Stay Ahead of the Compliance Training Curve

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Annual Compliance Training Requirements: What Every Office Needs to Know

As your chiropractic practice is a covered entity by federal law, Annual Compliance Training is not only a requirement but an important part of maintaining a compliant, safe, and productive healthcare office and business.

Why Are Annual Training Requirements Important?

Annual training helps you and your staff stay informed about regulatory changes, and potential risks. It also reinforces knowledge gained during onboarding of new staff or providers.

Understanding which training requirements apply to your office is the first step toward building an effective annual training program.

Here is a checklist of your required 2026 annual compliance trainings, due by the end of the year and required monthly reports to run:

ANNUAL

  1. New: UHC Dual Plan/SNP providers. (I went through the training and completed it in about five minutes): https://www.uhcprovider.com/en/resource-library/news/2026/snp-moc-training-requirement.html
  2. Waste & Fraud: Centers for Medicare and Medicaid Services/Medicare Fraud, Waste & Abuse for Part C Providers. https://www.cms.gov/Outreach-and-Education/MLN/WBT/MLN3995723-MLNPartsCD/FWA/story.html
  3. HIPAA privacy and security education, patient confidentiality, and applicable workplace safety trainings. There are a plethora of online resources available for annual HIPAA training for healthcare offices.
  4. OSHA for Healthcare. There are a plethora of online resources available for healthcare OSHA training.
  5. Any other commercial third-party payer which requires their own compliance training. The payer should notify you regarding additional training specific to their contract with you. Aetna and the new UHC training are examples.
  6. Once these are completed, you will need a signature log that both doctors and staff will sign off as completed, and/or a location to file any online Certificates awarded.

MONTHLY

Reports to Run: Every month, you will need to run two reports for everyone in your office, and upon a new hire to ensure no one in your office has been excluded from receiving Medicare/Medicaid payments or treating Medicare/Medicaid patients. These monthly reports are a requirement for most third-party payer contracts. One may end up on a list if they have been federally charged with fraud, waste, or abuse; or if they are behind on child support payments.

a. https://exclusions.oig.hhs.gov/

b. SAM/EPLS database: gov | Search, Navigate to “Excluded
Individual” and type in your search names.

c. Print the results and file, or save to .pdf. “No Names Found” is a
good thing.

If you are looking for a cost-effective resource to complete the HIPAA, OSHA, and Non-Discrimination pieces, our Friends at ChiroArmor are offering these 3 trainings for $59. Click link for further details: https://chiroarmor.com/annual-compliance-training/

You will still need to complete 1, 2, 5 and the monthly reporting above.

Consequences of Not Meeting Training Requirements

Failing to provide required employee training can expose practices to regulatory penalties, increased workplace risks, and reputational damage.

Potential consequences include:

  • Regulatory citations and huge financial penalties.
  • Increased workplace injuries and safety incidents.
  • Greater exposure to harassment, discrimination, or misconduct claims.
  • Data privacy and cybersecurity incidents.
  • Inadequate documentation during audits or inspections.
  • Reduced employee awareness of office policies.

Final Thoughts

Annual training requirements play an important role in protecting employees, supporting regulatory compliance, and maintaining a responsible workplace.

If you have any questions regarding the information in this article or need help updating or developing the compliance program for your office… Just ask Lisa

Lisa Barnett

920-334-4561

The Entrepreneurial Advantage

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entrepreneurial business is homemade relates to chiropractic businessesAnd the Structure That Makes It Work

If you started a chiropractic practice, or took one over, you are an entrepreneur.

And if you work alongside a chiropractor, you are working in an entrepreneurial business.

The entrepreneurial business is a completely different animal.

Think of Steve Jobs and Apple, Elon Musk and SpaceX, the McDonald brothers and McDonald’s restaurants, Yvon Chouinard and Patagonia, the clothing company, or Mari Medill Petty and Mari’s dress shop.

The list goes on and on.

Each one, in their own way, is a pioneer.

An entrepreneurial business is the epitome of the American way of life. Independent, seizing opportunities, and demonstrating courage and exceptional industriousness.

By working in this kind of business, like a chiropractic practice, whether you know it or not, you stand for something bigger than yourself: freedom.

And you may not have considered this: that chiropractic itself, as an industry, is still very entrepreneurial.

I have some experience with this subject. Our company, Petty, Michel & Associates, has been helping chiropractors and chiropractic offices for nearly 40 years.

We’ve also partnered with chiropractors to open and operate 25 clinics, so I’ve sat on your side of the desk: payroll, slow months, the whole enchilada.

But before Dave Michel and I started these companies, I had years of youthful exposure to entrepreneurs. Both my parents started and operated their own business in a small town. They employed many people and helped the local economy by providing useful services and products.

They enriched the fabric of the community they were part of.

This is what you do as well.

Your homemade business has more freedom. But every business has requirements. Meet them, and it’s still hard work. Miss the key ones, and it can be disastrous.

In simple terms, you need good systems, procedures, and team members to support the services and products you provide. If your practice is struggling, you are missing one of these elements.

This is well-known advice — though often ignored.

What is usually missed is this: these systems need to be kept in place.

Kept in place — is that so hard?

Yes, for an entrepreneur who is restlessly seeking improvements, or a doctor focused more on patient care than business, it can be.

The solution, even more than the systems and procedures and people, IS CONSISTENCY!

It’s not having a system so much as it is continuing to follow and improve that system.

All this leads us to a missing role in most offices: the manager. Or even an administrative assistant tasked with ensuring all procedures stay in place and are continually improved.

Corporations and governments have structure. What they don’t have is what you have – the vision, the freedom, the energy to create something new.

And the tight-knit rebel team to make it happen.

Add structure to your practice, assign someone to tend it, and you’ll have a more prosperous and rewarding 2027.

And stay Goal Driven.

Ed, and all of us at Petty, Michel & Associates.

P.S. Stay tuned for our new Goal Driven MBA for practice managers – coming in January.

Questions, ideas, help…! Contact us

Real Relationships Win In Chiropractic and Healthcare Practices

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chiropractic handshake

Your Best Marketing Is a Handshake

I’ll admit my experience with social media advertising is slimmer than my experience with newspaper ads.

Remember those things — newspapers?

But advertising is still part of the game.

As B.J. Palmer said: “Early to bed, early to rise, work like hell and advertise.”

Advertise, by all means.

But remember: a practice is a network of relationships, created and sustained through communication and service.

Relationships. Communication. That’s the foundation your practice is built on.

