Author Archives: Edward Petty

About Edward Petty

Consultant with Petty, Michel & Associates, Author of Marketing Manager System, the Goal Driven Business www.GoalDriven.com. Father and grandfather, husband, student, active in athletics, and in health and environmental causes.

3 Goals Management Introduction

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3 Goals Management System

How to Achieve Financial Abundance and Practice Freedom
A unique practice development strategy and process created by Petty, Michel & Associates

An Introduction

Goal Driven
We all have goals.  When we were younger, they might have been brighter than they are now, they might have been clearer, or seemed closer.  Maybe yours still are. Or, maybe, they have become dulled with wear and tear, with disappointments and frustrations.

But we are goal driven creatures and our goals stay with us. The better we can define these goals in concrete terms, the more likely we are to achieve them.

What All Doctors Want — The 3 Goals
Ultimately, all doctors would like to create a practice that allows them to provide the highest quality care to the most people for the most profit.

Most doctors want to do this with professional and personal integrity. Maybe most importantly, they want to be able to do this in such a way that they are not chained to their practice, slaving at their work at the expense of their personal and family lives.

This is a fundamental goal for all doctors, so fundamental that we call it Goal 2.

Even more fundamental, however, is basic survival and solvency. We call this Goal 1.

But nobody works just for money.  Whether it’s saving the planet, helping your grand kids, assisting the poor, or funding your church, we all have higher goals.

Goal 3 are your higher purposes.

All three goals can and should be achieved, and with over 20 years of experience, we have put together a practice development system that allows doctors, and their teams, to achieve all three goals.

The 3 Goals Practice Development System is a step by step approach to help your practice grow naturally to its full potential and stay there.

Goal 1
Goal 1 is survival. In business, this means solvency. Are you making enough profit to pay your bills? To achieve Goal 1, solvency and survival, you have to move fast.  It requires passion, energy, and an aggressively friendly approach to getting your services known and delivered. For the patient, you can think of Acute Care. For a staff position, you can think of 20 – 30% proficient.

Goal 2 and the Practice Development Process
Goal 2 is a fully functional, franchise-able, sale-able, and sustainable business that is very profitable.   For a patient, it is a maximum spinal correction. For a staff position, it is 100% proficient and competent, rain or shine.

After you have achieved Goal 1, you can now start identifying those procedures that worked best. You can write these down on checklists. These checklists will become your Practice Playbook.

With more staff training, you can delegate more procedures to staff. As you continue to grow, you refine your procedures and continue to train your staff so that they become more competent.

Every 2 months, or as needed, you assess your list of successful procedures and add to them, or revise them.  Every week you work on improving them, and train your team on them.  Much like any athletic team, you practice and review your plays and procedures.

We call this process the Practice Development Process. It helps you to continually improve the practice and gradually take the office to Goal 2.

Getting Organized: The Baseball Diamond
To get to Goal 1, organization is not vital. Production, speed, and promotional activity is. However, getting to Goal 2 requires good organization.

Imagine a baseball team that stands around the pitcher’s mound with the pitcher. A batter hits a fly ball to the right field. The whole team goes to chase it. Once they reach it, they realize that no one is on the first or second base to throw the ball to in order to stop the runner. They are all out in right field.

Many offices operate this way. For example, in some offices the front desk does insurance, the insurance department does therapy, the therapist schedules appointments, and the doctor takes time off to buy office supplies.

Moving the office upward to its peak capacity includes all areas of the office improving: first base, third base, centerfield, etc.  If you only have a few of the departments doing well, the other departments will hold down the entire growth.

Goal Three
Our greater goals give us meaning.  These are the accomplishments we want to have said we achieved at the end of our lives. They are based in love, hope, and faith. They are for our heritage, our parents and those upon whom we owe so much; they are for our legacy, our children and their children; they are for our community and the fellowship we share with rich and poor.

Goal three is your “Give Back” goals, to your family, to your community, and to yourself.

All Three
This is your road map up and out of the roller coaster. These three goals form a sequence, but you have to keep all of them in mind as you travel up your road to success.

This is directed to a business owner, but also applies to team members and how they can improve their competency. It applies to patients, and how they travel from acute care, structural care, to wellness.  It actually applies to many activities.

You have to be willing to shift between goals, and if you find yourself suddenly in the poor house, you have to lose your self-important attitude and run like a rookie again until you build your business back up to Goal 1.

Where many doctors fail is that they are not willing to shift, either up, or down, as needed. Having achieved Goal 1, they are two insecure to delegate their duties to staff and procedures, or work on improving themselves. Many doctors, having achieved Goal 1 who should be working on Goal Two, feel the need to keep doing what they did to get to Goal One and so, quickly find them selves back down struggling just to survive.

It is easy to get lost, but now, with the 3 Goals Management System, you have a road map.

