Warmest wishes for a joyous Holiday Season, a Merry Christmas and a prosperous New Year!
Ed, Barbara, Linda, Lisa, Dave and Phyllis
Merry Christmas from the PMA “Wild West” Team
Reply
Pain is the Last to Show and the First to Go in Chiropractic Healthcare
Previously published on The Goal Driven Business
An Important Chiropractic Patient Education Tip
I recently visited a highly successful practice that had its usual issues and wanted to expand to the “next level.”
What did they need? More marketing, more staff training, more associates!
Sure.
But they also needed to tend to the basics, and here is one that is simple but easily overlooked:
Chiropractic Patient Understanding of Symptoms
I learned this early on: subluxations and other dysfunctions of the spine and joints can be present long before pain or other symptoms show up.
Finally, the individual drags themselves in to see you, and you begin care. After a few visits, the pain subsides. Yahoo!
Are they fixed? Probably not.
They have moved from acute care to corrective care. (You may call it something different, but the idea is the same.)
Your patient may not be familiar with this distinction. Hence, the report of findings and the importance of future patient education.
“How are You Feeling?”
So it was with some dismay that, visiting this office with excellent doctors, I kept overhearing them greet the patients with “how are you feeling?”
What!! What did you say?
Nooo!
Patient thinks, “Hey, I’m feeling pretty good. No need to come in anymore. Bye!”
Two months later, they hobble back in: “Doc, I have the same problem.”
So, what should you say? You want to be nice and show interest. You do care, and would like an update, right? So what do you say?
Just be genuinely interested and ask them how they are doin’? Or better, try these:
- “How are you moving this week?
- “What improvements have you noticed?”
I am not a doctor and would not presume to suggest care procedures. But this is a matter of patient education, marketing, and business development.
You want to improve their function, structure, and health. Maybe their mindset as well.
And of course, you want them pain-free.
Just remember that pain shows up last, and usually leaves before your work is done.
Get this on your chiropractic and healthcare patient care checklist and for a reminder, review it often. I bet you’ll see an improvement in outcomes and retention. Even a 10% increase in patient retention can significantly impact your practice outcomes and bottom line.
If your goal for your patients includes pain relief AND better function, this can help.
Stay Goal Driven,
Ed
2025- Health Never Takes a Holiday – Complimentary Posters
Health Never Takes a Holiday is our signature holiday post for many years. It has proven to be very helpful for many offices to keep their patients on schedule during the holiday hustle and bustle.
For this program we offer free downloads of posters and tent posters you can use in the office to remind patients that we believe “Health Never Takes a Holiday” and it’s important to keep their schedule of care to stay well.
Please visit https://www.goaldriven.com/post/health-never-takes-a-holiday-in-chiropractic for this year’s complimentary posters.
Ask Lisa: It All Goes Back to the Goal!
I recently took a book off my bookshelf to re-read …
The Goal by Eliyahu M. Goldratt is one of my favorite business books. I love that Eli drives home being human, while at the same time having great capacity to improve systems and procedures in the workplace. As a business owner this relates directly to you.
Keep reading to learn how.
A few key takeaways from the book and how this ongoing process can help YOU improve your collections and income include:
Keeping in mind that the true goal of any for-profit company is to make money now and in the future. Two features of this are:
All operational decisions are evaluated based on whether they help achieve this goal.
Performance measurement is framed around three metrics:
- Throughput, or productivity (Service productivity is reflected in your NP, PV, charges, and collections stats)
- Inventory (making purchases intended to sell, such as supplements, pillows, exercise rehab supplies; and
- Operational Expense, which is money you spend to turn your inventory into productivity. This can include your practice management program and billing program’s monthly payments, maintaining and enhancing the office space, and maintaining functional chiropractic equipment such as your adjusting tables.
So, what specific actions can help you achieve the true goal for your business?
1. Identify constraints or bottlenecks in the office.
a. Look at time studies of the doctor(s) and staff. Can scheduling be done differently to open up blocks of time for more patients and/or paperwork.
b. Look for a breakdown in policies and procedures. How can it be done more effectively with better results?
2. Second, maximize and support the constraint,
a. decrease interruptions;
b. delegate tasks that are not directly clinical;
c. work on office flow for greater capacity.
3. Take note of variables. When a variable is presented such as doctor or staff
vacation and holidays , make adjustments to accommodate and still maintain your
goals.
4. Repeat steps 1 through 3, and you’ll find another constraint/bottleneck to work
through.
It may not feel good at first, but each time you cycle through the steps, according to the theory of constraints, you actually are improving the quality of your practice and its value!
Want to learn more about specific action steps for identifying bottlenecks and improving your collections and income? Give us a call. We’ve got your back. Just Ask . . .
Lisa
lisa@pmaworks.com
PS: Another great book that directly relates to this topic is “The Goal Driven Business” by Ed Petty.
Ask Lisa: Actions you can implement now to reach your Goals in 2026 and Beyond!
It All Goes Back to the Goal!
Greetings!
I recently took a book off my bookshelf to re-read …
The Goal by Eliyahu M. Goldratt is one of my favorite business books. I love that Eli drives home being human, while at the same time having great capacity to improve systems and procedures in the workplace. As a business owner this relates directly to you.