A book first published in 1994 is still bedrock for all marketing: The World’s Best Known Marketing Secret by Ivan Misner. It’s all about building referral relationships.

Misner also founded BNI (Business Network International), a referral networking group. Successful chiropractic doctors still attend, by the way.

Misner says we’re all cave dwellers! We wake up in our cave house. We drive our cave car to our cave office. Then we go home and stare into the cave glow of a screen.

And that was before AI.

Now the cave talks back to us. Texts are written by software. Videos are generated. Reviews are suspect. Your patients are starting to wonder: is this really Dr. Smith, or a chatbot?

A real relationship with a real human is probably more valuable now than ever.

In a world full of fakes, you are the real thing.

AI can’t shake a hand. It can’t swap stories about Friday night’s high school game.

That’s why word of mouth still works. It’s simple, and it’s human. And people trust a real person more than any ad.

This week’s tip: Once a week, leave the cave.

Put one hour on your calendar every week to meet someone in person. Some places to start:

  • The manager of the local gym or YMCA
  • An auto body shop owner, for personal injury referrals
  • A youth coach, yoga or dance studio, or running club
  • A BNI chapter or Chamber of Commerce meeting

Then bring the community to you. Host a Thanksgiving patient appreciation day and invite everyone to bring a friend.

One hour a week adds up to fifty-two new relationships a year. Each of those people knows dozens more.

With Facebook, you rent attention. But you own your relationships, and they keep paying off for years.

Your schedule this week has room for one hour to go out and meet someone new.

Book it today. And…

Stay Goal Driven,

Ed and all of us at PM&A

Play Ball, Doc! In Your Chiropractic and Healthcare Practice.

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baseball team is like a chiropractic practiceWhat the Brewers can teach your team about winning

(Dateline: Whitefish Bay, WI)

I’ve always liked sports. Football, baseball, basketball, you name it. Even chess.

But not golf. That’s not a sport. That’s punishment.

Games thrill us because we might win.

But games also mirror life: the challenges, losses, wins, players, roles, and rules. And of course, the stats!

You can learn a lot about life, your career, and your business by comparing what you do to what makes an athletic team successful.

The Milwaukee Brewers

I live in Whitefish Bay, just north of Milwaukee.

The Milwaukee Brewers just won the National League pennant. They’re going to the World Series ! – and nearly everyone here in Wisconsin is beyond excited about it.

The Brewers’ win was special and noteworthy.

They beat the Los Angeles Dodgers 4 games in a row. They won against a team that spent more than twice the Brewers’ payroll.

So what gave our small-market club the edge? Three things, and a bonus fourth I’ll save for the end.

The Winner’s Edge

1) The Manager. Pat Murphy, a former college coach at Notre Dame and Arizona State, has spent over 40 years developing overlooked players. He’s no softie. But his players know he’s on their side, and that he’s there to make them better.

2) The Systems. Craig Counsell, his staff (including Pat Murphy as bench coach), and the front office built the Brewers’ player development system during Counsell’s tenure (2015-2023). When Counsell left the team in 2023, the system stayed, and the team kept winning. (Counsell is a Whitefish Bay native, Class of ’88!)

3) The Purpose. When owner Mark Attanasio bought the team in 2005, the Brewers hadn’t made the playoffs in over two decades. He set out to raise expectations, hired good people, gave them authority, and held them accountable. The goal: a World Series. The why: the fans. As pitcher Brandon Woodruff put it, “We do it for the fans.”*

Your Chiropractic and Heatlthcare Practice

Like the Brewers, your chiropractic and healthcare practice is a team and needs a clear purpose. It needs routine procedures and policies that are followed consistently and kept in place.

And it needs someone to ensure each team member performs these procedures excellently. In other words, it needs a competent manager.

But what else?

The Game

Well, as Manager Pat Murphy put it, “They may have a bunch of Hall of Famers, but we’ve got a bunch of gamers.”**

What are “gamers”? Gamers are players who play to win.

4) The Game. Does your team have a year-end game? Do you have a game plan for the 1st quarter of 2027? If so, does your team know about it?

Keep your purpose alive, ensure you have well-defined, well-known systems, and get a competent manager.

Then… have fun playing the game of helping more people – and be the gamers and winners in health care in your area.

We can help you and your team with all four.

And like the Brewers, be Goal Driven!

Ed and all of us at PM&A

• Murphy’s “gamers” quote: Bleacher Report, Oct. 16, 2026 *
• Woodruff’s quote: Spectrum News 1, Oct. 16, 2026 **

The Five Stages of Practice Development in Chiropractic and Healthcare Practices

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five stages of business corn stalk image

Why you can’t get to Stage 5?

I’ve seen it so many times.

“Best months in years!”

And then… to see it all slip away.

What happened, and why?

Stages of Growth in a Chiropractic and Healthcare Practice

An essential component of the Goal Driven System(sm) is the five stages of development.

“To better understand these stages, it is helpful to recognize how organic a business truly is. It is a kind of bio-machine and growing it can be compared to the development of any living organism.” (The Goal Driven Business by Edward Petty)

Every plant, for example, goes through certain stages of growth: A plant starts as a seed, sprouts, grows leaves, flowers, and finally bears fruit.

Similarly, every practice or business goes through stages of growth.

5 stages business growth

Most offices that do well settle at Stage 3.

But could they do better? And if so, how?

Stage 4: The Ghosts Come Out

Something strange happens when you hit Stage 4. Ghosts come out of the closet. Old enemies drop by. Past invoices you forgot arrive in the mail. Staff starts to stray.

The practice has outgrown what one person can manage.

Stage 4 has a hidden barrier that prevents most capable, well-intentioned practice owners from achieving Stage 5.

The Sound Barrier

Stage 4 is like the sound barrier. In the 1940s, planes approaching the speed of sound shook violently, and pilots who pushed harder lost control. Chuck Yeager broke through in 1947, in a plane designed for it.

The fix wasn’t more gas. It was better design.

The same is true for your practice. You can’t push through Stage 4 with more effort. You break through with a practice designed to run on goals, not on you.

That design starts at Stage 3, with management.

What Elon Musk Figured Out

I will admit it – I am a fan of Elon Musk. On a different scale, of course, but he is an entrepreneur with a mission — like you.

SpaceX hit its own kind of barrier with rockets blowing up. Musk’s answer wasn’t to work harder. He improved SpaceX’s organization. In 2008, he made Gwynne Shotwell president.

Musk focuses on goals, technical work, and outcomes, while Shotwell focuses on people, processes, and the organization.

