Category: Practice Management

:dropcap_open:W:dropcap_close:hen doctors help high numbers of patients consistently for years with excellent results, other doctors want to know their secret. What is the one factor high-achieving doctors have in common? After three decades of interviewing the best, the one commonality I found in this group of ultra-high achievers is focus. I grilled a doctor about his huge following, asking, “How do you help so many people?”

He paused, and then replied, “One at a time.” He explained he worked on each patient at the exclusion of everything and everyone else around him, until he was done. Working this way was essential to his success.

I’ve watched leaders in our profession practice and received care from them, as well. The level of concentration they bring to their art has always impressed me. B.J. Palmer, in particular, had this quality. Old films from the 1920’s, showing him adjusting patients, reveal a man who was absolutely centered. One gets the feeling, if the entire world fell around him while working, he would have continued serving his patient.

Why Is Focus So Important?

Where is your mind when you adjust? The old timers called extreme focus, “being one with the bone.” Isn’t this the kind of care you would want?

Patients need focused care. They come to you after having little success with other doctors; they deserve your absolute attention. If you can put everything aside and lend your full attention to them, this may allow them to heal. This amount of caring can be profound and restorative, in and of itself.

In remembering the best adjustments I’ve received, the intense focus, the level of concern, and the precise delivery was life changing. Our patients will recall the same about us. A few moments of laser-beam focus can create a memorable event in patients’ lives. When patients are cared for this way, they will repeat their story, and chiropractic will keep growing. Isn’t this what you want for your practice?

Let Your Life’s Work Become a Work of Art

Something magical happens when we are totally involved in our work. It’s described as “being in the flow” and is one of the aims of the truly successful. Extraordinary people lose themselves in their work. Like great artists, they are in a meditative trance while working, yet they are fully present. The greats in every field love to experience this state: in a chaotic world, they enjoy moments of absolute clarity through focus.

How to Become More Focused

Often, growth in practice is counterintuitive. A close friend urged me to cut back my hours, saying that, if I did, my practice would grow. Although I was convinced he was lying, I finally reduced my hours after he continued to badger me. Suddenly, my practice grew. It grew so much, that I did it repeatedly. This worked because shorter hours demand more focus and higher energy. Allowing too much time to get things done decreases the quality of care by letting distractions into the workplace. If you must focus to get the job done, you get organized and do it.

Another counterintuitive way to develop focus is through rest. People who don’t relax can’t muster the intense focus necessary to build a great practice. These same doctors will protest about the high cost of having someone help them around the house and do it all themselves. By not resting adequately, they lose their clinical edge, and it costs them and their patients dearly. Intense focus demands a recovery period to recharge and perform at higher levels. B.J. Palmer often napped in the afternoon. During the rest of the day, he ran a college, sanitarium, cafeteria, two radio and one television station(s), wrote many books, and developed our great profession. Rest allowed him to be this productive. Are you well-rested? Discipline yourself to nap, meditate, take breaks, and play. Regenerate with regular vacations, seeing friends, and having fun.

Get Organized to Focus More on Patients

Rules for providing a quality service include:

1. Patients Always Come First
2. Doctor’s Time Is Primetime, and
3. Delegate Everything.

Patients Come First

In times past, patients expected to wait for a busy doctor and would tolerate a poorly-run clinic. Years ago, seeing a doctor required hours, but patients waited willingly because it was normal.

Today, this arrogant behavior is not well tolerated. Offices are usually better run, and the best offices provide the finest service. When a patient shows up, everything stops. The assistant hangs up the phone, or at least signals the patient, it won’t be long. The doctor drops his pen. All extraneous conversation stops and patients receive the attention they deserve.

In the best centers, doctors and staff anticipate every question and need patients may have. They are led through a seamless experience and receive appropriate care without much waiting. Ideally, the patient walks away thinking, “Wow, these people care about me. I can’t wait for my next visit.”