We have seen too few doctors achieve financial abundance and practice freedom. Hopefully, with the tools provided in the 3 Goals Management System, more doctors will be able to reach their dreams and help others do the same.

For information on our coaching and management consulting programs. LINK

(3 goals image copyright 2009)

Case Management in a Chiropractic Office

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Chiropractic Case Manager Job Description Summary

In many chiropractic offices the majority of the attention on patient care is on the first 5 to 12 visits. In some offices, it is only on the first 5 visits, or less. It can get so bad that the primary concern is only on getting more and more new patient first visits.

An old maxim in dental consulting is that the biggest cost to the dentist is the incomplete dental program. A patient who discontinues care after the first $1,000 of a total program of $10,000 just cost the dental office $9,000. This also applies to the chiropractic office.

Actually, many chiropractors are producing incomplete cases. This is not in the best interest of the patient’s health or in the viability of the office. Imagine a hygienist that only cleaned the upper teeth, or a baker that only baked his bread half way through. Yet, many offices are only getting their patients partially through their treatment programs.

The job of your clinic is to get your patients to complete their entire treatment program and on to a Wellness Program. During the course of a patient’s care, the doctor and staff may concentrate only on their specific duties with the patient, such as scheduling, treating (adjusting), collection, etc.  Usually no one has the job of overseeing the patient’s progress along the entire treatment pathway, through all the adjustments, scheduling, therapy, education, payments, until they finally “graduate” and go on to a Wellness Program.

Yet a full Wellness Program takes some of the pressure off of the need for a constant stream of new patients and makes for a smooth running office.

To help ensure that patients get complete and comprehensive care, the position of Case Manager should be held by someone in the office.

Who should be the case manager: It can be fulfilled by the doctor, or the therapy or back office assistant, or the front desk or even the billing and collections staff member.

Time spent as a case manager: It should take no more than one hour per week.

Mission: The mission of the Case Manager is to ensure that all patients move through the various departments of a health care clinic smoothly and quickly, ensuring that they get excellent service such that they complete their treatment program as quickly as possible.

Duties and Responsibilities

1.  Coordination. Once a week, or daily before treating hours, the case manager should get the doctor and essential staff together for a Case Management Meeting. A great time to do this is 20 minutes before the first patient for the day, or weekly for one hour. During this time, the appointment book or a list of active patients should be reviewed.

    This is the most important tool the case manager (or case coordinator) has. During these meetings, the following points, among others, can be reviewed on each active patient:

    • Patient’s Progress
    • Patient’s Satisfaction
    • Re-exam (last/next)
    • Re-x-ray, or other diagnostics
    • Re-x-ray, or other diagnostics
    • Re-reports (progress report of findings)
    • Supplements
    • Exercises, nutritional or other recommendations
    • Financial conclusion (Initial, subsequent, and transitional to Wellness.)
    • Education programs, such as spinal care class, special lectures, pamphlets, etc.
    • Awards, compliments, thank you for referrals, good attendance, etc.
    • Family and friends referrals
    • Transition or adherence to a Wellness Program.

    2.  Outcome and Statistics. Keep a statistic of “Completed Treatment Programs”. Once a patient reaches a maximum level of improvement they are ready to go on to Wellness Care. One way to keep this statistic is to track the number of patients beginning a wellness care program.

      3.    Patient Progress Card. Make up a general treatment plan for every patient in the form of a simple checklist. This would include all service procedures, therapy, diagnostic, as well as educational actions. The last steps would include transitional consultations onto a wellness care program. This could be called a Patient Progress Card, and placed in the patient’s folder.

      4.    Day 1 & 2 Procedures. Ensure that day one and day two procedures are well documented and kept up to date with current procedures, and a simple flow chart outlined.

      5.    Regular Visit Procedures. Ensure that regular patient procedures are documented, and a simple flow chart outlined.

      6.    Staff Training. Staff walk-throughs for day one and day two procedures, and other flow procedures rehearsed at least on a quarterly basis. The best offices practice monthly.

      7.    Financial Consultations. Financial consultations done on all patients as often as is needed.

      8.    New Patient Orientation. New Patient Orientation done on each patient.

      9.    Patient Satisfaction. Ensured patients are very happy with service.

      10.    Pathways. Pathways for different types of cases documented and reviewed by all.

      11.    Flow Charts. Flow charts for first three day procedures outlined and rehearsed.

      12.    Conversion. All patients completing services are converted to wellness or other programs.

      Outcomes. The major outcome of the position of Case Manager is “Completed Treatment Programs.” That is, patients who have completed any acute or chronic treatment programs prescribed by the doctor and have reached maximum improvement. This definition could be extended to include: a patient who has completed their active care program and is educated so that they will continue onto a wellness program.”