Your practice needs the same split. The doctor leads with purpose and clinical outcomes. A trained manager improves people and procedures.

Build It Before You Need It

Because organization is the barrier to a full-capacity practice, we work closely with managers and the practice team — and created the mini-MBA program for practice managers.

Getting through Stage 4 requires developing strong management and an expert team in Stage 3 before you hit Stage 4. When the practice grows at an accelerated pace, the organization needs to tighten down and keep the winning procedures and people in place. This lets chiropractic and other doctors focus more on patient care.

Stage 5 is operating at full capacity, comfortably and very profitably, with the choice to stay there or scale.

The five stages and their strategies are laid out in my book, The Goal Driven Business, beginning on page 61.

Get it, read it, and apply it.

Contact me any time if you want to move your practice to the next stage. Just reply to this email, or call me at (414) 332-4511.

And as always,

Stay Goal Driven.

Ed and all of us at PM&A

October – Rocktober in Chiropractic and Healthcare Practices!

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Petty, Michel Rock band at the CSW Chiropractic Convention - Rocktoberfest 2026

A Rock and Roll Month

Our gang just returned from a power-packed chiropractic seminar here in Wisconsin, sponsored by the Chiropractic Society of Wisconsin.

Hundreds of doctors and staff attended, with a wide range of education sessions tailored to both groups.

I love these brief, high-intensity seminar events to meet new people and reconnect with old acquaintances. Chiropractic is a BIG family!

We had a booth there, and our own David Michel gave two presentations for staff. Our booth, by the way, won the Best Booth award! (Yay!) Thank you to Linda Skiles, our business manager, who designed it!

Here we are!

Team Petty Michel and Associates at the CSW Chiropractic Rocktoberfest 2026 Convention(Ed (me), Barbara, Linda, Lisa, and David)

I attended parts of many presentations and want to pass on a few of relevant observations.

Communication in Chiropractic and Healthcare Practice

David Michel discussed the importance of taking time to understand the patient. He reminded the audience about PTC – Present Time Consciousness, a term I first heard Dr. Jimmy Parker talk about at a Parker Seminar years ago. Sometimes our attention is on the future, the past, or somewhere else when it should be on the here and now to communicate fully with someone.

Life Energy

Dr. Peter Heffernan, a Chiropractic Society of Wisconsin Lifetime Achievement Award winner, talked about how chiropractic improves life energy and referenced David Hawkins M.D.’s book, Power vs. Force. Hawkins explores how a person’s level of consciousness affects their health and influence on others. Your mood, therefore, may influence your patients’ outcomes.

Using Artificial Intelligence in Your Practice

Dr. Jay Greenstein spent 4 hours teaching doctors and staff the ins and outs of AI. His presentation was very informative. I took notes, or tried to, as he covered many aspects of AI. I have a lot to say about AI, but my number one advice is never to put AI where a real person should be dealing with another person. Faked empathy is still…faked.

Neurology and Chiropractic

Dr. Michael Longyear gave a fascinating presentation for doctors. While most of it went over my head, I found some points very interesting. Chiropractic is not just for aches and pains. Research shows adjustments change how the brain processes signals from the body. When the spine’s movement is restored, the brain gets cleaner input, and that shows up in things like balance, reaction time, sleep quality, and even mood.*

A few takeaways:

  • Practice present-time consciousness with patients and each other.
  • Chiropractic improves life energy.
  • Use technology, but NEVER let it (or scripts) replace a real person with your patients.
  • Educate your patients. They are bombarded with drug ads everywhere. Some of your patients would love to learn more about how adjustments positively affect the brain. Consider an occasional Patient Health Class.

And also, have a rocking good time with your team and a great Rocktober.

And stay Goal Driven,

Ed and all of us at PM&A

  • * Lelic et al., Neural Plasticity, 2016.
  • Haavik et al., Brain Sciences, 2024; 14(11):1124.

Ask Lisa:Cracking the Code

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icd 10 code revisionsICD-10 Code Revisions Start Today 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 2027.

Although there are only a couple of changes for 2027 directly relevant to chiropractic coding, the diagnostic updates contain 190 new, 30 deleted, and 4 revised codes. The 2027 ICD-10 codes will be used for patient encounters from Oct. 1, 2026, through Sept. 30, 2027.

The updated codes listed below may be relevant to your patient encounter and can be included on your claim form depending on payer group:

1. Plantar Fasciitis Current: M67.A

New subcategories distinguishing right from left foot: M67.A01 (right foot), M67.A02 (left foot); M67.A09 (unspecified/do not use if you get the information from the patient)

2. Plantar fascial fibromatosis Current: M72.2

New M72.20 (right), M72.21 (left), M72.22 (unspecified/do not use if you get the information from the patient)

3. The following Sprain codes could impact your Auto Claims:

Sprain of sternoclavicular joint or ligament
Deleted S23.420, S23.420A, S23.420D, and S23.420S
New: S43.61XA: Sprain of right sternoclavicular joint, initial encounter
S43.62XA: Sprain of left sternoclavicular joint, initial encounter
S43.60XA: Sprain of unspecified sternoclavicular joint (do not use if you learn from the patient which side)

4. M99.01 through M99.05 (segmental and somatic dysfunction) – No Changes

5. M54.2, M54.50, M54.51, M54.59 (cervicalgia and low back pain) – No Changes

Coding and Billing Tips:

  • Make sure if you use a code listed above, you relate it in your SOAP note to the patient’s condition as to 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 for Medicare and Medicaid (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 for Medicare and Medicaid.
  • Make sure your procedure codes and diagnosis codes align, so you can prove:
    • What was done (the treatment procedure)
    • What was wrong (the specific diagnoses)
    • Why the care was medically necessary

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

If you have questions on how these new codes can be implemented in your practice, reach out!

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 whether an onsite visit or video conference works best for your office.

*CM refers to the ICD-10 coding system used in the United States.

Happy National Chiropractic Month! Celebrate the entire month of October!

Lisa

Credits:

  • ChiroCode
  • Center for Medicare and Medicaid Services (CMS)
  • chiropractorbillers.com

 

Does Your Chiropractic and Healthcare Practice Have Rhythm?

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daily, weekly, monthly team meetings the chiropractic wayTeam Meetings the Right Way

Michael Gerber made the case in The E-Myth: a business runs well on its systems, not on the owner’s heroics.

This includes delivery systems, marketing systems, and revenue systems.

But the one system that runs all the others is the management system. And the heart of the management system is simple. It’s your meetings.

Meetings? Aren’t they a waste of time?