Doctor’s Time Is Primetime

Assistants in a busy office maximize a doctor’s time by minimizing interruptions. Experts in efficiency note that, every time someone is interrupted, the time to complete a task doubles. They also say that interruptions multiply the odds of errors dramatically.

In the best offices, phone calls, extraneous conversations, and other interruptions are tactfully limited, so that the doctor can offer his/her best. The staff dutifully runs interference for the doctor, so there are no distractions. Does your practice work this way?

Delegate Everything

Ideally, all work not requiring licensure to perform should be delegated. Assuming they can do everything better, delegating can be the hardest thing for doctors to do. Most doctors would rather do it all themselves than allow any aspect of care to suffer. When doctors won’t delegate, quality eventually suffers.

The greats throughout the centuries received support from qualified staff. Michelangelo and Leonardo had others stretch their canvas, mix their paints, and hand them brushes. They reserved their attention to the details only they were qualified to perform. Working this way, they contributed a vast body of work to the world.

Learn to hire well, train, and delegate. Give aspects of your work to people who can do it, and monitor their work. Manage so that you can focus on what you do best.

Conversation

No discussion of focus would be complete without covering what to say as we attend patients, and when to say it. This is often when we lose our focus.

There should be no conversation immediately before, during, and after the actual adjustment. Conversation should abruptly stop to allow absolute focus on this event.

Before and after the adjustment, the doctor should focus and talk about the patient’s needs, issues, and benefits of care; answer a question; explain his/her progress, results, how he/she adjusted, how he/she might feel; and give instructions and suggestions for self-care. As a rule, the focus of the conversation is on him/her. Is your “table talk” like this? If it gets off track, does it always come back to the patient?

Focus to Build Your Practice

The chiropractic champions have one thing in common: uncommon focus. They offer exceptional care and enjoy extraordinary results through this discipline. This is why patients flock to them. In the end, doctor and patient benefit. The patient enjoys wellness and the doctor his/her art. Do whatever it takes to center yourself on your patients needs. Retrain staff, rest more, and lead productive conversations. Lead your practice forward by managing your attention.

Dr. Steven Visentin, D.C., is a solo practitioner and clinic director for Care Chiropractic in Denver, CO. He authored an e-book entitled “Blow Your Head Off Practice Building Secrets” for the chiropractic profession.

As an accomplished public speaker, he is available for corporate events, training seminars, and other group functions as well as private consultations on a limited basis. For additional information, visit www.practicesecrets.com.

Double Your Practice Without Leaving Your Front Door

by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP

Over the years as a practice consultant, I always get the same question: “How can I get more new patients?” This seems to the mantra of the masses! This seems to be the only or best way to build a practice for most.

There are numerous issues that must be addressed before an answer to this question can be rendered. What is your volume, your patient visit average (PVA), practice mix of personal injury patients, cash, managed care, workers’ compensation, and Medicare patients?

Continue reading “Double Your Practice Without Leaving Your Front Door”

The Healthcare Stimulus Package: Navigating the Buzz

by Michael Failla, D.C.

There has been a great deal of buzz lately about the government’s healthcare stimulus package. And, as Doctors of Chiropractic, the plan is of great interest…as well as great confusion. The promising news is that this package could potentially provide reimbursement payments to qualifying chiropractors of up to $44,000 over the next six years.

We do know that providers mustUse a system which fulfills these

Requirements before the year 2013

As there has been much talk of the stimulus plan, there has also been much misinformation and speculation. So let’s take this time to set the record straight. Why do we say that clinics could potentially qualify for this stimulus package? And just how sure can we be that this stimulus package will apply to chiropractors after the measure is signed and sealed? Well, there are still some undefined areas and loose terms to be tightened up.

We do know that providers must use a system which fulfills these requirements before the year 2013 to receive the full incentive payout, and penalties for not adopting a qualified EHR (electronic health record) system will start taking effect after 2015, including a 1-3% cut in Medicare payouts.