Keep reading to learn how.
A few key takeaways from the book and how this ongoing process can help YOU improve your collections and income include:
Keeping in mind that the true goal of any for-profit company is to make money now and in the future. Two features of this are:
- All operational decisions are evaluated based on whether they help achieve this goal.
- Performance measurement is framed around three metrics:
1) Throughput, or productivity (Service productivity is reflected in your NP, PV, charges, and collections stats)
2) Inventory (making purchases intended to sell, such as supplements, pillows, exercise rehab supplies; and
3) Operational Expense, which is money you spend to turn your inventory into productivity. This can include your practice management program and billing program’s monthly payments, maintaining and enhancing the office space, and maintaining functional chiropractic equipment such as your adjusting tables.
So, what specific actions can help you achieve the true goal for your business?
- Identify constraints or bottlenecks in the office.
a. Look at time studies of the doctor(s) and staff. Can scheduling be done differently to open up blocks of time for more patients and/or paperwork.
b. Look for a breakdown in policies and procedures. How can it be done more effectively with better results?
2. Second, maximize and support the constraint,
a. decrease interruptions;
b. delegate tasks that are not directly clinical;
c. work on office flow for greater capacity.
3. Take note of variables. When a variable is presented such as doctor or staff vacation and holidays , make adjustments to accommodate and still maintain your goals.
4. Repeat steps 1 through 3, and you’ll find another constraint/
bottleneck to work through.
It may not feel good at first, but each time you cycle through the steps, according to the theory of constraints, you actually are improving the quality of your practice and its value!
Want to learn more about specific action steps for identifying bottlenecks and improving your collections and income? Give us a call. We’ve got your back. Just Ask . . .
Lisa
PS: Another great book that directly relates to this topic is “The Goal Driven Business” by Ed Petty.
Keep Hope Alive in Chiropractic and Healthcare Offices
Previously published at GoalDriven.com
A Message from the “Head Office” ?
Early Thursday morning, I drove to a suburban high school with two of my grandkids. We were participating with others involved with a service organization called Community Projects for Seniors here in Milwaukee.
When we pulled into the expansive parking lot, we saw hundreds of cars and people driving through designated stations, receiving boxes of hot Thanksgiving dinners to deliver to seniors across Southeast Wisconsin.
The loading was well organized and ran smoothly, despite everyone being volunteers. Everyone looked to be having a good time, smiling and high-fiving in the early morning, freezing temperatures!
The two grandkids and I delivered 51 meals to residences in a low-income section of Milwaukee. It was a good experience for them, knocking on apartment doors, wishing seniors a happy Thanksgiving, and sometimes offering short expressions of care and interest or best wishes for the Packers (professional football team) later in the day.
As we were getting to the end of our route, a senior gentleman, must have been 6′ 4″ or more, after accepting the meal, looked dead at my grandkids and said, “Keep Hope Alive.”
Keep Hope Alive
“Keep Hope Alive” was a phrase Rev. Jesse Jackson often used when he ran for president in 1988. Jackson participated in the Selma marches in 1965 and became a close aide to Dr. Martin Luther King Jr.
The Selma marches included Bloody Sunday, when 600 unarmed peaceful civil rights protesters were violently attacked and beaten, some unconscious, by state troopers in March of 1965 in Selma. The Voting Rights Act of 1965 was signed into law by President Johnson, guaranteeing the right to vote for African-Americans, especially in the South.
But here we are in 2025. What did this resident mean when he said “Keep Hope Alive” as he accepted the Thanksgiving dinner? Why did he say it to two suburban kids this Thanksgiving?
Unlike most of the other people we handed dinners to, he was the most cheerful. Perhaps, for him, an elder and certainly not well-off, he had hopes for a better future.
A better future for himself — and maybe for others.
Keep Goals for Your Chiropractic and Healthcare Practice Alive
The word “hope” is defined as the feeling of trust that something wished for can or will happen. The derivation of the word “hope” traces back to Old English “hopian,” meaning to expect, or look forward with confidence in a positive outcome.
Hope is more than just wishing… it is expecting what you want will happen.
Kinda sounds like a goal, doesn’t it?
You know, you can receive messages that are meant for you – from others.
Someone I know calls these “Memo’s from the Head Office!”
I think that, for me, the “message” from the senior gentleman was that any hope, or goal, for a better future must be actively kept alive.
That means, your dreams and goals for the New Year, including your chiropractic and healthcare practice, can’t be made and then parked.
They need to be kept alive.
Maybe his message was meant — for you too!
😊
Keep Hope — and Your Goals — Alive.
Ed
How the Gratitude Attitude Helps Healing in Your Chiropractic and Healthcare Practice
Previously published on Goal Driven
The Gratitude Attitude: Proven to Speed Healing and Grow Chiropractic and Healthcare Practices
I don’t know about you, but I just like saying…” Gratitude…Attitude.”
There are plenty of studies on this subject – how just being grateful can improve health outcomes.
Here are just a few highlights:
- Fewer aches and overall better health – Grateful people report less pain and are more likely to take care of themselves (exercise, regular checkups, etc.) (Emmons & McCullough, 2003 – UC Davis. My old alma mater!)