They can be. But done right, they can be the heartbeat of your practice that keeps it on track – and improves it.

CHIROPRACTIC TEAM MEETINGS DONE RIGHT

First, let’s get the format down – simply:

  • each team member checks in
  • the numbers get reviewed
  • the plans get adjusted
  • and the goals get set.

Your meetings are where you check the other systems. Without them, every other system can slowly drift.

But here is a fact even I haven’t fully appreciated: the most essential element to these meetings is just doing them regularly.

A meeting that happens “when we get around to it” has already drifted. The other systems will soon follow. You’ll see it in your declining numbers soon.

Verne Harnish discusses this in his 2002 book, Mastering the Rockefeller Habits. He calls regular meetings “rhythm.”

Regular team meetings require structure and discipline. You and your chiropractic and healthcare team will be facing the raw facts of how you are doing individually and as a team – for better or worse.

By maintaining the discipline of routinely scheduled team meetings and following the basic format above:

You will prevent practice crashes

You will be constantly working to improve the quality and quantity of your services.

YOUR MANAGEMENT RHYTHM

Each meeting begins with the “End in Mind,” as Stephen Covey recommends.

That is…Goals!

Here’s a rhythm of basic meetings we’ve used in many offices as part of the Goal Driven System:

  1. Daily – Morning Huddle (10 minutes). Before the first patient, the whole team meets away from patients.
    1. Case management: The manager reviews the day’s schedule, ideally with a short printout for everyone. The manager or doctor flags patients who need a re-exam, a financial consultation, or another procedure.
    2. Daily goals: Visits, new patients, and attendance at tonight’s health class.
  2. Weekly – Team Meeting (30 minutes). Led by the manager or director. Each person gives a quick report on their week, including key numbers for their area. It’s a fast “show and tell.” The director reports on the whole week, reviews action steps on projects, and sets next week’s goals. That’s it.
  3. Monthly – Team Meeting (40 minutes). Same format as the weekly meeting, plus planning upcoming projects and setting the month’s goals. The director also reminds the team of their purpose, their Why, perhaps with a patient success story.

Once these are in place, other types of meetings can occur, including quarterly marketing meetings, meetings with your accountant, investment manager, etc.

And for practice owners who want to do their best, there are regular calls and visits with your practice consultant.

Like us!

Give us a call. We can help.

Stay Goal Driven,

Ed and all of us at PM&A

Read about the Goal Driven System in the book for practice owners, The Goal Driven Business.

The Big Month of October is Made for Chiropractic Healthcare

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Made Just for You

Here comes the Big Month of October!

Kids are now in school and summer is over. (That went by fast!)

November is full of elections and holidays.

December has more holidays, end-of-year parties, vacations, and year-end admin.

Then…Boom. A New Year!

So now is the best time to accelerate your practice before the year ends … and build the momentum that will take you to the start of 2027.

October is Your Month

October is National Chiropractic Health Month as recognized and promoted by the American Chiropractic Association (ACA).

October is also:

  • Spine Health Awareness Month (Formally recognized by Congress in 2021)
  • World Spine Day is October 16, 2026 (led by the World Federation of Chiropractic)

Even if you specialize in extremities, this month is your still your domain. This year’s ACA theme, “Joint Efforts,” is all about joint health.

October is your territory – so move in and use your voice.

What You Can Do to Promote Your Chiropractic Healthcare Practice

Consider your internal and external marketing actions.

Internal Promotions.

  • Reactivation Program. Email, and even mail postcards, to patients who haven’t been in for six months or more. Invite them back for a no-charge or discounted re-exam and, if needed, a discounted X-ray. You might also consider donating the re-exam fee to a local charity and tell patients you’re doing it. (As always, be mindful of payer rules regarding discounts.)
  • Referral Program. Build it around National Chiropractic Health Month and Spine Health Awareness Month. Try a “Bring a Buddy” week, where active patients invite a friend or family member for a screening, and thank them for it.

External Promotions

Social Media. Use the spine health theme in your posts. The ACA’s hashtag this year is #JointEfforts, so you can ride along with their campaign if you want.

Events. Externally, there are still local fairs where you can meet old and new patients. Set up a consultation and screening booth. Make friends, build allies and referral sources, and set up appointments for in-office exams. Have some apple cider!

There are many different approaches to promote your practice that align with Chiropractic and Spinal Health Month.

Contact us if you would like some ideas or what we have seen work.

ALSO, you can hire us! 😊

But, as always,

Stay Goal Driven,

Ed and all of us at PM&A

Is Skynet Here? How Chiropractic Offices Can Thrive

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How to beat the robots.

Artificial Intelligence IS here.

And the ads for it are in your face – AI scribing, AI documentation and coding, AI billing/revenue cycle, AI patient intake and reception, and AI marketing.

AI is moving fast. I saw one genius tech guy say that the next 6 months’ growth will exceed the last 10 years.

Then what?

As Elon Musk quipped, “The worst-case scenario is a Terminator situation where AI kills us all.”

But the fact is, no one really knows the future.

What Do Your Chiropractic and Healthcare Patients Want?

Let’s first consider what your patients want.

Well, I’m pretty sure your patients don’t want to go to a Walmart and lie on a roller table while a Mr. Robot puts a vibrator to their back.

I know I don’t want that!

People want people-to-people interaction.

My prediction is that your personal touch and authentic interest in your people will BECOME more valuable than ever.

A few days ago, I was at my dentist’s office and could overhear him chatting with a patient. On and on. I mentioned to my hygienist, “Doc likes to chat a lot, doesn’t he?” She smiled and chuckled at first, but then frowned with disapproval. I know why. Reception room was filled – practice was busy.

Many of our best offices have doctors who often seem to run just a little late because they are gabbing away with their patients about sports, local affairs, kids, whatever. It drives the staff nuts because it holds everyone up. But somehow, the appointments stay full.

Same with the front desk staff – while being tough schedulers, they can also be interested in the patient’s personal lives – kids, family, and school. Authentically too, not as a gimmick.

I’ve been visiting chiropractic offices for 40 years now, and the ONE thing that stands out in the best chiropractic practices is the people-to-people connection. There is almost a camaraderie between the staff, doctors, and patients—patients bring in their summer cucumbers for the staff, and mothers hand off their 6-month-old to the front desk so they can get their adjustment.

The clinic director at one office we worked with was concerned about the front desk not following procedures. Meanwhile, the practice was full. The front desk staff, while overly friendly and maybe just a little hippie, were creating great relationships with patients. (Not to discount procedures — or hippies.)