We also know that, in order to be eligible for participation, clinics must submit over $24,000 for the year 2011 in Medicare Part B claims under a certain set of chiropractic treatments. These treatments are narrowed to include only the treatment of spinal subluxations. These treatments must be submitted using the AT (Active Treatment) modifier to ensure that they fall under the umbrella of medical necessity.

The stimulus plan also requires a “meaningful use” of a “certified EHR system.” This verbiage is subject to a wide range of interpretation and, therefore, the implications are still pending:

• Meaningful use will require the record-keeping and distribution of prescription medications, interoperability with other certified EHR systems, electronic exchange of medical records, and the provider’s submission of clinical quality measures. The specifics of these requirements have not been decided upon in any clear form, and so we will have to rely on future clarification to understand the extent of this term.

• A certified system will most definitely require the software system to be reviewed and accepted by a formal certification panel, surely either the Certification Commission for Healthcare Information Technology (CCHIT^®) or the National Institute of Standards and Technology (NIST^®).

The Secretary of Health and Human Services has a deadline of December 31st, 2009, to solidify a set of standards for meaningful use and EHR certification. It looks as though we may have to wait patiently until then to learn the full requirements for participation in the stimulus package.

So why buy an EHR system now?

If you research and make an educated decision about your EHR system now, while you have the time, you can ensure a boundless return on your investment before a mandated switch causes you to scramble for a system that may not meet the specific needs of your office. Selecting the right software for your practice is an important decision, and not one to make hastily when penalties for non-compliance are creeping up behind you, and you’ve missed your chance at a sizable stimulus payout.

Choose your EHR system carefully, and go with a progressive company that has its finger on the pulse of American healthcare. Select a company that is informed, responsive, and dedicated to keeping on top of the latest information. If you take the time now to choose wisely, your investment will be in place and ready to carry you effortlessly through the inevitable changes that are hovering on the horizon.

Dr. Michael Failla is the President and Co-owner of Integrated Practice Solutions, the makers of ChiroTouch. Dr. Failla graduated from Life University College of Chiropractic in Atlanta, Georgia and went on to run a highly successful chiropractic office in Seattle, Washington for 25 years. Dr. Failla sold his practice in 2007 and continues to promote health and wellness by helping chiropractors run streamlined and successful practices with more time for their patients and less time with their paperwork.

Medicare Audits Becoming More Common in Deteriorating Economy

by John Davila, D.C.

Recently, Iowa Senator Grass ley started looking into Medicare’s acknowledgment that the amount of money overpaid to Durable Medical Equipment (DME) providers, due to fraud and abuse, has increased by 44% in the past few years. You may ask, what does this have to do with chiropractic and my practice? The answer is, “A lot!” With the Federal Government feeling the pressure of reduced income and increased expenditures, they are looking at any and all ways to reduce spending, especially for things that shouldn’t have been paid for in the first place.

The answer is, “A lot!”

Even though the cost of drugs far outweighs the amount of money spent on DME, it is the percentage of overpayments, due to fraud and abuse that makes this issue a political football. In chiropractic, we have been saddled with the same issues as DME ever since the 2005 office of the inspector general review of chiropractic. Because of the percentage of claims that should have been denied (67% according to the OIG report), payment for chiropractic care has become a political football that has nothing to do with patient care. To make things worse, within the next year Medicare will have launched recovery audit contractors across the country to review and try to recover part of the $10,000,000,000 overpaid within the Medicare System every year. But, what causes an audit? There are many things that cause an insurance carrier to decide to pick a specific provider of alignment. In the past, the most common causes of an audit were related to billing and coding procedures that took place within the office. But, because of increased scrutiny from the Federal government, there are many new reasons why a provider would be chosen to be audited. Those reasons can range from not charging for services provided, to paying for referrals. So, why does the government care if you give free X-Rays and examinations to Medicare beneficiaries? The answer is simple. The Office of the Inspector General released a special advisory bulletin in August of 2002, titled Offering gifts andother inducements to beneficiaries. The bulletin states: Offering valuable gifts to beneficiaries to influence their choice of a Medicare or Medicaid provider raises quality and cost concerns.Providers may have an economic incentive to offset the additional costs attributable to the giveaway by providing unnecessary services or by substituting cheaper or lower quality services. The use of giveaways to attract business also favors large providers with greater financial resources for such activities, disadvantaging smaller providers and businesses. But, what is considered a valuable gift? The bulletin states: The OIG has interpreted the prohibition to permit Medicare or Medicaid providers to offer beneficiaries inexpensive gifts (other than cash or cash equivalents) or services without violating the statute. For enforcement purposes, inexpensive gifts or ervices are those that have a retail value of no more than $10 individually, and no more than $50 in the aggregate annually per patient. Violating these rules can create harsh penalties for the practice. The bulletin states: A person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection

