observations from our travels in the world of chiropractic

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Anthem Chiropractic Network Reductions

(Wisconsin, April 4) Chiropractors in WI received certified letters from Anthem BCBS announcing that they are initiating a sweeping reduction of their chiropractic provider network to supposedly “right size their provider network as a result of the ACA”.

According to Mr. Dave Michel of Petty, Michel & Associates, if you have one of these letters, you’ll be removed from the BX network on Sept 30 “without cause”, as allowed under your provider agreement.

He says that it looks like they may be targeting larger clinics in each city with higher utilization and also possibly those with a focus towards wellness,and that this doesn’t bode well for their customer base.

Dave mentioned that a similar tactic was used by insurance companies in Massachusetts with the introduction of “Romney-Care” in 2006 and after the hue and cry, chiropractic offices continued to grow. This has also been the case with offices that we have worked with when the doctor was booted from a network – stats go up!

In many cases, the out of network benefits are close to those in network.

Dave has written a letter that you can customize and send to your patients should you get hit by an insurance company claiming they need to “right size.” You can download a copy of this letter as a Word file with the link provided below.

A key to survival is patient education, not only on chiropractic, but also on chiropractic benefits. This is why we stress the Patient Financial Consultation, or the Post Report of Findings.

Lastly,  Dave recommended working together as a group with your state associations and respectfully confronting any insurance company that discriminates against chiropractic services with the facts.  And the facts are that chiropractic care doesn’t cost… it pays.

While you may not practice in Wisconsin, there may be a time when you receive such a letter and if you  do,  these suggestions  can help.

For PM&A clients, if you have received a letter like this, let us know and we’ll work with you on your options.



Dave Michel’s Letter to patients: Anthem Termination Letter

April 7, 2014   No Comments

Tent Poster – “Life is a Torch” – George Bernard Shaw

This is the true joy in life, being used for a purpose recognized by yourself as a mighty one. Being a force of Nature instead of a feverish, selfish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy.

I am of the opinion that my life belongs to the whole community and as long as I live, it is my privilege to do for it what I can.

I want to be thoroughly used up when I die, for the harder I work, the more I live. I rejoice in life for its own sake. Life is no brief candle to me. It is a sort of splendid torch which I have got hold of for the moment and I want to make it burn as brightly as possible before handing it on to future generations.

—-  George Bernard Shaw Preface in book called: “Man and Superman: a Comedy and Philosophy.”


Printable Tent Poster

April 2, 2014   No Comments

ICD-10 Implementation Delayed until 2015 – Chiropractors Breathe a Sigh of Relief

Good Grief!

After all the pressure to get compliant and ready for the new ICD-10, it looks like it will be delayed for another  year.  Again.

According to a report issued by the AHIMA (American Health Information Management Association):

“On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA

Please note the number of capital letters behind Thomas Gordon’s name. This should give us all an idea of how convoluted this process is and will continue to be.

The same article, issued on March  31, 2014 states:

CMS (Centers for Medicare and Medicaid)  has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay.  This does not include the lost opportunity costs of failing to move to a more effective code set, AHIMA said.

Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices had begun moving into the final stages of costly and comprehensive transitions to the new code set—even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM/PCS Coordination and Maintenance Committee.

The delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.

The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification. ICD-10 proponents have called the new code set a more modern, robust, and precise coding system that is essential to fully realizing the benefits of recent investments in electronic health records and maximizing health information exchange. (AHIMA article)

 ICD-10 is not going away. But for those of you who felt that you weren’t going to be ready by the deadline… looks like you have more time to get everyone trained and the systems worked out.

Which is nice!

Stay tuned for more info from your state associations, carriers, and CMS. We will do our best as well to keep you up to date.

March 31, 2014   1 Comment

Disruptive Technologies: Why Cal Jam Is the Future – and You are Too

Petty Michel Following the Force to Cal Jam

 Next week, a few thousand chiropractic professionals will attend a chiropractic seminar called Cal Jam sponsored by the Dead Chiropractic Society.  (Some of us from PM&A will be attending as well as a number of the offices with whom we work.)

Cal Jam is what could be called a disruptive event.

I take this from a term used in technology called “disruptive technology” or “disruptive innovation.” It refers to a product or discovery that forever changes the future. It creates a true paradigm shift. For example, the automobile, telephone, and of course, the Internet. We see this happening with FaceBook and soon, perhaps with Bitcoin, drone home deliveries, and other culture shifting technologies.