Do Not replace your front desk with AI.

And Do Not replace all of your marketing with AI. I am headed to an office now to help them organize their yearly event at their local county fair. Community events where you show up, meet new people, give them a consultation, and reactivate old timers cannot be replaced by AI. (Nothing like watching a good tractor pull with a former patient!)

And… don’t let AI make you less human.

Use AI to give you more time with people. Remember:

A practice is a network of relationships
that is created and sustained through
communication and service.

Do this, and you withstand the changes that will come.

Keep it personal, friendly. And yes, keep it Innate! (I don’t care!)

🖐️😎

And stay Goal Driven,

Ed

PS Have questions about growing your practice — or tractor pulls? Contact me. Let’s gab! Email (414)332-4511)

Skynet: the fictional AI defense system in the Terminator films that becomes self-aware, decides humanity is a threat, and launches a nuclear war to wipe us out — then hunts down survivors with killer robots.

    1. Wharton Magazine
    2. Musk v. Altman trial, April 2026

The Pillars of Patient Care in Chiropractic and Healthcare

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pillars of patient care in chiropractic supported by Goal Driven leadership, team management and marketing

Here’s What’s Really Driving Your Results

Labor Day in the U.S. is over, and I hope you had some healthy recovery time with family, friends, and nature.

Today is your Monday and Tuesday, all in one. So this is a short note… straight to the point…

…You and your team have 4 months to make this your best year — even better!

Actually, let’s do it in 3 months so you can cruise in December. So, here’s a plan to consider that can help you and your team over these next 3 months:

Everything you do is in service to your patients in chiropractic and in any healthcare service.

Their results, their happiness with you and your team, and their service are what will make your practice the best.

So focus on this first and foremost.

But… your services must be supported.

There are 3 categories of support:

  1. Leadership. This is the persistent fire that drives you and your team to achieve your patients’ goals — and those of your practice. It is the motivation, the discipline, and the energy that drives everyone to do their best. And on the best teams… EVERYONE is a leader. And Goal Driver!
  2. Marketing. People don’t automatically know your services exist, or what they can do. And what is more — they don’t care. Therefore, you have to keep your message out there. Marketing includes everything you do to acquire and retain patients. Marketing is not just advertising.

The need for marketing never goes away. Even if you have all the patients you need, atrophy is real.

3. Management. Management keeps all the moving parts in your business in sync. It takes care of your people, keeping them and your procedures aligned and coordinated. It keeps the structure in place – and improving.

There it is! Your plan for ending 2026 with a full and happy practice!

It is ALL about the quality of care and service your patients receive, but that depends on your leadership, marketing, and management.

Let’s end the year with this in mind … and in HIGH GEAR!

Stay Goal Driven,

Ed

Ask Lisa: Want to Sell or Grow? How to Elevate Your Practice’s Value Now

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how to elevate your practice's value now

In today’s healthcare landscape, practice value is a complex blend of operational effectiveness, modern technology, financial health, and clinical reputation. Whether a practice owner is looking to sell, partner with, or simply build a sustainable business, several areas can significantly enhance its market value.

Keep reading as I delve into a few of these areas with you.

  1. First, maximizing financial and collections management and diversifying revenue streams remains critical. Practices that depend on a single payer, service, or a narrow patient demographic are viewed as high-risk and are rare nowadays. Enhancing value requires rigorous billing and collections processes to minimize days in accounts receivable.
  2. Integrating ancillary services and hiring non-DC providers can boost revenue per patient while providing comprehensive, whole patient care one-stop. Group chiropractic practices are getting more on board with implementing a hybrid model by hiring PTs, LMTs, Acupuncturists, MDs, PAs, as well as continuing to perform ancillary services such as custom orthotics, ultrasound, EMS-Interferential, Laser, EMMS, Nutrition Counseling, Exercise and Rehab Education, ergonomic and backpack checks, and Shockwave therapies. Yes, all of these are billable and some are insurance payable.
  3. Clean, auditable financial records and practice statistical reporting are the foundations of a high-value practice. I’ve been there and have helped clinicians and managers with this while working at offices to help improve collections and revenue.
  4. Adopting robust, user-friendly digital systems and procedures. A modern (EHR) system that integrates seamlessly with billing and patient portals is a significant asset. Offices and clinic owners need and want systems that reduce administrative burdens. I’ve seen this – the better and more open staff are to learning the plethora of features in your practice management and EHR programs, the better collections are. Newer technologies in advance scheduling, automated appointment reminders, and digital intake forms minimize costly no-show rates and maximize physician utilization. The EHR-rating website Capterra just updated its list of top-rated, and compliant, chiropractic software programs. Click [Here] for details. Insert hyperlink with here as link name.
  5. A tech-forward practice signals to prospective buyers that the business is built for the future. For example, technology to administer and record a precise adjustment can help prevent wear and tear on your body, and includes devices such as the Activator, Impulse Adjuster, Sacro-Occipital Technique (SOT) Blocks, Impulse Adjusting Instrument, ArthroStim Adjusting Tool, PulStar FRAS Adjusting Instrument, and the Atlas Orthogonal Percussion Instrument.
  6. Patient retention and brand loyalty serve as powerful indicators of value. A practice with a high volume of recurring, satisfied patients represents predictable future cash flow. On the other hand, a steady flow of new patients under the pain relief only model can also prove a powerful indicator of value-based services. Implementing structured patient feedback systems and maintaining a strong online reputation can drastically lower patient acquisition costs.
  7. Additionally, standardizing clinical and operational workflows ensures that the practice can function smoothly without relying entirely on the founding physician. When operational knowledge is documented and transferable, the practice becomes far more attractive to external buyers.
  8. Cultivating a positive workplace culture reduces staff turnover, which is notoriously expensive in the healthcare sector. A practice staffed with skilled people demonstrates operational leverage and shows revenue generation is diversified across the clinical team.
  9. Ultimately, improving a healthcare practice’s value is about reducing risk and proving scalability. By implementing and maintaining solid financial workflows, embracing modern technology, and fostering patient and staff loyalty, practice owners can maximize their business worth and ensure long-term clinical success.

Now through October 31st I’m offering a complimentary 30-minute consultation on how you can boost your particular practice’s value and answer any questions you may have

Complete the easy form below for details on this complimentary offer.

Complimentary Offer

And just ask…
Lisa

*Offer does not apply to current active PM&A clients. You’re already getting the best bang for your buck in Abbondanza with us anyway!!  😉

Structure Supports Function in Chiropractic and Life

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goal driven recursive principlesA Recursive Principle

Our last two newsletters have been about structure.