of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMP’s) of up to $10,000 for each wrongful act. There are two simple steps that a practice can take to avoid giving an auditor additional ammunition to use against the practice:

1. If you offer gifts to patients in your practice, make sure they are less than $10, no more than five times a year. In addition, the gifts must not be considered an inducement for a reward to create new business from a Federal Healthcare program.
2. Include your staff in all training on compliance issues. This will reduce the chances of a staff member becoming a whistleblower, which is the number one reason why a practice would get audited for offering inducements and expensive gifts to beneficiaries.

Dr. John Davila is a 1994 graduate of Palmer College of Chiropractic in Davenport, IA, and practiced in the Myrtle Beach, SC, area for 13 years. Since 2000, he has been consulting with insurance companies and doctors in private practice in the areas of coding and documentation. In 2001, he re-wrote the Medicare LCD coverage policy for Palmetto GBA (SC Medicare). His company, Compliant Services & Solutions, Inc., helps doctors of chiropractic to ethically maximize their practices, while avoiding audits and repayments to insurance carriers. You can reach Dr. Davila, toll free, at 1-877-322-6203 or by email at [email protected] or on the web at

Frustrated with Bad Tech Support

by Dr. Michael Failla, D.C.

After years of having to deal with the customer service departments of insurance companies, most doctors and their staffs have grown numb from having to navigate through a series of “Press 1 for this,” or “Press 2 for that” computer animated call centers. Collectively, we are all tired of being shuffled from one impersonal system to another. This experience is only compounded when we are having difficulty with our computers or software, since there is a sense of helplessness and a stagnation of all productivity when our systems are down.

The technology industry is notoriously bad at providing good support for many of their users. In an article in Consumer Reports, many of the larger technology companies were out shined by smaller companies in providing solutions to their problems in over 30 percent of the cases. The major frustrations these people faced came from long hold times, repeating information over and over to multiple representatives and the high cost of support per hour.

One study stated that 85 percent of customers said that they would stop using a company’s product after a bad experience with a call center. As professionals and business owners, we don’t have time to waste on the phone with strangers or, even worse, automated systems attempting to correct a problem we are struggling with. Nor do we want to have the time of a staff member being expended in this manner.

In the past, lousy and impersonal service may have been forgiven because the number of options that customers had were fewer, so they made do and suffered through it. However, in this age where we need our problems solved yesterday, quality customer service is an expectation, not just a luxury. Any software company that you deal with today should make it a part of their corporate culture to have resources available to overcome support issues. It should be the norm that your software is backed with:

As with any purchase you make for your office, it is important to do your homework about the quality of the product and equally imperative that you research their customer service record. Larger companies may be more impersonal, while smaller companies may be under staffed, which can lead to frustrations in the future. Since changing vendors takes a significant investment of time and effort, it is important that you form a relationship with a company that you can trust.

Healthcare Information Technology — The Key to Unlocking the Door to National Reform

by Dr. Steven J. Kraus, D.C., D.I.B.C.N., C.C.S.P., F.A.S.A.