      Performance Monitors

      • Number of Completed Treatment Programs
      • Number of Patients Beginning Wellness Care Programs
      • Number of Wellness Program Visits

      It is easy to drop out important but not urgent actions with patients during their care. Ultimately, this leads to poor quality and a deterioration of results. With a Patient Progress Card, and the Case Manager System in place, quality and patient results will improve, and your volume will increase. Often it is not what we see that hurts us, but what we don’t see. It is the gradual omissions that eventually add up to an empty office. Ensure each patient completes all of the steps of their treatment programs.

      For better patient retention, increased referrals, improved treatment compliance, and more revenue, implement the Case Management System!

      Chiropractic Special Promotions

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      • What is a Special Promotion?
      • How often do you use them?
      • Why do you use them?
      • Are there times that you shouldn’t use them?
      • What is the key to their success?
      • Plus- 14 Questions for each promotion.
      • Plus- 24 examples of special promotions.

      What Is a Special Promotion?

      A special promotion is a promotion that is not a regular part of your standard patient marketing procedures.  Every clinic should have routine and recurring procedures that serve to promote its services.  This would include different forms of patient education, recommendations to patients to bring in family members for a check-up, the manner in which the phone is answered, newsletters, etc.

      On occasion, however, you may want to celebrate a special event, like the anniversary of our clinic, or hold a party for all of your patients for the holidays, or take part in a community wide donation program with your patients.  This is called a special promotion.  They can be targeted to your entire patient base, or just a section of it. For example, you could set aside a special day for just for kids or an after hours “Girls Night Out.”.

      How Often Are Special Promotions Used?
      Because these promotions can be directed at select groups of patients and non patients, you could have as many as one or two per month.  However, they do take up staff time to prepare properly and to execute each promotion effectively. Therefore, a special promotion every 2 to four months is usually adequate.

      Why use Special Promotions?
      There are a number of reasons to do special promotions.  First, of course, they can generate new patients.  But there are other reasons as well.  For example, handing out carnations to mothers on the week before Mother’s Day is done just for the goodwill– because it is a nice thing to do.  Another reason is that it can add fun for the staff by providing them with an activity outside of their usual patient services and admin duties.

      Another benefit of special promotions is that it draws attention to your office. Patients and non-patients see that there are extra exciting activities occurring with your office in addition to the great service you provide.  It helps create marketing “buzz,” or conversations about your office.

      When Not to Use Special Promotions
      If you or your staff are already stressed with extra work, major in-office changes, or have repeatedly done new patient promotions recently, do not schedule a special promotion soon.  You need to build up your routine and recurring internal and external promotional procedures for a while in order to “grow” more new patients.  A special promotion is like a special harvesting… you can’t pick apples off a tree more than once in a season.

      Special promotions can act like an artificial boost.  Often, the real energy has been built up in the office or in the community and a special promotion just “releases” it.

      You may have seen other doctors trying to run a special promotion in the newspaper over and over, usually for something free.  It may have worked once, and may work again, but probably not right away.  Continuous “specials” poorly targeted and improperly timed will grind your other promotions down to a halt.

      Preparation Is The Key
      Plan ahead.  At least 70%, of the work of a special promotion is in preparation.  Avoid “too little too late”, a common mistake with  many promotions.

      Plan several special promotions for the next six months.  You can always cancel them later if you have too many. You can tie them into seasons, holidays, special events, or anything that might be of particular interest to your community, to your patients, and … to you and your staff.  They should be kept fun and creative.  Everyone should be involved.  The event should be discussed at staff meetings, and different projects delegated to different staff, even the doctors.

      Different promotions can be delegated to different team members.  You can give each person the option of creating their own event.  In one office the Billing and Collections Coordinator took on the month of August and organized a  “Flea Market” on a weekend in the clinic’s parking lot.  Patients rented booths and a food vendor set up a shop, and health screenings were provided by the office. It was a resounding success.

      Lastly, someone should act as the Special Promotion/Event Coordinator to help keep things organized.

      14 Questions to Ask for Each Special Promotion

      1. Why are we doing this event and how does it align with our mission
      2. Who exactly is the special promotion for?
      3. Is the event just internal to the office, or just external, or both?
      4. Is the event designed to directly generate new patients, just generate good will, or both?
      5. What does the target market get out of it?  Why would they want to participate?  What is in it for them?
      6. What are we going to get out of the event?  How will it benefit our clinic?
      7. When are we going to have it?
      8. What is the duration of the event?
      9. What is our budget?
      10. How are we going to promote it?
      11. What needs to be done?
        1. Before the event
        2. During the event
        3. After the event.
      12. Are all of the duties listed above delegated to individual staff?
      13. Who is the coordinator for the event?
      14. Do they have time scheduled to prepare for the event?