Practice growth depends on putting the right structural elements in place at the right time. Internal procedures, hiring, training, marketing, and many other elements come into play. In addition, aligning each function with the others is part of the challenge for the practice owner and the practice team.

But your patient has their challenges as well. Their success depends on how well you lay out, and then help them follow, a structured pathway to their health goals.

Structure is needed to help ensure the function of the practice – its energy and capacity for growth – occurs unfettered and unimpeded. It is also needed so your patient sees how they will progress to their health goals and how you will help them.

Lack of Structure in a Chiropractic Practice and the Practice Roller Coaster

I have seen this in so many offices…

…an otherwise ambitious, caring chiropractic doctor with well-meaning, positive staff grows the business over many months. The appointment book starts filling up, the patients come in with summer cucumbers as gifts, and the adjusting tables are full.

But 6 months later, appointments are spotty, the tables are empty, and the doctor wonders where the patients are. Where is the “leak?”

The Practice Roller Coaster is a well-known malady.

The energy is there – and so is the hope, the care, and the drive.

But the structure wasn’t.

It may have been at one time, but it didn’t hold. Successful procedures that helped grow the practice dropped out. Others that were needed were never put into play. The improvements needed were overlooked.

The structure – the policies, procedures, and people – wasn’t organized to continue the progress and growth.

You might even say that the misalignment and lack of structure impeded patients’ and the practice’s progress.

Perhaps you have experienced this. Maybe it sounds familiar.

The Recursive Principle – Structure Supports Life

What is amazing about chiropractic is that its basic principles can be seen at different levels of life and work.

  • The spine. The chiropractor adjusts the spine (structure) to improve the body’s function. (This is why all professional football teams have chiropractors!)
  • The patient. The practice team puts the patient’s care plan (structure) in place and helps the patient achieve their health goals.
  • The practice. Leadership, management, and the team ensure the practice procedures (structure) are in place – and continually improved – to allow the practice to grow.

Structure supports function.

And I think you’d agree… function has its own goals.

Function is life – and life naturally wants to thrive.

You do, right?

Whether you are a chiropractor, a support professional, or the director, you work with the structure that helps the patient’s life and the practice’s life flourish and reach their goals.

Give us a call if you are wondering if your practice needs an adjustment.

And stay.. Goal Driven!

Ed Petty

Your Patient as the Hero

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stick man bending over

How to help your patients on their health journey

Last week, we reviewed your journey as an entrepreneur, a doctor, and a support professional.

But what about your patient? What about their journey?

Are they making it all the way to better health, or do they leave after their symptoms subside?

Generally, most offices look at a patient’s journey, or pathway, covering three phases of care: Acute, Corrective, and Maintenance. I have seen other variations, but they are all similar.

The idea is that as patients make regular visits, they progress through their phases of care.

Patient Visits (for example):

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

Acute ————> Corrective ———————————> Wellness

How to Improve Patient Retention?

First, it is NOT about improving retention. That is secondary. It IS about helping the patient achieve their health goals by getting through their Phases of Care and into Wellness/Maintenance.

  1. Make a list of key procedures for each visit.
    1. Break down what happens on each day, by each team member. Who does what?
    2. Make a list of key procedures done on Day 1, Day 2, Day 3, etc. Progress exam on Day 12? Good Patient Award after visit 12? Patient education on Day 8 and 14? Great Patient Award after visit 24? (You can download a sample. Link at end of article.)
  2. Practice – rehearse — these steps with your team.

Practicing Your Patient’s Journey

Below are simple steps for a fun team-building and practice improving drill. It WILL improve retention as a byproduct of helping your patient better achieve their health goals.

  1. Schedule extra time over lunch. Get your team together.
  2. You, or someone you delegate, act as the patient. (This is something I often do when I visit offices.)
  3. Each staff member, and the doctor, goes through their procedures for each day.
    1. On Day 1, for example, how did the Front Desk greet the patient and what did they say?
    2. How were they routed to the consultation room?
    3. What did the doctor say?
    4. Who did what for the rest of the exam and x-ray? Review it
    5. How were they routed back to the front desk, and how was the next appointment made?
    6. Day 2. – Same step by step. Practice it and then discuss it.

 

What you are looking for is:

  1. Procedures
    1. Were any procedures dropped out?
    2. Missing procedures.
    3. Redundant procedures.
    4. Unnecessary procedures.
  2. Application of procedures.
    1. Was the team member genuinely interested in the patient
    2. How well were the procedures communicated — with kindness, intention, and patience?
    3. Were the procedures correct – nothing left out, nothing extra included, everything correct?

The best teams practice.

Do this exercise at least once per quarter and be the best… and help your patients be heroes on their journey to their health goals.

And, of course, stay Goal Driven.

Ed

Download: Sample Patient Pathway and Flow Chart 2026

The Hero’s Journey – Your Journey in Chiropractic and Healthcare

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heros journey chiropractic journey

Moving from One Stage to the Next

You are reading this because you are on a journey.

And you are also a hero.

You see things differently—you left the institutions and their mandates and took a different path. Like pioneers. Most of you reading this are involved with an alternative path of service – of helping people – chiropractic, nutrition, biological dentistry, acupuncture, midwifery, and more.

To us at PM&A, your goals are noble, and you are on a hero’s journey!

For nearly 40 years, our singular goal has been to help you, and others like you, succeed on that path.

A few years back, I wrote a book called The Goal Driven Business, where I laid out the methodology we’ve used to help doctors of all types, chiropractors, medical, dental… and business owners navigate that journey.

Your Progress as a Chiropractic and Healthcare Practice Owner Unfolds in Stages

The goal for any business practice or career is to operate at a level where you can do your most, at your best, comfortably. We call this Stage Full Capacity.

When you begin your career or practice, you may not have fully defined your end goal—just a general sense that you want to be successful.

Operationally though, the real goal is to deliver services at your highest comfortable capacity. That’s the most logical and economical level, since expenses like your building, equipment, and staff are mostly fixed — and you’ve already invested serious time and money developing your skills.

Getting to this goal means passing through other Stages first. Each one demands its own unique strategy. Apply the right strategy for the Stage you’re in, and you move to the next one. Fail to, and you stay stuck — or slide back down.

In our Goal Driven System, we’ve mapped the journey to Full Capacity into 5 major stages. For details, read the book The Goal Driven Business or contact me!