Cal Jam is a seminar that is unlike all past seminars I have attended or know about.  It is, in itself, a paradigm shift.  I have been traveling off to chiropractic seminars for few years now. The first one I attended was back in 84 or 85 when Dr. Parker (Dr. James Parker) had it in Reno one year. Had the chance to talk to him then up in his suite.  Since then, I have been to maybe a 100 or more over the years. Cal Jam is dif-er-ent.

Petty Michel & Associates is not really a seminar company, but we encourage them. Seminars can be useful for teaching, motivating, selling, and networking, but we find that the real work begins and ends in the office, where you work on the office. Like the old phrase: “Education Begins at Home.”

But Cal Jam is unique.

  • As a whole, Cal Jam is not about itself.  There may be speakers or vendors that have invested a great deal and need to promote themselves, but the theme is not about Cal Jam or any one management company or product.  It is really about the bigger issues of Chiropractic and Health.  So, there is kind of a lack of self-importance which is very refreshing.  It genuinely puts chiropractic and the health of your family, friends and community first.
  • Cal Jam starts with chiropractic and then takes off to vital issues affecting health.  It takes on critical – and controversial — health subjects that go way beyond the conventional and challenges you to learn how they affect your patients and what you can do about these issues.
  • Principles and history. It has presenters that deeply discuss chiropractic principles and history, the foundation for your profession which is often overlooked and, in our years of on-site work,  a major reason for many floundering practices.
  • Totally classy. In fact, the digs are luxurious. The venue is in a modern performing arts center that is nothing short of first class.
  • All done by just one practicing Doc. It is championed by just one person, Billy DeMoss (supported by Mary Jane), a practicing chiropractor who lives and works in an office just like all the tens of thousands of other chiropractors. Chiropractors like you. He is not school president, he is not a practice management seminar speaker, and he is not selling supplements or equipment.  So, in many ways, he is just like you.
  • Purpose. Except for this: he is authentically driven by a greater purpose to promote chiropractic and good health to such an extent that is is creating this thing called Cal Jam.  And by his actions, he sets an example for you. You have to ask yourself: “Besides growing my own business, what could I also be doing to significantly help others?”
  • Rock and Roll.  Lastly, I have never attended a rock concert that was also a seminar.  This is my 4th Cal Jam. It is fun!

It is not too late to hop on a plane and attend Cal Jam. The seminar is modestly priced. Go to Cal Jam.

But if you can’t, you can apply its spirit – the spirit of honestly helping others improve their health.  And being disruptive.  This may go beyond your comfort zone, but it will be worth it.  It is no news that chiropractic is, and always has been, a disruptive health system. Imagine, adjusting someone rather than having them receive back surgery! Back surgery brings in a lot of money to hospitals yet at least one study cited estimates as much as 90% are unnecessary. I am you as doctors see this first hand. But chiropractic has frightened and upset the medical monopoly for years, as evidenced in the 1988 Wilk vs AMA case.

Be just a bit disruptive. Have fun and be friendly and don’t take yourself too seriously. But be something new and fresh in your office and in your town. Get people off the couch, off their drugs, get them adjusted, educated and moving. This is what people, more and more, know they need.  For that IS the spirit of chiropractic, in my opinion.

And if you want, turn up the jute box – or Internet radio. Get your patients dancing to some rock and roll music*… and you can have the spirit of Cal Jam every day.

*“Just let me hear some of that rock and roll music, anyway you choose it,
It’s got a back beat, you can’t lose it, Any old time you use it.”
(Chuck Berry)


February 19, 2014   No Comments

Where in the world is Phyllis speaking now?

While we are struggling to stay warm here in the Midwest,  our Phyllis Frase will be heading to sunny Puerto Rico the weekend of February 1 and 2nd to share her expertise on the Chiropractic Front Desk and better communication in a chiropractic office.  Last report was the weather was 86°.

PPMs CAs Boot Camp_Flyer (3)


We’re certain she will “light a spark of chiropractic passion” for the CA’s in attendance and we only ask that she brings some of the warmth back home with her.

January 27, 2014   No Comments

Your Biggest Chiropractic Bill Each Month


You may be overlooking your biggest bill. Most chiropractors do.

What is it? If you are in the upper Midwest or Eastern part of the US in the winter of 2014, it might be your heating bill.  It has been pretty cold.

How about personnel or marketing? Your lease? Staff benefits? How about your pay? (Probably not, I would guess.)