      Examples of Special Promotions
      (I-Internal, E-External)

      1. Senior’s Day (I&E)
      2. Valentine’s Day (I)
      3. National Correct Posture Month (May) (I&E)
      4. Mother’s Day (I)
      5. Father’s Day (I)
      6. Kid’s Day (I&E)
      7. Back to School Day for Kids (I&E)
      8. Patient Appreciation Day (I)
      9. Community Appreciation Day (E)
      10. Open House (I&E)
      11. Grand Opening (E)
      12. Anniversary (I&E)
      13. Spinal Health Care Month (I&E)
      14. Food Drive (I&E)
      15. Toy Drive (I&E)
      16. Other donation drives, such as YMCA (I&E)
      17. Christmas gifts, coupons and health certificates (I&E)
      18. General referral coupons for friends and family members of patients
      19. Teacher’s Appreciation Day (I&E)
      20. Care to Share (Internal)
      21. Doctors with a Heart
      22. Girls Night Out (Internal/External)
      23. Cinco de Mayo Party
      24. Fireman Appreciation Week
      25. Blame Someone Else Day

      Example of One Doctor’s Successful Promotion

      For more articles on practice development for your chiropractic office.

      To learn about our Marketing Manager System.

      Family Referral Procedure

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      A systematized procedure for generating more chiropractic patient referrals.

      How many more patient referrals could you generate if you simply asked for them?

      Sure, your patients refer others to you now, but how many more could you generate if you asked for them?

      One of the best times to ask for referrals is at the beginning of care, just when they are starting to see some benefit. At this time, patients are excited about discovering your office and are more willing to tell others about your services.

      This usually occurs between visit 3-8.  After about 3 weeks, the ”newness” of the experience can wear off and the patient can settle into a routine.

      One procedure that we have seen effective is talking to the patient about a “Family Check-up Plan.”  We recommend that you present each patient with a “Family and Friends Guest Pass”, or “Get Acquainted Gift Certificate” for his or her family, and friends, good for a free spinal check-up as a routine procedure, usually on the 3rd visit.

      Below you will find an example of a script for your chiropractic assistant, procedure notes, and an example of a gift certificate. You can edit the gift certificate and insert your office name and other information so that it is customized for your office.

      SCRIPT AND PROCEDURE

      Front Desk Chiropractic Assistant: After the 3rd visit, as the patient checks out, the Front Desk C.A. asks the patient:

      “Did Dr. ABC mention our Family and Friends “Health Check-up Program?”

      Patient: Responds.

      C.A.: Explains or re-explains the program:

      “Well, Dr. ABC wants to make sure that the family members of our all patients are properly checked for spinal related problems. We call it our Family Check-up Policy.

      So many times he sees patients who come to us, in pain, who have spinal problems that could have been more easily corrected had we seen them sooner before they were in pain.

      Now, there is no charge for this. Dr. ABC just wants to make sure your whole family is checked and healthy.

      Any questions?

      Patient Responds.

      C.A. O.K. Here is a Gift Certificate you can give to a family member. It is good for (whatever you want to offer.) an 8-point spine and neck check-up and a consultation.
      And, (smiling), as a bonus, we are offering a 15 minute massage from our massage therapist as well.

      Patient Responds. That sounds pretty good.

      C.A. Well, it gets better. This coupon is also good for any family member. You can even use it for a friend of yours too.

      In addition, this makes you eligible for our Massage Therapy “Care To Share” Credit Program.  Every person you bring in allows you to receive a credit 15 minutes free massage on your account. This is our way of thanking you for sharing the benefits of chiropractic.

      Patient Responds. Wow. That’s great!

      C.A. Let me go over the card with you. (C.A. goes over how to fill out the card). Now, how many do you want?

      Patient. Well let’s see, my son, my sister, and her husband. That’s three.

      C.A. Great. Here they are. Let me initial them and get them numbered. Now they are good for 60 days. So try to encourage them to call and make an appointment before then.

      [Makes a note on a log, usually kept at the Front Desk. Ask the patient about who the gift certificates are for.  Try to become familiar with the family and friends of the patient. Make a note of whom they are. In the following days, you can ask about these people again, showing interest and helping to remind the patient to bring their family and friends in for a health check-up.]

      Patient. I will do it. Thanks!

      NOTES:
      Print the gift certificate on card stock and cut with a paper cutter. Your local copy shop can do this for you or you can in your office. The better you make the coupon, the more valuable it will be to the patient.

      Only hand the gift certificate out to the patient personally. Never let them lie around or on the desk. Treat them as $100 bills.

      If you miss the patient on the 3rd visit, ask them on the subsequent visit. Usually the 3rd to the 6th visit is the best time. The patient should start to benefit, and still be excited about the services he or she is receiving.

      (For customizable samples in Word format, active PM&A and Marketing Manager System clients and members can go to the MMS Members web site.)