- Heart failure patients who kept a gratitude journal for 8 weeks showed reduced inflammation, better heart-rate variability, and improved sleep (UC San Diego, 2015)
- Lower blood pressure in grateful individuals (Teixeira et al., 2024)
- Reduced depression and anxiety (Seligman et al., 2005)
- Better sleep quality (Wood et al., 2009)
- Improved diabetes management (multiple studies, 2010s–2020s)
- Stronger immune function (University of Utah & others, 2003–2021)
The list can go on and on.
Two Simple Ways To Use This In Your Practice Right Now
- With patients – At the end of a visit, ask your chiropractic and healthcare patients to name 3 things they’re grateful for today (family, a sunny day, the fact they can walk into your office, etc.). Studies show this tiny habit alone can accelerate their healing.
- With your team – End your next team meeting by going around the room: everyone shares one thing they’re grateful for in the practice. I have seen this done, and the practice has grown as a result!
The benefits of gratitude may seem obvious and something we already know, but they can be easily overlooked. We focus on our daily challenges and can take for granted the people who support us, and who have done so in the past.
Faced with patient and practice demands, we can under-appreciate the opportunity we have to live an extraordinary life helping others.
So it is good to take time – right now — to give thanks.
Best wishes to you this week, wherever you are.
All of us at Petty Michel & Associates are truly grateful for you – and all you do to make the world and your community a better place!
Sincerely,
Ed
P.S. (On the other hand, you have to be careful!- You know you’ve overdone the Gratitude Attitude when you stub your toe and automatically think, “I’m so grateful I have toes to stub! And a chair to stub them on! And nerve endings that let me feel pain! Pain is a gift. This is so much amazing!” Ha-Ha! A little humor for ya! 🙂
More P.S. Here’s an old-fashioned poem:
Thanksgiving (Edgar Guest 1881 – 1959)
Gettin’ together to smile an’ rejoice,
An’ eatin’ an’ laughin’ with folks of your choice;
An’ kissin’ the girls an’ declarin’ that they
Are growin’ more beautiful day after day;
Chattin’ an’ braggin’ a bit with the men,
Buildin’ the old family circle again;
Livin’ the wholesome an’ old-fashioned cheer,
Just for awhile at the end of the year.
Greetings fly fast as we crowd through the door
And under the old roof we gather once more
Just as we did when the youngsters were small;
Mother’s a little bit grayer, that’s all.
Father’s a little bit older, but still
Ready to romp an’ to laugh with a will.
Here we are back at the table again
Tellin’ our stories as women an’ men.
Preparing for a Powerful New Year in Your Chiropractic Healthcare Business
Previously posted on (Goal Driven.com)
42 more days until a New Year is here.
Before we know it, it will be at our morning doorstep. Like a happy eager dog ready to be taken for its morning walk, tail a wagin’.
But before we look at all what is coming, we have the next few weeks to wrap up 2025. This includes the Holidays, both in business and in our personal lives. We also have all the year-end admin details to complete.
NOW is the time to nail everything down — to plan the events and complete the admin tasks.
And while doing this, filling the end of the year with Christmas cheer, ready for 2026 — your best year yet!!
We’ll prepare for the New Year in a few weeks, but let’s finish off this year with a flourish. Consider these 4 actions:
- Relationships. Focus on re-bonding with all your patients and supporters from this last year.
- End of year care. Encourage them to come in and get care.
- Referrals. Bring in their family and friends for an end of year check-up.
- Year end admin checklist. Review and complete all year end admin duties that need to be done.
Most important is your connection with current and past patients and supporters.
Remember:
a practice is a network of relationships that is created and sustained through communication and service.
Be ready to take a little extra time to chat, to communicate, and to listen — and an extra “a cup of kindness, yet.”
Marketing. I gave a list of some marketing activities you can do for November and December in a recent newsletter. You can review them here. Get those planned and going.
End of Year Administrative Checklist for Chiropractic and Healthcare Businesses
In addition, we have put together a short list of administrative items that should be reviewed and completed by year end for your chiropractic and healthcare office. It is by no means complete, but the idea is you want to get them taken care of as soon as possible, or at least scheduled, so you can focus your creative energies on launching your 2026.
Block 2-3 hours in early December to work through this list. Delegate sections to your manager, billing staff, and bookkeeper.
You can also contact Lisa who is an expert in these subjects. You can contact her anytime.
Just Ask Lisa! (Lisa@pmaworks.com)
The checklist covers these categories:
2025 ADMIN WRAP UP CHECKLIST
- FINANCIAL & TAX
- CREDENTIALING & LICENSING
- EMPLOYEE ADMINISTRATION
- INSURANCE & PATIENT ACCOUNTS
- COMPLIANCE & OPERATIONS
- BUSINESS ENTITY & LEGAL
Download the ADMIN LIST below and tend to the admin.
Meanwhile, have a great time with your patients over the next 6 weeks.
And let’s prepare for your best year ever – in practice, in business, and in life!
And stay…Goal Driven,
Ed
Download the Checklists HERE
What is Special about L.L. Bean and How Does it Compare to Your Chiropractic or Healthcare Practice?