  1. Stage 1. Beginning – You’re just starting out. (Well, sometimes, we crash and burn and need to start over!) The strategy: actively getting out with the message: “Get to know me, and here’s what I can do for you! ” (The Goal Driven Business, Page 75)
  2. Stage 2. Goals and Roles. You’ve generated interest and delivered services — now it’s time to clarify goals and roles: who does what, when, and why. Like a growing organism, this is your cell-differentiation phase. Set your blueprint here, while you keep growing promotions and services. (Page 101)
  3. Stage 3. Stability Stage. Here is where you strengthen your people and procedures. Stage 1’s efforts are still firing, and your goals and roles are defined. The driver now is management — take care of your people, refine your procedures, and keep improving without any big change. (Page 141)
  4. Stage 4. Acceleration Stage. In time, with the earlier stages in place, you are going to hit your Best Ever! This is the most dangerous Stage — most practices never make it past this level. They hit it, crash, and try again — sometimes for years — until they settle. Key drivers: lean management, professional discipline, and extraordinary customer service. (Page 175)
  5. Stage 5. Full Capacity – Team Leadership. This is the goal: in business and in your career. All pistons firing at maximum — but at a sustainable RPM. (Page 211)

Whether or not you reach Full Capacity, we applaud your courage and purpose — your refusal to fit into a system that doesn’t always put health or people first.

You, and everyone you work with, are heroes in our eyes. And you might be surprised to learn: you’re heroes to the people you serve, too.

Carry on — and stay Goal Driven.

Ed

P.S. And reach out if you need some guidance along the way.

Does Your Chiropractic and Healthcare Practice Structure Determine Your Practice Function?

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comparison of two buildings one with poor structure resulting in poor function and the other strong structure, strong function. similar to a chiropractic businessHow a few adjustments can improve performance!

Over the years, I have worked with many talented, intelligent, and dedicated chiropractors and doctors—both men and women who were compassionate and effective with their patients.

However, not all of them were successful in business.

The reason was that they lacked organization—and organizational discipline.

That is to say, they lacked the business structure that would support a strong practice function.

What is Chiropractic Business Structure?

It is showing up on time.

It is the routine consultation, history, and exam procedures you do with all patients on their first visit.

It is the standard re-exam visit.

It is keeping up with patient notes.

It is also the regular team meeting that follows a routine procedure.

It is your monthly marketing programs.

It is effective financial management.

And especially, your weekly and monthly management review and planning meetings with your team and coach – if you have one.

Over and over and over – daily, weekly, monthly.

That is structure.

What is Chiropractic Business Function?

Ah… FUNCTION… this is the life of the practice!

It is getting to know your new patient as a unique person.

It is having a chuckle with one of your staff.

It is sincerely congratulating an established patient for a success in their life – and feeling happy for them.

It is cheerfully participating in an event promoting the good works of you and your team.

It is feeling pride at the end of the week with the care you and your team provided.

It is the structure of your business that allows the function of your practice to achieve its full potential.

Sound familiar!

How to Maintain Your Chiropractic Business Structure

THE HUMBLE CHECKLIST. I write about this almost quarterly. I don’t have to reiterate it here. There are some links below to earlier references.

But here’s the trick: you must put someone in charge of ensuring the checklists are getting done.

It’s a reminder role. And in all honesty, most of us need at least some reminding, nudging, even nagging…now and then, right? (How’s that exercise and workout program going for you…?)

Your practice manager should do this.

We went over this again and again in our MBA program.

So, there you have it.

A practice is like a body – its function depends on how well it is structured.

Make the adjustments as needed, and keep it aligned – and enjoy the full potential of your practice.

And stay – Goal Driven,

Ed

 

Why Are Group Practices – Chiropractic and Others — Growing?

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group of 4 chiropractors of a group practiceIs a Chiropractic Group Practice for You?

In 2014, roughly three out of four chiropractors owned their practice solo.

By 2024, that’s down to about half.

And the flip side of that decline is real growth: the share of chiropractors working in a multi-doctor or multidisciplinary setting has roughly doubled in ten years — from about 22% to about 48%.

Doubled. In ten years!

We’ve seen this happening in the field. But with better research tools, I was able to confirm it. Two separate industry surveys, from the National Board of Chiropractic Examiners and Chiropractic Economics, both show the same trend, year after year.

Why is this occurring

  1. Administrative demands keep piling up. Prior authorizations, OSHA compliance, personnel management, documentation requirements — it’s a full second job that doesn’t shrink just because your practice is small.
  2. Marketing has gotten harder and more expensive. With more providers, more provider types, and more channels to compete on — social media, review sites, paid search — its more than any solo doctor can keep up with alone.
  3. Overhead keeps climbing. Equipment, staff, and competitive wages all cost more than they used to, and they cost the same whether you’re splitting them one way or four.
  4. Third-party pay keeps shrinking. Medicare’s actual chiropractic payment rate has fallen roughly a third since 2001, adjusted for inflation. Commercial insurance pays better, but it comes with its own squeeze — visit caps, prior-authorization requirements, and tighter claim scrutiny every year.
  5. Succession has changed. Aging solo owners need someone to hand the practice to — retirement, sale, or simply relief. An associate who eventually buys in solves that. Staying solo to the finish line often doesn’t.

This is one of the reasons corporate chains like The Joint are growing — from about 309 clinics in 2016 to nearly 1,000 today. That’s roughly tripling in under a decade.

A group practice has many advantages:

  • Shared overhead — rent, equipment, and staff, split instead of carried alone.
  • Focused management to smoothly take on the increased administrative and marketing demands, and better support the doctors and staff.
  • Local market strength — a three-doctor practice out-competes both the franchise down the street and the lone operator across town.
  • Real vacation coverage — your practice doesn’t close when you do.
  • Camaraderie — a colleague to talk through hard cases and hard days.

But you don’t have to sell your name to get that. An independent group practice gets you the same advantages, minus the franchise fee, the corporate playbook, and institutionalization.

And the timing works in your favor: chiropractic use is climbing nationally, not shrinking. The demand is there. The only question is whether your practice is built to catch it.

Here’s what group practice owners already know — most independents don’t: none of this works without dedicated management. The practices that thrive as groups are built on a management structure that has a purpose.

That Shift — from a personality-based, one-doctor practice to a business built on goals and led by a team — is exactly what I cover in my book from 2001, The Goal Driven Business.

Ready to make the Shift? And if you already are part of a group practice — is it time to upgrade your management?

Read (and apply) The Goal Driven Business.

And stay Goal Driven,

Ed

Let me know you bought the book (email an image!), and I will send you another at no charge.

