner, the insurance company does not have to pay you.  Reporting is part of health care today.  Keep good notes and records; this is the key to referrals. 
  • Obtain a lien against the settlement by contacting the patient’s attorney.  The lien basically states that the attorney and patient must pay your bills out of the settlement before the patient receives his/her portion.
    Beware of two dangers with liens.  First, a hospital lien takes precedence over a physician lien, so you may not get paid.  Also, an “unscrupulous” attorney may not honor your lien.  If that happens, you should contact the BAR.  You have worked hard for your money.  Everyone must play by the rules.
    Some attorneys will not sign a lien.  Be careful of these attorneys.  Have the patient sign a lien.  If no one will sign a lien, consider not taking on this case.  You are setting yourself up for more problems.
  • Follow up on the settlement’s progression.  Write a reminder to check up on the account, and keep in touch with the lawyer’s office and the patient.  Set up a meeting with the attorney.  DO NOT CHARGE FOR THIS MEETING.  Be a doctor, not a salesman.  Talk about the case only.  Review your notes; help him or her establish value to the case.  Do not ask for referrals at this meeting.
  • If all else fails, turn to outside collection agencies.  If your patient loses the court case but doesn’t end up paying you, what do you do?  Do not forget about the money.  YOU EARNED IT.  Consider sending the claims to an outside collection agency, which has “better sources” for collecting.  Your patient may receive a settlement large enough to cover the medical expenses, but may try to skip out on paying.  This is why a lien is so important.  Try to have the attorney pay your bill upon receiving the settlement money.  A good relationship with the attorney can help you here.  Put in the time that is necessary.
  • Integrate your practice.  Many of my clinics add an MD, this way they improve their chance for a greater settlement.  By providing both medical and chiropractic records, you build up twice the case.  Often this results in a larger settlement.  Remember, this is what attorneys want.  This is what they do for a living.  The PI market is also getting competitive on their end.  They want to make more with fewer cases.  An MD/DC clinic offers a “one stop shop” for PI, by providing chiropractic care and medical care.  It almost removes the paper IME component.  This also helps our profession, as now MD’s validate chiropractic care.  For the purist at heart, remember B. J. Palmer had MD’s working in his rehabilitation clinic and documenting the validity of chiropractic.
  • Be Professional.  The key to a PI practice is being professional.  Prepare your file with care.  Put the time into your records and reporting.  If you are good, attorneys will find and court you.  The PI world is a competitive world.  Scout the competition and develop a better game plan.  A more complete and professional plan.  Also, be proud of what you do and do it with excellence.  If you do that, you will do well.


Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation’s largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

Feeling vs. Functioning: A Simple Solution to a Common Practice Problem

Despite our extensive background in the philosophy of our profession, we, as chiropractors, often fall into the “MEDICAL MODEL OF THINKING.” We may find ourselves making care decisions based upon the symptoms the patients report on the day we see them, rather than relying upon objective data collected that day or at a previous appointment.

People in today’s society have been led to believe that, if they feel fine, then they are healthy.

They also have been indoctrinated to believe that, if they have a symptom, then they need to see a doctor. Symptoms, therefore, are believed to mean that a person is not “healthy.” When the symptoms are no longer present or are less bothersome, people feel they no longer have the need to see a doctor.

Many times, chiropractic patients also fall into this medical model of thinking. They base their progress and the need for future care on how they “feel” rather than the objective actuality of their current physical condition.

When a chiropractor asks the patient how they are feeling, the medical model of thinking is intensified. When a patient enters your facility for the first time, the chances are good that he or she IS experiencing symptoms. If you ask them on each and every visit how they are feeling, then they will begin to adopt symptom-based criteria for their continued chiropractic care. As a result of this method of thinking on their part, they will likely decrease their care or drop out of care as soon as they are feeling better. We have all seen them, The Relief Care Patients.



The Primary Objective of Your Office Visit!

The primary objective of a chiropractor is to effectively communicate to patients, thereby changing this medical model of thinking. An educated patient with a good understanding of how their body should function is more likely to follow through with their prescribed treatment plan and also pay for the care needed to improve their health and well-being. The well-educated patient knows their health is their responsibility.

Knowing how entrenched we are in this symptom-based medical model of thinking, we should quickly realize that a change is in order. The first step of this process is to change the way a patient is greeted every single time they enter your practice. Keep in mind, if the receptionist asks a patient how they are feeling, they will typically answer the question with a symptom. Then, the doctor asks them how they are feeling. Once again, they will answer with a symptom. Very quickly, your patients will develop the idea that it is important to be aware of how they feel each time they visit the chiropractor. Do you see the problem?!!!

You have the power to change this sequence simply by changing the question. Greet your patient in a new way. You and your staff should always ask, “How are you FUNCTIONING?”