“Originally published on Goal Driven.com – republished with permission.”
The Key to Building a Chiropractic and Healthcare Practice that Lasts
L.L. Bean. You’ve probably heard of them.
I just received a Christmas shopping catalogue from them (hard copy!). They are a clothing company out of Maine. Founded in 1912 by Leon Leonwood Bean. I probably bought something from them years ago, and I am on their Christmas list.
We also receive a catalogue from Patagonia each year. It is another clothing company. It was founded more recently, in 1973 by a rock climber, Yvon Chouinard.
I like both companies and I will tell you why – in a minute.
= = =
Recently, I saw an ad of a young man (chiropractor) coming off a stage saying that he just sold his practice for “seven figures.” It was a bit of brag and sounded like he wanted to help other doctors reach that level. He said he was able to grow his business quickly and sell it thanks to his marketing.
I’m all for marketing, and I truly hope he can help with other chiropractic practices.
But it made me think: aren’t there significant financial advantages to owning a business in the long term that compound?
When you own a practice for 10-20 years, you’re not just collecting a salary — you’re able to take advantage of tax benefits that can add $30-50K annually to your real compensation! These can include vehicle expenses, health insurance, retirement contributions, continuing education, and equipment depreciation. These can all reduce your tax burden.
Over 20-25 years, these ownership benefits can add $500K-$1M in value that disappears the moment you sell.
And beyond tax advantages, long-term ownership allows your business equity to compound alongside your income. A practice worth $500K in year 5 might grow to $2M by year 10 or $5 -10M by year 25 – or more — IF you have good management, create a strong reputation, and even bring on other providers, or add other locations. And all the while — taking profit distributions, building retirement accounts, and enjoying the flexibility that ownership provides.
The doctor who sells early gets one payday; the doctor who builds strategically gets decades of tax-optimized income plus a potentially much larger exit.
Back to L.L. Bean and Patagonia
Now, back to those Christmas catalogues! Both show how patient, long-term ownership and excellent management, products, and services can build generational wealth over decades of brand-building and customer loyalty.
L.L. Bean, a billion-dollar empire, is still family-owned. Patagonia, now worth billions, wasn’t sold at all. Chouinard transferred ownership to the Patagonia Purpose Trust to ensure profits protect the planet in perpetuity.
Both companies show how owners who focus on purpose-driven growth and lasting customer relationships can build enduring companies that dwarf what any early buyer would have paid.
Purpose and Values of Your Healthcare and Chiropractic Practice
But here is what does not show up in the spreadsheets of these two companies: their values and purposes.
And, their discipline to stick to them!
Selling your business earlier rather than later can be a valid choice. However, if you ensure it remains focused on its purpose and values, you’ll enhance its profitability and make it more valuable for whoever takes ownership next.
L.L. Bean built its reputation on an unconditional guarantee and commitment to customer satisfaction. “At L.L.Bean, we design products that make it easier for families of all kinds to spend time outside together.”
Patagonia’s environmental purpose became so central that Yvon Chouinard ultimately gave away his $3 billion company. “We’re in business to save our home planet.”
The lesson is that a business rooted in purpose beyond profit attracts loyal customers and dedicated employees and creates a brand that competitors can’t copy.
Your purpose — and the discipline to stay creatively and positively true to your goals — pays off.
So…
Stay Goal Driven!
Ed
P.S. And have fun doing so – maybe fishing, camping, or just outside and enjoy the fall. (Or spring, if you’re Down Under.)
Ask Lisa – Compliance 201: Your Shield Against Bad Risk
As a follow-up to our previous compliance articles, I thought what I’d do this month is put together a FAQ list for my dear readers and call it Compliance 201. Keep reading to learn about upcoming new requirements in the compliance/cybersecurity world to keep you at least safe-guarded when you are hit with a cybersecurity incident. Special thanks and credit goes out to ChiroArmour and Dr. Scott Muensterman for his research and presenting at the Chiropractic Society of Wisconsin Fall Experience last month on some of the content in my FAQ.
Q: What is HIPAA and HITECH?
A: HIPAA is the acronym for Health Insurance Portability and Accountability Act of 1996, in which uniform standards and requirements for the electronic transmission of certain health information were put into place and made into law. HITECH is the acronym for Health Information Technology for Economic and Clinical Health Act of 2009, a countrywide adoption and standardization of information technology to securely support the sharing of clinical data.
Q: What is Cybersecurity?
A: Cybersecurity is the practice of protecting digital systems, networks, and data from malicious attacks, damage, and unauthorized access.
Q: Is there a checklist available to ensure we are in compliance?
A: Yes. Current and Active PM&A clients have access to our HIPAA/HITECH compliance checklist, on the PMA Members Site, and compliance services are included upon request from the client. If you are currently inactive or not a client, we can provide you with the checklist for a nominal fee. Please keep in mind your staff are already very busy, so ask yourself who is going to take on ensuring compliance at your office and going through the checklist? We can help.
Q: Isn’t it a matter of IF a cyberattack at my office occurs, not WHEN as you stated above?
A: On average there are 11 to 12 cyberattacks happening per minute in the US. So in today’s world yes, it is a matter of when, not if. And after research, it has been found that small businesses are more of a target for an attack than large organizations mainly because large organizations can put more dollars into security measures.