      SAMPLE FAMILY & FRIEND HEALTH CHECK UP GIFT CERTIFICATE FILLED OUT.

      Much more of this information can be found in the Marketing Manager System computer program.
      Also, look for more free tips and tools to grow your practice. Link. Link.

      Chiropractic Newsletters

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      Newsletters to Your Patients

      Pity the poor practice newsletter!

      So misunderstood. Forgotten, neglected, and ridiculed.

      Scorned as too expensive, dismissed for eating up too much staff time, and disregarded because they just don’t “work.”

      But is any of this true…?

      Not necessarily.

      Too expensive? They can be. Fancy paper, color photos, six pages,  and sent first class can cost thousands.

      Take too much time? Oh boy, how true this can be!  Who is going to get the information and write it, format the newsletter, get the mailing list, organize the mailing, do the printing, add the postage, and take it to the post office?  That is a LOT of work, and costly staff hours.

      Do they work? After spending so much time and money on any other promotion, you would expect the new patients to come in for a good return on your investment. Often, this does not occur.

      BUT WAIT… it doesn’t have to be like this. IN FACT:

      Patient newsletters can cost as little .50 cents per newsletter. That includes, postage, paper, printing, and taking them to the post office.  The offices where we see them used regularly have shown an increase in patient referrals and in reactivated patients.

      Before we outline how to do it, here is why you should.

      Why You Should Do A Newsletter
      When a patient starts care with you, you and that one person, old, young, male, female, it doesn’t matter, that ONE person and you – have started a conversation. They confided in you about some things about which, outside of close family friends, no one knows. It is personal. Professional, yes, but the fact is, you and your patient have started a dialogue.

      It is your job to continue it. It is not their job to do so – it is yours.

      You are the doctor and they came to you. They reached out for help. All you have to do is to keep the conversation going. It may be one sided for a while, but they are listening.

      We are all spammed to death. It has been estimated that each one of us receives up to 3,000 to 5,000 separate advertising impressions each day in the U. S. People are numb to advertising. It is no wonder that your ads in the local paper just don’t have the pull they used to.

      Patients who have once been to you already know who you are. When they receive a letter from you, it is from someone who knows them.  You are communicating to someone who already knows you and knows that you know them.

      Statistics tell us that it is much more profitable to invest in keeping the patients you have, and marketing to them, than trying to procure new patients that do not know you.

      Patients stop seeing you because sometimes, Life gets in the way. Finances, personal problems, work, and after a while, they kind of just loose touch.  But you are mistaken if you think that your relationship with them is over.  Once someone tells you intimate details about their personal condition, a relationship has started. Think about who you have confided in personally. You feel a special connection to them, right?

      So, a conversation has started and by simply maintaining it, you will find that the patients stay with you longer, come back to care more frequently, and refer more of their family and acquaintances.

      How To Do A Newsletter
      For those of you who have the Marketing Manager System (sm)  computer program, there are a number of sample templates and examples that can be easily reformatted for your office.

      Newsletters are thrown away, of course,  but they are reminders and brief advertisements about your services. They should not look like another pamphlet – homemade newsletters work very well. Too fancy is too expensive and look like the regurgitated pulp that gets thrown in most health articles and brochures.

      Add a column just from you. We have a sample doctor’s column which you can use. On our members site for our clients, we have others.  Add some news, maybe one of Margie’s favorite non fattening brownie recipes, a snapshot, a testimonial, and a list of upcoming events. That’s about it.

      Put it on one piece of paper that gets folded over twice and become self mailer. Bid it out to local mailers and you will find that the printing, paper, postage, and mailing all comes out to about fifty cents each.  If you have 1000 patients to whom you are mailing, that comes out to $500. If you do the mailing every 4 months, it averages to be $125 per month.

      Make sure that one person is delegated to oversee the newsletter. It should not take but a few hours to do.

      Email newsletters are nearly free, of course, and can be effective.  You can capture the email addresses from your patients and send out personal newsletters using services such as constantcontact.com, aweber.com, or a new one icontact.com. There are many others that have simple templates where you can simple type in the information and send out.

      Homemade Newsletters versus Preprinted Newsletters

      There are a number of companies that will print and mail newsletters out to your patients for you.  There are also a number of chiropractic commercial websites that will send out prefabricated electronic email newsletters to the email addresses you supply them.  The advantages are obvious – someone else does all the work and patients receive a professional good looking copy in their mail box, or their email in box.

      We have seen these work, however we prefer the home made newsletter.  The reason is that professionally done newsletters are a bit like pamphlets – they look nice, but they are generic and soulless.  This can be particularly true of email newsletters. Some prefabricated newsletters make room for your customized inserts.  In this case, these might work well.

      The primary problem with the preprinted newsletter, whether “hard copy” or electronic, is that it can take you out of the loop. You cannot really delegate all of your patient communication.  You can delegate some of your communication, but the point is, you want to maintain a personal relationship with your patients.