President Obama’s administration recently hosted forums on healthcare reform in cities across our country. I was fortunate to be included on the invitation list to the forum held in Des Moines, Iowa. The Iowa White House Forum on Healthcare Reform featured a panel of high-profile elected officials, including Senator Tom Harkin, Iowa Governor Chet Culver, South Dakota Governor Mike Rounds, and Nancy-Ann DeParle, who serves as the director of the White House Office on Healthcare Reform.

As one of the few selected to ask a question of the panel, I inquired about evidence-based practices and the role they would play in impending reform. I discussed how evidence supports that low back pain treated by a chiropractic physician is a best practice for its effectiveness and cost efficiency, but the challenge we face is having no way to communicate this conclusion to the broader healthcare community. The essential question: If we are to have true healthcare reform, how are we going to make information on best practices available, quickly and to all medical providers?

The answer: Through technology.

The Obama Administration is pushing to launch a reformed healthcare model by the end of 2009. Senator Harkin is leading much of the reform policy discussions and has announced his goal to establish policy rules by June. Senator Chuck Grassley, influential on the financial side of the healthcare equation, and Senator Harkin are committed to fulfilling the President’s bipartisan promise and are working aggressively toward these timelines.

Senator Harkin gave insight into his viewpoints, and what we might anticipate as a national model, when he used my inter-disciplinary clinic as an example at the forum. My clinic employs MD’s, DC’s, physician assistants, physical therapists and others, including acupuncturists. Senator Harkin’s belief is that we need integration and collaboration; healthcare professionals must come together and work as a team to deliver the best possible patient outcomes. He also indicated that we have a “sick care” system, rather than a healthcare system. In order to have a healthcare system, we must also focus on wellness and prevention, and not exclusively on those who are already ill. And finally, true reform is not just looking to pay for coverage of all Americans. If we only seek to pay the bills, we are simply expanding coverage for the uninsured with no true system reform. The goal for healthcare reform is to change how care is delivered, and much of that change will be supported by technology.

The forum attracted attendees from all facets of healthcare, including dentists, surgeons, Advanced Registered Nurse Practitioners (ARNP’s), chiropractic physicians, and more, and everyone is seeking to be integrated into this anticipated collaborative model. But, reform is not about racing to the front of the line and just being counted. Rather, it is about changing the method of selecting services, how we integrate patient choice and patient responsibility, and addressing physician responsibility for treating the whole person and not just the ailment that prompted the patient to make a clinic visit in the first place. Reform is about managing the total health of the patient and, ultimately, with the right technology and care plan, letting the patient heal himself.

Only those who demonstrate preparedness and an understanding of the true need for change will be taken seriously in reform discussions. In the current climate, preparedness is synonymous with technology, and chiropractic physicians who implement Electronic Health Records (EHR) are more likely to get the attention of the federal government and policy makers. Preparedness gives us influence and tells those leading reform efforts that we, too, are serious about participating in a changed system. In this situation, there is great power in numbers. The more doctors of chiropractic who adopt an interoperable EHR system, the more credit we will get for responding quickly to government imperatives on the front end, instead of waiting, like many others, until the last minute.

When we adopt this technology, it is absolutely critical that we select something more than a digital note-taking system. Such a program will not be sufficient to support the anticipated depths within reform. Does the system you’re considering assist you by offering alerts about non-compliant patients? Does the proposed system monitor the plan of care? Is there intelligence built into the technology to guide you, rather than just capturing information you enter? We can only improve care if we move to a digital system that works side-by-side with us, to share best practices, measure outcomes, and provide detailed patient information to other practitioners when requested. A true EHR program accomplishes this, and more.

The reality is that care will be managed jointly by the doctor and the patient, and technology that allows for the transfer of data back and forth provides guidance on best practices, and monitors information to provide valuable alerts and reminders which are key to helping the doctor better manage case load. Get the right technology now and be a player in early healthcare reform—the train has actually left the station, so catch up and get on board, before it’s too late.