Q: What does Windows 10 and Windows 11 have to do with compliance?
A: Windows 10 no longer supports the security patches it used to support, effective 10/25/2025, so all of your computers must be operating on Windows 11 at minimum by this time. You CAN extend your Windows 10 protection for 1, 2, or 3 years at a significant price, but your software vendor may not honor the upgrade.
Q: I heard that there is something called an OIG Exclusions report – what is this and does it affect me and my practice?
A: The OIG Exclusions database is a reporting site listing every individual who is prohibited from seeing Medicare/Medicaid patients due to prosecution of a criminal activity, which can include being found guilty of fraud against Medicare/Medicaid, non-compliance of court-ordered child support payments, and illegal drug convictions. It is and will be a requirement to run a report MONTHLY on every person in your office including owners, subcontractors, and upon a new hire.
Here’s the link to check names: https://exclusions.oig.hhs.gov/
If you don’t see your name, that’s a good thing. Some of you are already running and checking this report due to insurance contract requirements. Save or print and file the results page.
Q: How can I confirm if my practice management program is fully compliant?
A: The website for verifying compliant healthcare software programs is down as of this writing, so for peace of mind if you are not 100% certain, call your software company or IT person.
Q: When do changes/new requirements occur?
A: As of now, no date has been set by HHS, but if you are doing the above steps and have written policies in place, you should not worry, but watch for future communications. You can subscribe to HHS email notifications here: https://cloud.connect.hhs.gov/subscriptioncenter
Q: What does Medicare documentation have to do with cybersecurity?
A: To avoid a documentation audit and subsequent potential visit from the OIG to further audits on compliance with HIPAA and your cybersecurity policies, keep your documentation and billing practices solid per Medicare chiropractic documentation standards, and make sure to securely send your notes to Medicare upon audit (and any other payer group who requests) to ensure you are staying HIPAA compliant.
Q: Can my staff be our Security officer?
A: By law, yes, but you as the doctor owner are always ultimately responsible for any attack or breaches, and payments to the government, so it is strongly recommended that the doctor owner be the compliance security officer for the business.
That concludes our FAQ for now. I know you’ll have additional questions. Feel free to reach out with those we’ll respond within three calendar days!
Stay Secure,
Lisa
References: ChiroArmour
Fun and Effective Promotions for November and December
Spark Some Magic in Your Chiropractic Practice This Season!
Special Promotions for November and December 2025! These are loud and lively events that engage the entire team!
Why do them?
- Increase new patients with great offers.
- Energize less active patients and get them back.
- Build greater team spirit for a shared purpose.
- A reason to promote your office and let patients and your community know how active you are!
- Increase your presence as the Health Hero’s in your community.
Even without an offer, just the fun of giving back will boost your visits and instill greater loyalty.
Read the full Goal Driver Newsletter at Goal Driven.com and checkout the fun, festive promotions that will spark magic in your office this holiday season!
2026 Marketing Habits for Your Chiropractic and Healthcare New Year
2026: The Year to Make Your Healthcare Practice Thrive
2026 will be a make-or-break year for healthcare business owners—potentially your best ever. More details in future newsletters, but for now: build unbreakable marketing habits starting today.
Trust: The Core of Healthcare Marketing
“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” – Aristotle (via Will Durant)
You’re selling the invisible—outcomes patients can’t see upfront. That’s why trust is everything. Build it through:
- Consistency
- Empathy
- Proven Results
Your brand = how you consistently show genuine care and deliver excellence.
The #1 Killer of Momentum? Stopping What Works
I’ve seen it repeatedly:
Q: “What were you doing when patient numbers were high?”
A:
- “We sent newsletters.” → Not anymore.
- “We called new patients post-visit.” → Nope.
- “We did thorough financial consultations.” → Are you kidding? No!”
Stopping proven tactics = death by roller coaster.
You lose trust, momentum, and the systems that made it effortless.
Your Fix: The Recurring Marketing Checklist
Discipline is hard—but checklists make it stick. Systems atrophy without them.
Monthly Discipline Hack:
- List your top 10 internal + external marketing actions (70–80% of your total efforts).
- Assign ownership to your manager.
- Review at every staff meeting.
- Grade % completed—full accountability.
Layer In: Special Promotions
With recurring actions locked in, plan 2–3 months ahead for:
- Facebook ads with a partner
- Food drive with a local pantry (especially needed now)
- Health talk at a yoga studio
Deliverable:Monthly Marketing Planner
→ % of recurring actions completed
→ # of special promotions scheduled
Let’s Make 2026 Your **Best Ever**
Download Free Tools:[LINK]
— Ed
The 4-Hour Fix for the Chiropractic Healthcare Practice Roller-Coaster
One Simple Role to Streamline Chiropractic Marketing and Growth**
Chiropractic practices often face inconsistent growth due to a Practice Roller Coaster, where marketing drives patient numbers up, but attention shifts to patient care, staff management, and other tasks, causing marketing to stall. This leads to fluctuating growth. To address this, assigning a trusted staff member as a part-time Marketing Coordinator (4 hours/week) can ensure consistent marketing efforts. Their role is not to handle all marketing but to keep systems like recalls, referrals, and metrics tracking active.