      There is more to it than this, but don’t worry about getting it too prefect or too fancy. Funky, friendly, and funny is good.  Just do it and keep the conversation going. You will see your old patients returning, referrals increasing, and established patients coming in to thank you for that the recipe you put in your last newsletter.

      #  #  #

      [Petty, Michel & Associates offers special practice development programs designed to help you achieve your goals.  For more information on our 3 Goals Seminars, coaching programs, and products: Services Products]

      Organic Health Week

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      Special Promotion:  Earth Day and Organic Health Care Week

      Earth Day is celebrated this year on Tuesday, April 22.   As general awareness increases about the harmful affects of toxins on our body, as well as on our planet, chiropractic continues to rise as the shining star in the world of true health care solutions.

      Earth Day is a great opportunity for you to promote the benefits of your chiropractic services.

      You can set aside one week as a “Buddy Week” and encourage your patients to bring in family and friends for a discounted check-up and introductory service.  The discounted fee that they pay you for the introductory services can be used as a donation to a local park fund, or earth related charity.

      You can place posters in your office and at key locations around  town, such as coffee shops, hair salons, etc.  A simple press release or notice can also be placed on your web site, newsletter, patient statements, newspaper and community calendar.

      You can also order some buttons for you staff to wear. 300 of them cost about $120 and you can use them next year as well.  For a sample button provider, go here (www.affordablebuttons.com)

      Here are some sample buttons:

      This is an excellent time to take pride in your profession.  Chiropractic:  always organic, healthy, and ahead of its time.

      Sample Posters

      Spring and Meaning

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      Spring.

      And almost three months into the New Year.

      It was just 3 months ago when the New Year began. What about those goals you set? Those resolutions you made? How are you doing on achieving them?

      You know, it is just amazing, working with the great doctors and staffs that we do. It is so evident that success is so attainable. It is just peeking around the corner, waiting for you to do just that next key action that will propel your office to pick up the speed needed to take you to the next level.

      One doctor we are working with, after being in practice nearly 20 years, is hitting his best ever days and highest ever weeks this month. His staff have been emailing us their successes as if they are texting us from a rock concert!

      We live for this stuff, by the way – your successes. Many times after years of gradual improvements, it is so gratifying to see an office take off with stability.

      Another doctor who has been in practice for years has been breaking collections records. And volume…seems like it is nothing to have a 1000 visit month – with many if not most new patients coming in from referrals.  One doctor we work with routinely sees over 1000 visits each month, and each month works with his colleagues and associates to help them hit their best-evers. Another doctor had over 150 on the books for him to see yesterday (Wednesday).

      From our perspective, it looks like chiropractic is having a renaissance.

      Of course, this is not the case with all of our clients. Some are still laying foundations for future growth. Success can come, but sometimes only after years of implementing the right procedures.

      But what are these “right procedures”, and where do you look? Insurance department, clinic management and organization, marketing?

      Some of you may feel that you are in a rut,  that you and your practice are stuck. If so, take heart and have hope. Things can change and you can do better. We have seen it happen with many doctors in these last three months.

      There are so many distractions in our lives, and many of them are negative and disheartening. Demoralizing. Frightening. Discouraging. Yet, we see doctors who have been stuck, finally get things going and do better. After years of stagnation, we see them do their best ever.

      Practice development success is dependent on the quality of your systems and organization.  That’s 50%

      What’s the other 50%?

      Part II

      The other 50% is an “Inside Job.”  That is, your success is dependent upon the structure of your office, but also on the function of your behavior. The quality, and quantity, of your energy, your attitude, and your creativity is easily 50% the cause of your success, or not.

      So, if your numbers are down, you should spend half your time improving your systems, and half your time…improving yourself.

      Are you frightened stiff? Have you developed “hardening of the attitudes”? Are you resentful, a seething caldron of anger? Do you feel burned out, frustrated, or feel like you just can not make the changes needed?  Believe me, this manifests one way or another in your practice. And in all areas of your life.

      We all experience these feelings, among others, at times. Sometimes they are acute. But after you have been in business for a while, you may not even notice that you have become less than enthusiastic about practice.

      Yet, even if you were locked up in solitary confinement, you would still have the power of choice. You could still be creative.  Even if you were shackled, starved, beaten, imprisoned, you could still find meaning and purpose in your life.

      This is the basis of an entire branch of psychology as developed by a former prisoner of the Nazi death camps, Victor Frankl. His observations lead him to identify what he saw as the basic principles of living, including:

      1. “Life has meaning under all circumstances, even the most miserable ones.
      2. “Our main motivation for living is our will to find meaning in life.”

      Successful people have meaning in their lives.

      If you can find purpose and meaning in this very moment, in this day, with your next patient, with this year, your probability of success will be greatly increased. More importantly, you will find that what you are doing is more satisfying.