Initially, out of habit, people will answer the question with a symptom. It will be your responsibility to immediately change their thinking. You will want to shift their focus toward how their body is functioning and away from their current symptoms. When you ask a patient to consider how their body is working as opposed to how they are feeling, they will begin to realize symptoms are not the only factor involved in determining whether they are “healthy” or whether they need continued care. The answers you are seeking from your patients include statements regarding improvement in their ability to carry the laundry basket up the stairs or an increase in energy levels when playing with their children. As chiropractors, we can ascertain whether we are improving the overall health of a patient as it relates to their ability to function in their activities of daily living.

Instead of the patient thinking we, as chiropractors, are trying to improve their symptoms, they will quickly get the viewpoint that we, as chiropractors, are really improving their life, and all aspects of it. What a difference this can and will make in your practice when you shift the patient’s focus away from symptoms during the course of their care plan.

When a chiropractor improves a patient’s functional capabilities, lifetime patients are created. When the symptoms are the only things that are improved, the relationship with the patient is going to be short lived, and so is your referral cycle. When you change the way people function, and they truly understand that the mechanism for their improvement is due to your educational process, you will broaden the scope of referrals this patient will contribute to your practice. When a person realizes they no longer suffer severe pain, but ALSO have more energy, a better appetite, are less irritable, perform better at work, sleep better, create better relationships among their family members and friends, etc., they WILL refer others!

This type of patient is more inclined to be a long-term chiropractic patient, because they have experienced the increase of function and the benefits of optimum health and well being. They will want the optimum condition to continue, and will, therefore, be willing to pay for maintenance or wellness care.

Chiropractors and their staffs need to make this change and be consistent with the change in order to make a difference in this widely accepted medical model of thinking. The change of only one word in your dialogue with patients over a few weeks time will make a difference. Your patients will begin reporting they have, indeed, experienced a change in the way their body functions. The amount of words used and the amount of time spent on handling patients regarding their symptoms can be saved and used as dialogue for all of your new patients. This one word is worth a million words! TAC


Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist. He is well known for his practice management expertise, as well as new patient development programs. He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation. Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO. He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Chaos vs. Control Are You Organized for Success?

Organization is a large word that can have a great impact on the success of your practice.  Without a systematic way of organizing your practice, chaos and havoc will rule with no guidelines to help sort out the confusion.  In a chiropractic practice there are three components to building a successful organization:  Policies, procedures and systems.
Policies, procedures and systems add the structure that is necessary to run a successful practice.  It is helpful to understand the difference between these components and why each is important for your success.


Policies are the rules and regulations of running your practice relative to your staff and your patients.  Policies are written in order to help your practice run smoothly.  Each and every chiropractic office should have a General Policy Manual that is followed by all staff members (regardless of position or seniority.)

Chaos vs Control - Are You Organized for Success?

A General Policy Manual will minimize and eventually eliminate staffing problems.  When all staff members are following the written policies, there are fewer issues for staff members to discuss or dispute.  Once the rules and regulations are in place, correcting a staff member also becomes easier.  Most staff or practice problems are in equal proportion to the doctor’s willingness to confront the staff member.  Having a well-written and proven set of policies supports the discussion and resolution of the problem.
When a new staff member is hired, it is imperative that you introduce them to the General Policy Manual and make sure they understand and agree with your policies.  Have them complete a “Check-Off Form” to ensure they do not miss any important policies.  Also, have them write several essays during their probation period on their understanding of your policies.  This will eliminate any misunderstandings and potential staffing problems down the road.
You can change the way your practice operates by following these few simple suggestions.  Policies allow you exponential growth in your practice, regardless if you have one, five, fifteen or thirty staff members.  Policies are critical.


A procedure is a specific course of action that can be repeated in order to achieve a certain response.  Procedures are the step-by-step processes that you utilize in your practice.  Your procedures take place from the moment a patient walks through your front door, until the time they are released onto maintenance care.
Procedures are critical for a chiropractic practice to continue to expand.  Once you have developed your procedures, you should write them down or put them on audio or videotapes.  By doing so, you are making them available to everyone to learn from and incorporate into your daily operation.  The more specifically your procedures are defined, the smoother your practice will operate.
The anxiety level over hiring new staff members will significantly diminish when you have proper procedures in place.  It will be easier for a staff to duplicate a position when the procedures are already defined for that position.  You will find that you will have more compliant staff members and a greater willingness to replace non-compliant staff members with the appropriate procedures in place.  Procedures are vital.