The Marketing Manager System, developed by Edward Petty in the early 2000s, emphasizes four key issues: marketing fails when it’s not done, no one is in charge, insufficient time is allocated, and the coordinator needs support and accountability. To succeed, the clinic director should schedule weekly marketing time, hold monthly planning meetings, track metrics with charts, and ensure accountability through written plans and reports. This approach eliminates marketing bottlenecks, sustains momentum, and reduces stress, helping practices grow steadily.
Note: A Monthly Marketing Manager Program to support coordinators with training and systems is planned for launch soon.
Building a Practice Through Relationships
Advertising has always been important. When we grew our Wisconsin network to 25 offices, we invested heavily in newspapers, shared mailers, radio, and even TV. Today, the focus has shifted to social media, SEO, and now Artificial Intelligence — positioning your practice for AI discovery will soon be essential (more on that later!).
But advertising is expensive. What truly sustained our growth was relationship marketing — connecting authentically with patients, referral sources, and our own team.
What Is Relationship Marketing?
Relationship marketing involves creating trust-based relationships with patients and referral sources, generating loyalty and organic referrals through genuine care and ongoing connection.
Examples:
- Host a community event like a holiday food drive — invite patients and their families to participate and offer consultations in exchange for donations.
- Encourage patients to refer loved ones with a personal touch (“Let’s check your spouse before their next soccer game!”).
- Build partnerships with local professionals — massage therapists, trainers, or nutritionists — and support each other through referrals or shared promotions.
Your Most Important Relationships
Don’t overlook your team. When doctors and staff work together with shared purpose and positive energy, patients notice. It’s almost magnetic — phones start ringing and old patients return.
As Stephen Covey reminds us in The 7 Habits of Highly Effective People, success comes from empathy, communication, and a win-win mindset that creates synergy — or, as some might say, Universal Intelligence at work.
GETTING AND KEEPING PEOPLE ON YOUR BUS
As a doctor and clinic director, you are like a bus driver. You aim to make sure you are on time and complete your shift according to schedule.
One day, you turn around to look at the back of your bus and wonder why there are so many empty seats. “Where is everyone?”
Well, maybe you missed some stops and the people never got on! Or, you didn’t take time to say “hi” when they boarded, so they all left at the next stop. Or, you were so busy driving, you didn’t ask about your assistant’s new workout routine.
Take time to connect with people.
More than anything, you are in the people business.
Enjoy the ride!
Ed
“What’s Wrong with a Chiropractic and Healthcare Personality Practice, He Asked?”
Just wrapped up an outstanding chiropractic convention put on by the Wisconsin Chiropractic Society here, you guessed it, in Wisconsin!
We enjoyed catching up with old friends, some we’ve known for decades. And making new friends.
For more on the Convention, you can check out our Facebook site, link below.
Personality Practice
While I was out listening to a presentation, I was told that a doctor dropped by the booth and asked about my book, The Goal Driven Business. He was told that it was about how to improve profits and outcomes by shifting from a personality-driven practice to one that was goal-driven. He felt that the personality practice was better.
I am sorry I wasn’t there to explain more – and hopefully he is reading this email.
Let me explain: A Personality Driven practice is propelled by the doctor’s behavior – their feelings, attitudes, and habits. What they personally do.
When opening a new office, the new business owner, of course, builds their new business on their behavior. It is their ambitious determination that is driving the initial growth of the practice. So, yes, a Personality Driven practice works at the launch of a new endeavor. What else is there? A dream, and the raw desire to manifest it.
So, the Personality-Driven practice works — at first.
However, after the practice is up and running, it needs to transition into a Goal Driven and systematized business.
The concept of a systematized business was hugely popular in the 1980s, thanks to Michael Gerber’s book, The E-Myth. In it, he says:
“The system runs the business. The people run the system.”
B. J. Palmer said something similar, much earlier. And he built a school that many of you may have attended. In his book, Up From Below the Bottom, he says:
“The size of a chiropractor’s business depends upon:
1st – His ability to notify people who he is, what he is, and where.
2nd – His systematization to take care of it as it grows and increases in volume.”
Gerber comically explains what happens when you don’t have systems running your business.
“If your business depends on you, you don’t own a business—you have a job. And it’s the worst job in the world because you’re working for a lunatic!”
–Making the Shift from Personality Driven to Goal Driven–
Making the SHIFT from a Personality Practice to a Goal Driven business is not easy. This is because you have established survival habits that have shown you that the practice depends on you, your feelings, attitudes, and overall behavior. You are the doctor, after all. You see the practice as DOCTOR-CENTERED.
A better approach, I recommend, is to keep it GOAL-CENTERED.
There are two echelons of goals to consider:
- Higher goals, including your purpose and “why.” This is your North Star.
- Practical goals, or outcomes. For example, you could have front desk goals (percentage of appointments kept), Billing and Collections goals (percentage of collections), and marketing goals (new patients and returning patients), and patient goals (patient completing tx program with an excellent review.)
Get your team on board with these goals. If you do, they can now help you put together the best approach to achieve your goals. These are the systems.
So: Personality Practice – YES! When starting a new business.