      Fear will vanish, hardened attitudes will become flexible, and your energy will return.

      Structural changes will need to take place, of course. Better clinic systems and organizational procedures will then take you to the top. And keep you there.

      We can help with all of these, by the way. But you should know and be reassured that chiropractic is happening. It is hip, it is popular, and it is growing, probably more so now than ever before.

      Naysayers say otherwise to promote their goods or services. They are sell outs. Don’t buy what they are peddling. Chiropractors have always been challenged and it is actually what has helped you be strong and survive.  Insurance cutbacks are not new.

      After more than 20 years in business,  we are still amazed each day when we hear of the stories patients tell of their success.

      Chiropractic works. It has, does, and will for at least the rest of this year. So, find your meanings and purposes, get help to upgrade your clinic procedures and organization, and make those yearly goals you set for 2008.

      Heck — why not beat them and make this year your best ever?

      Spring has its own meaning, its own purpose: to grow and create. This can be your purpose too.

      Every moment, every day. Right now.

      Your Chiropractic Practice Marketing Plan

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      How is your marketing plan?

      Do you have one?

      You really should have a marketing plan for your chiropractic practice, and it should be updated monthly, nudged weekly, and totally reviewed every three months.

      This may sound oversimplified, boring, or too too obvious, but in our experience, it is a major key to practice building.

      Sure, there are many other factors behind a successful business, but constantly marketing is essential. And, if your practice is not growing, it may be because you are not routinely marketing.

      And how do you make sure that you are marketing? Have a plan.

      A Marketing Plan Is Simply Marketing Activities Scheduled,
      Assigned, Regularly Supervised, And Measured.

      The key to effective marketing is simply planning. This is because marketing often just does not get done.  It is not that your marketing did not work. More than likely, it just didn’t happen.

      To overcome this, you need to schedule short planning times each week, and longer periods each month.

      This is the core of the Marketing Management System as we have developed it.

      Your marketing plans should include the following:

      •    Recurring Marketing-Oriented Procedures. These include not only your internal marketing procedures, but recurring clinical and administrative procedures as well. They are the usual recurring procedures that go on regularly in your office. Often overlooked and neglected, they are the most important form of marketing. They need to be reviewed and practiced regularly to be keep fresh and important. Because they are so routine, I usually schedule them last.

      Very successful offices rely mostly on these types of procedures. When you hear chiropractic doctors say “We don’t do marketing”, it is because they have their marketing as part of their internal procedures and they do these extra-ordinarily well. These could be the way the phones get answered, the report of findings, the new patient lecture, the simple consistency of patient flow procedures, great internal staff and doctor communication, staff training procedures, staff meetings, etc.

      •    Special Promotions. Hold special promotions every now and then. These could include a Kid’s Day, a donation drive, mother’s appreciation day, teacher’s appreciation week, etc. I walked into an office a few days ago and in the middle of a very cold, snow packed winter, the doctor and staff were wearing summer clothes, offering smoothies (without the run), with a big sign saying: “Welcome to Chiroville”, no doubt referencing “Margaritaville” and warm ocean lifestyle. What a refreshing and friendly surprise greeted each patient that day!

      •    Patient and Community Education Programs. These are usually held in your office. Educate your community through your office and patients by providing special workshops that are chiropractic or health related. Or, you can sponsor a special “Awareness Week”, such as a Headache Awareness Week, offering no charge or discounted condition specific screenings, consultations, and or exams.

      •    External Community Services and Networking Events. These can range from spinal screenings, to in office ergonomic workshops, lunchtime “Lunch & Learns” for local businesses, setting up referral sources with business or other professionals, or working in the food pantry twice a month feeding the homeless.

      There are other procedures, such as advertising, PPO soliciting and reviewing, yellow pages, web site, but many of these can be put onto a yearly, quarterly, or monthly recurring checklist.

      The above are various categories of marketing. But again, the most important part of marketing is doing it, and the key to getting marketing done is to schedule it and assign it and measure it.

      For the best reference, review the materials in your Marketing Toolkit which is part of your Marketing Manager System computer software, if you have it.

      Here is a sample marketing calendar for a chiropractic office.

      NOTE TO CLIENTS AND PMA MEMBERS: You may find a customizable sample calendar on our PMA Member’s web site.

      What the Moon Has to Do With You Success

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      The moon is back to normal again.

      Just a few hours ago, though, standing in the middle of a snow-covered playground near Lake Michigan, in the night sky at about 3 degrees above zero, it looked like a smudge. A grey brown spot that was almost black, like someone had tried to erase it with an old eraser, but part of its image still remained.

      For a few hours, the earth blocked out the sunlight to the moon, at least from our perspective. These unimaginably huge spheres of matter, nearly perfectly in balance, were gracefully moving like billiard balls in a ballet.  Compared to this, all else really seems insignificant.