In running a chiropractic business, many doctors try to maximize the profit of their business by reducing expenses. They often get this idea from their accountants, and, from a certain perspective, it is a good idea. But accountants are trained such that their primary function is reporting income for tax purposes and not managing business finances.

You definitely need to review your Profit and Loss and Balance sheets regularly. Sometimes you can get carried away with expenses, not noticing that things are getting out of balance when you have 4 x-ray units, 15 computers and only 1 staff member.

But what your financial statements don’t show you, and what your accountant isn’t trained to see, is your ROI – your return on your investment.

And what is your biggest investment? (Pause while you consider this question….)

It is YOU.

And what is your biggest bill? What is your biggest expense?

It is the income that you could and should be making that you aren’t.

Your biggest bill is the amount of money you could be making if you were operating at your full capacity but aren’t.

Here is an example: Let’s say you are relatively healthy and are capably of seeing  200 patient visits per week comfortably. This excludes new patient visits.  This averages out to about 860 visits per month.  Let’s drop it down to 820 visits for vacation days, etc.  Now, let’s say you collect only $40 per visit, average. This would mean you would be collecting $32,800 per month.

Let’s leave aside the possibility you could collect more per visit and imagine that you are seeing 150 visits per week, or 645 visits per month, or 605 if we take out a few visits for vacation days (40 visits per month).  At $40 per visit, this leaves you with $24,200 per month, or $8,600 LESS than you should be making each month.

In other words, if you could and should be making $32,800 per month and you are only making $24,200 per month, you are essentially writing a check for $8,600 EACH MONTH, payable to “Inefficiency, Inc.”

You are wasting that much each month as a negative return on your investment on yourself.

This is so brutal to face that most doctors would rather look the other way.  But whether you squint at it, or not, the reality is there: you are wasting your hard earned cash each month that you are not operating at full capacity. You are throwing away a portion of the time, training, and sacrifices you have made to get to where you are now.

It is as if you are writing a check, each month, for the amount of money you should be making, but aren’t.

Savvy CEO’s and large corporations understand this.  They need to get the full measure out of their investments. As a result, they invest heavily into solutions that improve production and services so their business can achieve full capacity.

One investment that shows the greatest return is corporate training and coaching. This is a huge industry: corporate training grosses $138 billion yearly in North America and executive and business coaching is at $9 billion a year and growing.

Various studies show that executive coaching brings back a return of 5 to 8 times the investment.

Obviously this speaks to our services, but beyond us, coaching and team training help you get the most out of your biggest investment – you.

Read a book, go to a seminar, watch a webinar, participate in 4 Mastermind groups, and get an executive coach to help train and guide you. Invest in yourself so that you can take the necessary actions to reach your full capacity.

In today’s economy, you need to get more out of what you have.

Quit wasting money. Invest in yourself. You can afford it.

Ed Petty



January 23, 2014   No Comments

Chiropractic Team Tryouts: Tips on Interviewing Potential New Team Members

 Tryout: a test of someone’s ability to do something that is used to see if he or she should join a team, perform in a play, etc. (Merriam-Webster)


We routinely help our chiropractic teams with the hiring process.

Getting the right players can make all the difference in whether you are a winning team or just a mediocre one.

 It is often difficult to find the right candidate for the job. The prospective employee is trained to be sweet at the interview and have an impressive resume and you are expected to ask her just the right questions that will evoke her true character. This is usually not adequate.

In addition to interviews, practical tests that challenge candidates for the job position can be included as part of the hiring process. Much like a “tryout” for any sport team, musical group, or an audition for a play, we want to see how the prospective new employee performs.

A good management motto is: “Look, don’t listen.” This definitely applies to hiring.

After the first interview, if you are still interested in the person, have them come in again for a practical interview. This is the “tryout” or audition. For the front desk position, present them with some challenging but common situations and have them demonstrate how they would handle each. Have them demonstrate as in role playing, not just tell you how they would do it.

 In the examples below, the doctor can be in the role of the patient, or prospective patient, or have another team member in that role.

For the Front Desk position, you can have the candidate take on the following situations:

  •  Appointment book is full. Patient calls in and wants to see the doctor.
  • Patient calls in and is in pain.
  • Calls but is skeptical of chiropractic
  • Calls, asks how much for an adjustment, and then says it costs too much
  • Patient is leaving after an adjustment, needs to be scheduled, and the phone is ringing.
  • Patient owes $37.67. Collect it.
  • Promoting upcoming talk, next Tuesday at 6:30 on “Spinal Fitness.”