But once it is running, NO. Gradually back out and put in place goals and systems. And train your people on these.
For more details, read The Goal Driven Business.
If you want help with this, contact me. I’d love to help. (Been doing this for a while, so lots of tips!)
Stay Goal Driven. Stay Free!
Ed
Photos of us and our friends at the Chiropractic Society of Wisconsin Fall Experience
Ask Lisa: Cracking the Code – ICD-10 Code Revisions Start on October 1
Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes for proper reimbursement. The translation is called the International Classification of Disease codes, or ICD-10-CM*. There are annual updates which may include deleting codes, adding codes, and minor edits to existing codes. Keep reading for information regarding ICD-10 changes for 2026.
Although there are very few changes in 2026 relevant to chiropractic coding, the updates contain 487 new, 28 deleted, and 38 revised codes. The 2026 ICD-10 codes will be used for patient encounters from Oct. 1, 2025, through Sept. 30, 2026.
The new codes listed below may be relevant to your patient encounter:
- Pelvic Pain
- R10.20 Pelvic and perineal pain unspecified side
- R10.21 Pelvic and perineal pain right side
- R10.22 Pelvic and perineal pain left side
- R10.23 Pelvic and perineal pain bilateral
- R10.24 Suprapubic pain
And new codes related to socioeconomic circumstance:
- Z56.6 Other physical and mental strain related to work
- Workplace stress
- Z56.89 Other problems related to employment
- Furloughed
- Underemployed
- Z59.02 Unsheltered homelessness
- Lives in a homeless encampment
- Z59.19 Other inadequate housing
- Poor housing weatherization
- Z59.86 Financial insecurity
- Z59.861 Financial insecurity, difficulty paying for utilities
- Difficulty paying for electricity
- Difficulty paying for heat
- Difficulty paying for oil
- Difficulty paying water bill
- Utility disconnect notice due to inability to pay
- Excludes2: inadequate housing utilities (Z59.12)
- Z59.868 Other specified financial insecurity
- Bankruptcy
- Z59.869 Financial insecurity, unspecified
Coding and Billing Tips:
- Make sure if you use a new code listed above, you relate it in your SOAP note to the patient’s condition and why they are seeking care.
- If you bill a 98941: 3-4 region adjustment, make sure you have at least three ICD-10 subluxation codes (The M99.0X series) on the claim.
- If you bill a 98942: All 5 regions adjustment, make sure you have at least five ICD-10 subluxation codes (again the M99.0X series) on the claim.
If you are interested in obtaining the entire file of new/updated/deleted ICD-10 Codes, click this link from the Centers for Medicare and Medicaid Services:
https://www.cms.gov/medicare/coding-billing/icd-10-codes#CodeFiles
And, BTW… we still make house calls! Not collecting what you are owed? Something just doesn’t seem right with collections and your deposits? Give us a call to discuss if an onsite visit or video conference is right for your office.
Happy Birthday Chiropractic! Celebrate the entire month of October!
Lisa
920-334-4561
*CM refers to the ICD-10 coding system used in the United States.Sources:
Sources:
ChiroCode
Center for Medicare and Medicaid Services (CMS)
Why Clear Roles Build a Stronger Chiropractic & Healthcare Practice
Better teamwork, smoother operations, and improved patient care all start with clarity.
Years ago, I visited a chiropractic office where the doctor was frustrated: patients weren’t keeping appointments, and he blamed his front desk staff, “Sue.” The problem wasn’t effort—Sue was polite and friendly—but she had no clear job description, no checklist, and no real understanding of her responsibilities.
Once we clarified her role, outlined simple procedures, and scheduled regular reviews, the practice quickly improved. Patients kept their appointments, and both the doctor and Sue felt more confident and motivated.
This is a common issue: when roles are vague, results suffer. But when roles are clear, teams thrive.
—
The Three Elements of Every Role
According to the Goal Driven System, each role should include:
- Purpose – Why the role exists.
- Outcome – The measurable result it should achieve.
- Procedures – The specific actions to reach the outcome.
Example – Front Desk Role:
- Purpose: Help patients achieve health goals by ensuring they stay on schedule.
- Outcome: Patients consistently keeping appointments.
- Procedures:
- Greet every patient with a smile.
- Answer the phone warmly.
- Confirm each patient leaves with their next appointment scheduled.
—
Action Steps for Your Practice
- Have every team member list their roles.
- Define the purpose, outcome, and 5–10 key procedures for each.
- Add measurable indicators (e.g., % kept appointments, total visits).
- Review and rehearse roles regularly, just like a winning sports team practices.
Clear roles create accountability, boost morale, and drive better patient care. Keep it simple, keep it consistent, and keep it fun.
Stay Goal Driven,
Ed
Want More New Patients in Your Chiropractic or Healthcare Practice? Start Here.
Most doctors think the first step to getting more new patients is marketing. But that’s not always true.
Years ago, a large chiropractic office asked for help because their new patient numbers were slipping. After analyzing their situation, it was clear their promotions were weak—but the real problem went deeper.
The senior doctor, in practice for 20+ years, had become bored. Patient visits felt routine. Long-time staff were stuck in old habits. Meanwhile, the two younger doctors had enthusiasm but lacked confidence and experience.