A system is a functionally related group of elements that interact harmoniously.  Systems need to be put into place in order to have your practice function overall.  A system incorporates your policies and procedures into a workable and consistent structure that will succeed regardless of the personalities involved.
For example, you would have a “new patient” system that would handle all aspects of serving a new patient, from the time they walk in the door until they are put on a maintenance program.  The system would specify the exact way to handle setting up the first appointment, how to greet the patient upon arrival, paperwork procedures to follow, etc.   With a system, nothing is left to chance.
Systems are incorporated into a practice for a number of different reasons.  Regardless of the specific end result of the system, it is only considered effective if it will work for anyone, in any town, in any practice, at any time of year.  A system is bulletproof, and put into place in order to help your practice function more effectively.  Increase your systems, increase your productivity and increase your opportunity for growth. Systems are essential.
Organize your practice for success.  Eliminate chaos and embrace control.  Write your policies and procedures and put your systems in place.  You will be setting the stage for success in an organized and expanding practice! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Increased Public Awareness + Education = New Patients

You love chiropractic.  You want to share the benefits of chiropractic with the whole world.  You would like to add a few new patients a week to your practice.  Accomplish all this and more through a performance workshop presentation. 
Offering a performance workshop to businesses is a cost-effective way to share the benefits of chiropractic, establish yourself as the chiropractic expert in your community and increase your new patients.  You want to present a comprehensive workshop designed to improve the health and well-being of the individuals in attendance.  Look for a performance presentation product, such as a lecture series which might include video and/or slides, that has an established track record and focuses on increasing energy and productivity levels and decreasing the level of stress in the lives of the participants. 
Once you have chosen your performance workshop product, you need to target your audience.  Within your community are hundreds of businesses with thousands of employees that can benefit from a performance workshop.  Where do you start marketing this program?  Pick up your local telephone book and flip to the business-to-business section of the yellow pages!  You have at your fingertips, an abundance of prospects.
Focus your initial efforts on the professions that involve activities causing strain on the individual.  For example, businesses that fall in this category include hair stylists, factory workers, retail workers, and public service employees.  Companies operating within an office environment also make good prospects because of the level of stress the employees face on a day-to-day basis.  Employees in almost any type of business can benefit from the information and education provided during a performance workshop.
Compile a list of fifteen to twenty-five companies to contact and introduce yourself and your program.  Your goal is to speak to the person responsible for scheduling employee activities and to schedule a day to conduct the performance workshop.  Typically, the person you will need to speak with is the human resource director, employee relations supervisor or company owner.
Once you have the appropriate person on the phone, introduce yourself, provide your credentials and outline the benefits of the performance workshop.  Explain how this powerful program will help their employees function more effectively and work more efficiently.  The workshop that you choose should contain information that will teach individuals how to:

  • Enhance their Energy Level
  • Improve their Body’s Ability to Function
  • Strengthen their Body’s Structure
  • Increase Coordination and Safety
  • Reduce Stress

Address any questions or concerns the decision-maker may have regarding the performance workshop.  Highlight a few successes of the program that you experienced when it was presented to other businesses in the same or similar industry.  Be sure to schedule a time that is convenient for the majority of the employees and suggest that the company make the presentation mandatory.  This will help ensure the success of the program for the business and for your practice.  Once the presentation is scheduled, send a confirmation letter to the decision-maker.
You should always maintain a prospecting list of fifteen to twenty-five companies to call and schedule a performance workshop.  Keep in mind that companies add employees, change ownership and relocate on a regular basis.  With the yellow pages, you will never be without a database of prospects for your practice.
The presentation is scheduled.  Now you must prepare to present the performance workshop to your audience with confidence and enthusiasm.  Review your slide presentation and rehearse your scripts.  You should be comfortable with the material and the manner in which you will deliver the information.  If necessary, rehearse until you achieve a level of comfort that satisfies you.
On the day of the presentation, check the slide show and all audio-visual equipment.  Be sure to take all presentation materials, handouts, business cards and office brochures for distribution.  Arrive at the meeting location at least thirty minutes early.  This will give you enough time to set up your equipment, get comfortable with the environment and personally greet the attendees.
Keep your energy level high at all times and command the group’s attention.  How you close your performance workshop is extremely important.  Describe the type of help you can offer the attendees through chiropractic, productivity enhancements, increased energy, injury prevention and pain relief.  Explain that someone will contact them to ensure they receive information on the area in which they have a health concern.
Before leaving the company, schedule another performance workshop in six months.  The second presentation serves as a refresher course for current employees and an introduction for any new employees that have joined the company.
Within forty-eight hours of the presentation, call all the attendees of the workshop to schedule an appointment with them.  Track the number of new patients you receive from each workshop.  Use these numbers to evaluate your success in doing the performance workshop and securing new patients.
Decide how many external lectures you would like to do every month.  Use your list of fifteen to twenty-five companies from the yellow pages as your guide.  You will be amazed at how many people are eager to learn more about chiropractic and feeling better, naturally!

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist. He is well known for his practice management expertise, as well as new patient development programs. He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation. Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO. He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.