Someone applying for Patient Accounts could role-play the following:

  • Perform a patient financial consultation on a new Medicare patient who also has a secondary.
  • Call for chiropractic benefits.
  • Receive a letter “not medically necessary.” What actions to take?
  • Promoting upcoming talk, next Tuesday at 6:30 on Spinal Fitness.

Other situations can be presented that are appropriate for your office, depending on the position, such as therapy, external marketing, etc. Be creative and keep it fun, but challenging.

You can give the candidate a few lines to help them, but tell them you want them to improvise to the best of their ability. It doesn’t have to be perfect and probably won’t be that smooth as they are new to your office.

What you are looking for is their ability to be genuinely interested in the patient. You want to see how much in command they are of the situation, their friendliness, compassion, and general quality of their communication.

If you want a winning team, when hiring, use “Tryouts.”

January 23, 2014   No Comments

GOOD TO GREAT: The 1st Step in Taking Your Chiropractic Office to Greatness

Jim Collins, author of Good to Great, after researching many successful companies, noted that great companies “confronted the brutal facts.”


“All good-to-great companies began the process of finding a path to greatness by confronting the brutal facts of their current reality.”

If you want to take your chiropractic business to the next level —the 1st thing you need is an exact and honest picture of where you are now.

You see, you can’t get to “THERE if you aren’t exactly clear on where “HERE” is.

You may be looking at where you want to go — visualizing your goals — and you should. But before you head out on your path you should really look at where you are now and review your strengths and weaknesses.

It is goal setting season now. If you don’t clearly assess your current practice condition, a year from now you may be right back where you started.

In a hurry to get THERE, we often don’t spend enough time really LOOKING at and assessing what is honestly going on HERE.  In fact, it has been our experience that most doctors do not face the blunt facts right in front of them but instead try to “solve” their practice challenges with a new solution.   It is similar to a patient embarking on a new treatment program without first receiving a thorough examination.

We have often seen a doctor set goals designed to fix a challenging practice situation in one area when the problem was really emanating from another.  For example, your external new patient difficulty may really be coming from messes in your office management.

How is your front desk team member doing (really) after her husband lost his job? What is going on with that therapy procedure you wanted to implement three months ago? Is my billing coordinator writing off too much? How many new procedures has the front desk been given over the last 6 months? How much money am I spending/not spending on marketing? What’s going on with our newsletter program? Where’s my blue coffee mug?

Sometimes we just can’t see the forest for the trees. We become so accustomed to what we do each day that we can overlook what can be choking off our growth – or potentially fueling it to the next level. Plus, we are busy.

Half the battle of growing your business is in squarely observing what is in the way, as well as recognizing what are your greatest resources.  Only then can you effectively set your goals.

To help with this, we have developed a practice assessment specifically for chiropractic businesses. It digs into your office and measures 11 different dimensions of your operation.  Our first version of this was created nearly 14 years ago and has been used successfully since. This new version is even better.

Much like a functional assessment for your patients, this survey inspects vital areas of your practice and gives each a score. From this, we make a chart that gives you a portrait of what areas are strong and what may need immediate attention.  We also provide a written interpretation of the assessment.

Originally, this assessment was used with our active clients as part of their service. Using this assessment tool as well as practice statistics, we could uncover what areas of their business needed the most correction. We also discovered untapped or underutilized strengths that could help energize the office. At regular intervals, we could reassess and note the improvements and what to work on again.

We are now offering this assessment again as a special service which includes:

  1. The assessment
  2. Graded and plotted assessment
  3. Statistical analysis with charts
  4. Phone consultation
  5. Written report with practical action steps.

Each question will provoke a greater understanding of your practice. With the results of the assessment charted and the consultation, you will obtain a new perspective of how your office operates. You will also see more clearly what needs to be done to bring it to the level of success that you desire.

Practice Statistics. Of course, you can’t evaluate a business without also analyzing its performance monitors. Most offices keep practice numbers – somewhere.  Unfortunately, they are rarely reviewed properly.  We know how to analyze them and show you your ratios and the trends that they reveal. If we do not have your current practice statistics already, we will request them on a separate form. After interpreting your statistics, we plot them on charts and correlate them with the results of your Practice Development Assessment.  Together, this will allow us to give you an excellent overall analysis of your business and what needs to be done to take it to the next level.