UPDATES: Fulcrum Closure August 31, 2026

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Note:  This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest

Following up on my June article, I wanted to update you on insurance plans and who will be managing them at the time of this writing.   Plans and which company is managing them are quickly changing, but it’s only fair to keep you in the know as these changes impact your bottom line and admin burden.    Here is an updated listing of the payer groups and what is scheduled to happen now and going forward with contracts and claims:

Plan Managing company and other information
Health Partners Optum UHC is managing effective 7/1.  As of this writing, 1) no pre-auths/clinical submissions are required, and 2) Use Health Partner’s payer ID, 94267 for claims
Cigna Unknown at this time.  Possibly direct-contract (groups only) or going to American Specialty Health.  Continue sending claims per patient insurance card.
Aspirus Medicare Advantage Whole Health/Tivity
The Alliance Whole Health/Tivity
Aetna Whole Health/Tivity
Aspirus Commercial HMO Unknown at this time
Quartz Direct contract only via invitation from Quartz
Zelis Direct contract for now
WPS Chiropractic Management Services, Brookfield, WI

Remember!

  • Tip: Use the actual payers’ IDs for claims submission.
  • Tip: Continue doing your financial consultations after verifying new patient benefits. Patients who are already in the middle of a care plan shouldn’t need a separate exam due to the above changes.

Are patient pre-pay packages looking like a better option for you and your practice?  Let us guide you within the can-do’s and can’t-do’s to set up these plans!

Additional Questions?  We can help!  And we will find an answer for you.

Lisa
920-334-4561

The Fully Engaged Goal Driven Practice

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Coach game plan

How to Have Sustained Motivation

How engaged and driven are you in growing and improving your business?

How about your team?

Would you say Very Engaged, Not Engaged, or Actively Disengaged?

Employee Engagement

Each year, Gallup grades the engagement level of both employees and managers in the U.S.

Gallup defines employee engagement as the level of involvement and enthusiasm employees have toward their work and workplace.

In 2025, it was 31%.

Managers were also surveyed. They usually rate higher, but they also rated at 31% in 2024.

Being Engaged, Goal Driven, and Successful

A team that is fully engaged is a team that wants to see patient successes. They also work hard to generate more patients through referral procedures and promotions. They stay inspired by the office’s purpose.

According to Gallup, comparing high-engagement vs. low-engagement teams, high-engagement teams had: [2]

  • 21% higher profitability
  • 17% higher productivity
  • 59% lower turnover

lower absenteeism, fewer safety incidents, higher customer ratings

It’s The Manager

Gallup’s core findings were that the manager accounted for at least 70% of the variance in team engagement (Gallup, State of the American Manager, 2015, since reaffirmed [1]).

In most practices, the doctor is the manager. But in a busy, growing practice, it’s hard for a doctor also to be an effective manager, business owner, property manager, and everything else. That’s why we’ve always recommended bringing on or assigning a qualified person — often part-time — to take on the manager role.

It’s also why we offer the Goal Driven MBA course for practice managers. (More on that in future emails.)

Increasing Engagement

Look at yourself and your team as athletes playing in a health care conference.

Are you winning?

That’s the question Jim Loehr and Tony Schwartz asked when they studied elite athletes for their book The Power of Full Engagement.

Their conclusion: performance depends on managing energy, not just time. Like athletes, people perform best by alternating focused effort with deliberate recovery.

Recovery time for your office could include:

  • Monthly team meetings that discuss how the office is doing statistically, patient successes, promotional plans, team member wins, and a fresh angle on why the practice exists.
  • Short weekly meetings.
  • Daily case management meetings.
  • Individual coaching of employees and professional development.

These are not just meetings – there are review and revival sessions. They are huddles, chalk talks, and reviewing game films.

Why? Because you want to win.

The best teams do this.

You should too.

Stay Goal Driven,

Ed

References

  1. Gallup Business Journal, 2015. Drawn from Gallup’s report State of the American Manager: Analytics and Advice for Leaders (2015).
  2. Harter, J.K., Schmidt, F.L., et al. Q12 Meta-Analysis: The Relationship Between Engagement at Work and Organizational Outcomes. Gallup, Inc.

The Frog Doesn’t Notice

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How your practice can quietly erode.

There’s an old story about a frog dropped into boiling water — it jumps out immediately.

But put that same frog in cool water and slowly raise the heat, and it stays put. It never feels the moment it should have jumped.

Biologically, this isn’t actually true of frogs. It’s a fable.

But it’s true of practices.

No one decides one morning to lower their standards. You never wake up one day and say: “Patients are going to get just a bit less of me today.” Or, “the business performance will drop over the next month.”

It happens one degree at a time — an exam abbreviated and rote because the schedule was tight or a report of findings that never quite landed.

In an earlier newsletter, I wrote about “procedural atrophy” — how the steps that made something work are shortened until the quality quietly deteriorates. This can continue to occur until a “quality threshold” is reached. This is the point beyond which poor quality is obvious – in patient complaints and practice decline.

GRADUAL DECLINE IN PERFORMANCE IN YOUR CHIROPRACTIC AND HEALTHCARE BUSINESS

Procedural atrophy erodes not just what gets done, but the intention and care behind it.

The difficult truth about this is that — we agree to it. Not out loud. Not on purpose. But each small degradation gets accepted because nothing bad shows up right away. That acceptance becomes the new normal. The next shortcut looks small, too, because we’re measuring it against the last one, not against where we started.

This is the flip side of the elephant story I wrote about before*. The elephant never tests its ceiling — it’s held down by an old belief about what’s possible. Erosion is the opposite problem: a floor that quietly drops, with nobody really deciding to lower it.

To prevent this from happening, from slowly slip-sliding away:

Look at your numbers now and what they were in the past.

Check your purpose from years ago and what it is now.

Review your policies and successful procedures – and what is being missed now.

Review your patient successes.

Do this with your team.

When I have done this with chiropractic offices, we always unearth rusty old goals, policies and procedures.

“Oh yea, back when our numbers were higher, we would always call the new patient after the first adjustment to see how they were doing.”

It takes work, and comparisons can be uncomfortable. But it’s the only way to catch water that’s heating up too slowly to feel.

You must look at your business objectively – that is why we implement a fast and simple statistical management system for all our clients.

This is how you stay focused on your goals and what you’re actually capable of, instead of drifting toward whatever is easiest to accept.

Stay Goal Driven,

Ed

* Increase Your Capacity

Goal Driven Metrics Program for Your Office