We started by focusing on quality of care, not ads. The senior doctor began coaching the new doctors on cases and patient communication. Staff refreshed their service procedures and rehearsed ways to create a stronger patient experience.
The result? Without launching a single new promotion, new patients and visits went up. Only after that did we create a marketing calendar—because now they had something truly worth promoting.
The Lesson
Before you spend time and money on external promotions, make sure your practice delivers the kind of care that inspires patients to return and refer. Quality care and continuous improvement are the foundation of real growth.
As Stephen Covey said, “Sharpen the Saw”—renewal and improvement keep the drive alive.
Stay Goal Driven
Ed
Read the full article here: Goal Driven Blog
Don’t Get Left Behind
Football Season, Chiropractic, and Winning Strategies
Football season is here—and it’s a perfect time to highlight chiropractic. Every professional football team has a chiropractor, proving that even million-dollar athletes rely on it to perform at their best.
Top athletes agree
- Aaron Rodgers credits chiropractic (and his chiropractor father) for helping him stay at peak performance.
- Tom Brady says adjustments make him feel taller and better aligned.
- Joe Montana calls chiropractic a key part of his game.
If chiropractic works for them, imagine what it can do for local athletes and weekend warriors.
How to Market Your Services with a Sports Theme
Position your office as the place for athletes of all ages to boost performance, recover faster, and prevent injuries.
Ideas to promote chiropractic through sports:
- Workshops:
- The Injury-Proof Playbook: 8 Moves That Keep Athletes in the Game
- Weekend Warrior Survival Guide: 8 Strategies for Active Families
- Business Talks: Offer lunch-and-learns, screenings, or mini-chair massages.
- Athlete Recovery Days: Host Monday Morning Quarterback Recovery sessions for post-game soreness.
- Community Partnerships: Team up with schools, youth leagues, and local teams for education, sideline care, or screenings.
Promotion Tips:
Use your newsletter, office fliers, social media, and table talk. Assign a part-time Marketing Coordinator (3–5 hrs/week) and hold monthly planning meetings so every staff member contributes.
Build Your Own Winning Team
Think of your practice like a football team:
- Have a game plan.
- Play 4 quarters each month.
- Work as a team.
- Keep score (track progress).
- And most importantly—keep it fun.
Chiropractic helps athletes win on the field. With the right marketing and team mindset, it can also help your practice win in the community.
Ask Lisa:What’s up with BCBS and Therapies Reimbursement?
Within the last two years, Blue Cross Blue Shield started requiring precertification (precert or pre-auth) on select plans for therapy codes. This came about because by Insurance Equality law they can’t require precertification for chiropractic services 98940, 41, 42, and 43, so they got around that by requiring it for many therapy codes regardless of the provider type.
If you call to verify coverage for “chiropractic”, the customer service representative (CSR) may tell you that there is no precert required for chiropractic. They may or may not understand that they have separate precerts for physical therapy codes. You’ll need to give the CSR the specific codes you want verified for coverage and limits. You can also verify benefits and usually are able to request authorization for therapies using Availity: https://www.availity.com/providers/
Specific Claim Tips for billing BCBS:
1) Qualifier 431: Make sure you are entering in Box 14 OR 15, the 431 qualifier to indicate onset date within a treatment plan.
2) Taxonomy code for chiropractic, which is 111N00000X, in Box 33. Some states’ BCBS plans require the use of a ZZ prefix before the taxonomy. Please ask when verifying benefits with your patient’s state plan what their billing requirements are. For example, is the ZZ required in front of the taxonomy code? You can add the taxonomy code for specific payers by going into your Maintenance application in your practice management software, and once added to the payer information, it will automatically generate the claim form with this information defaulted.
3) Modifiers: I understand some of you are using XS GP for therapies and are getting paid. Great! But use this with caution. The XS modifier indicates a separate and distinct service done by a different provider than the one billing under. Better to use GP and 59 for accurate billing if one licensed provider did the therapy and chiropractic adjustment. Your 59 modifier indicates a separate, distinct service but does not distinguish between providers.
What about 98940-98941-98942? For your Medicare Advantage plan patients, make sure to use AT modifier indicating the treatment was active care vs. maintenance/supportive. BCBS usually will not pay for the GA modifier use indicating maintenance/supportive care services were provided. You’ll want to advise the patient ahead of time they will be financially responsible for their maintenance/supportive care, while presenting your cash options or packages offered. Use AT when billing BCBS Medicaid plans, all states, while the patient is under a care plan.
Where are the preauthorization requirements headed?
Here’s a recent (June 2025) article from Blue Cross Blue Shield regarding precertification requirements going forward: BCBS News
Here’s what it states:
“Reducing prior authorizations:
BCBS companies routinely review their prior authorization requirements, and many have taken steps to reduce the volume of prior authorization requirements in recent years. We will build on these efforts and commit to reduce in-network prior authorization for medical services as appropriate for the local market each plan serves with demonstrated reductions by Jan. 1, 2026.”
Reach out to us lisa@pmaworks.com or dave@pmaworks.com, and we can give more “boots on the ground” info for your specific state.
Lisa
920-334-4561