Send in when Completed.  When you have completed this assessment, you can fax or email it back to us at Services @ pmaworks.com or Fax: 877-868-0909.   We will score and chart each section of your assessment and set up a time to discuss the outcomes with you. We will also send you the results with our written observations and recommendations.

The standard fee for this for non active clients is $250.  

NOTE: As of January, 2014, for a limited time promotion, we will be charging only $25. This is almost free, but I don’t want to take up our team’s time with people who aren’t seriously interested in this service. If you take us up on this assessment, I will assume you are hard core about improving your business. As hard core as we are!  :-) Use the promo code  CPDAPROMO to get the discount when you click the link below.

Ed Petty

To purchase: LINK



January 3, 2014   No Comments

Using Checklists to Improve Your Chiropractic Practice

We are what we repeatedly do. Excellence, then, is not an act, but a habit.  ~Aristotle

Don’t overlook the humble checklist as an important tool in developing your business. Simple and low tech, the checklist is yet so powerful and vital that everyone from pilots to surgeons use them.

Here at Petty, Michel and Associates, we have been promoting the use of checklists as a simple tool in chiropractic practice development since the early 1990′s.  All successful businesses use them, and certainly all professionals, from airplane pilots to cowboys.

Are they just more paperwork? Or can they really make things faster, simpler, and actually improve the quantity and quality of your services?

It really is just a simple matter of helping to ensure that your office continues to do the things that work.

Let’s be honest: sooner or later, we all get bored.  When we start something new, we are fully engaged. But after a few weeks, months, let alone years, continuing to do the same thing can be painfully tedious. So much so that we are tempted to follow other diversions.

Excellence does require creativity and innovation. But it also requires doing the same thing that worked yesterday – today and tomorrow. Improve upon it; add a new service or product or communication channel.  But don’t let your feelings of monotony dictate your management planning or procedures.

At PM&A, we advocate management by the numbers and by your own proven procedures.  Execute your procedures routinely with care and interest. Don’t manage by emotions or chase other people’s bright ideas or change everything to follow the current management flavor of the day.

The fundamentals ALWAYS apply.

This is the meaning of what Aristotle spoke of as recorded in his talk on ethics:

We are what we repeatedly do. Excellence, then, is not an act, but a habit.

Practically, a checklist is a reminder of a what should be a habit: “Don’t forget to:____. ”  We are all busy and sometimes can take things for granted or take necessary shortcuts.  There is a tendency for any activity to atrophy to its minimal functions. For example, at the beginning of the year you got up early, had a cup of freshly ground coffee, and went to the gym for 40 minutes. By July, you were settling for instant coffee and a walk to and from your car.

A simple list of duties, such as how to open and “start” the office in the morning, “closing” the office in the evening, or “10 things to do on a patient financial consultation” can act to help train and as well as review excellence in performance. A list of duties for each position in the office is also very useful for training and just reminding.

Atul Gawande, an endocrine surgeon, saw the need for checklists in surgery.  He surveyed  fellow surgeons who said that they did not want to do checklists before surgery. But when asked if they wanted their surgeons to use a checklist if and when they went under the knife, almost all said they wanted their surgeons to use a checklist.

“What is needed… is discipline.

Discipline is hard — harder than trustworthiness and skill and perhaps even than selflessness.  

We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals.  We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything–a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps–the ones that even the highly skilled professional using them could miss.

Good checklists are, above all, practical.

                                     -Atul Gawande, M.D., Endocrine Surgeon, Associate Professor at Harvard. (author of The Checklist Manifesto)

Managing the work you do as a chiropractor or chiropractic team member in your office may not be as complicated as surgery, but your patients are just as important.   Maybe even more important.  Why? Because your chiropractic care may help keep your patients from ever needing surgery.

The Checklist: a simple and humble tool to improve the quality and quantity of your chiropractic services.


Links to Atul Gawande: Quotes, TED

November 17, 2013   2 Comments

2014 Appointment Calendars

It’s that time of year again!

Many of you are starting to make multiple appointments for your patients which automatically takes you into 2014.

Below are some helpful appointment calendars that you can use help get those appointments scheduled and keep your patients on their treatment plans.

Appointment-Calendar 2014

Personal Appointment Calendar 2014

PMA members can find a word doc version of the calendars, for customization, on our members side under the Front Desk Library

November 15, 2013   No Comments