      Before street lamps, car lights, TVs and late night computers, the night sky entertained us. Everyone could recognize the constellations, and an interplanetary event such as an eclipse was a very big deal. All our ancestors were stargazers – the night sky gave them the comfort of familiar signs, as well as wonder and awe. And mystery.

      Besides the city lights to distract us, we have our daily duties and deadlines that rivet our attention to the near. Your patients, your notes, your computer, staff members, phones; most things are just a yard stick away.  Like a ping-pong game, your focus has to be complete, quick, and close, or, you lose.

      When your attention drifts, patients think you don’t care, staff thinks you take them for granted or are displeased, and insurance companies can’t read your notes.   Success in practice requires keen attentiveness.

      You can’t survive asleep at the wheel, dreaming or daydreaming. To be a winner you have to be alert and actively attentive to your job each minute you are at the office.

      And if that is all you do, you soon will burn out.

      Studies have shown that you have to, now and then, disengage. Take a break. Learn Japanese. Play with your kids. Help the poor.  Pray. In their best selling book, The Power of Full Engagement, the authors offer studies and examples on why it is important to become involved in disrelated activities to balance our hectic if productive lives.

      All this goes back to the moon and the sky.  I don’t think we look up enough. The sky, the stars, and the whole natural God given world are about us, mysterious and awe inspiring.

      In business, we have to focus on the short term and build for the middle term. But it is the far away that calls us, if we can stop to listen.  What makes you curious, fills you with awe, love, and seems a mystery? What does your future whisper back to you, as if you could hear your eulogy years from now? What are your greater purposes?

      Balancing these three is the key to a successful practice, business, and life.  Your first goal is to play each day fast, full out, like a basket ball game you have to win. Your second goal is to gradually build a strong organization with the right teammates and the best plays that have proven to work for you. But your third goal, and there may be many, are why you work at all.

      If your business has plateaued and stopped growing, it is because one or more of these goals is not being worked on correctly.

      We have developed a general pathway and framework for doctors to move upward so that they can correctly work on and achieve all three goals. It doesn’t matter what technique you use, therapies, providers, or offices.

      We are excited and pleased about the development of this new approach to practice management and marketing and how it impacts our consulting and the results our clients can see, as well as our own business and personal lives.

      We will be publishing and just talking more about these three goals, but we encourage you to come to our seminars.   You can learn more about them by clicking here. 3-Goals Seminars

      And, in the meantime, as my old pal, Jack Horkhiemer the stargazer always says:  “Keep Looking Up.”

      photos from Microsoft and NASA

      Billing Audits and “Red Flags”

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      Angie’s Angles
      From a Chiropractic Billing Consultant

      For your protection, you should be aware of the Top 10 Red Flags for a billing audit in a chiropractic office. Here they are.

      Since this is the beginning of a new year, I will start with the Top 10 Red Flags for a billing audit (in no particular order):

      1.  “Phantom Billing”—Billing for services not rendered.

      2. “Double Billing”—charging more than once for the same service, e.g., using an individual code again as part of an automated or bundled set of tests.

      3. “Clustering”—Using only a few codes on the theory that it will average out.

      4. “Upcoding”—Using a higher reimbursement code than the code reflecting the service rendered; e.g., billing for complex services when only simple services were performed, billing for brand named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.

      5. “Unbundling”—Using two or more billing codes instead of one inclusive code where
      regulations require “bundling” of such claims. Submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.

      6. “Code Jamming”—Inserting or “jamming” fake diagnosis codes to get insurance coverage.

      7. Billing for non-covered services

      8. Billing for services that are not reasonable and necessary.

      9. Inappropriate balance billing—billing Medicare beneficiaries for the difference between the total provider charges and the Medicare Part B allowable amount.

      10. Routine waiver of co-payments and billing third-party insurance only.

      The complexity of managing a practice is not a walk in the park. As a Billing Consultant with PM&A, my job is to free doctors from the worries that can accompany running the financial end of a medical practice.  I can review and streamline your billing department, train staff, and credential doctors with insurance companies, among other services.

      Questions on how any of these might apply to your office? Contact me and I will let you know.
      Next month – look for tips on nailing your Financial Consultations!!

      Goals For Patients and Chiropractors

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      Goals Give Us Tools to Put Dreams Into Action

      Phyllis A Frase

      If each of us is on a lifelong journey to find our hat, to know who we are, then by implication we are all on a journey to somewhere. It is our passion for that destination that makes us engaged and purposeful about our work and lives. Without a dream, without goals, we have no direction. As the old expression says, “If you don’t know where you are going, any path will get you there.”

      William James, the visionary turn-of-the-century psychologist, might be considered one of the fathers of self-actualization. He understood the power of our thoughts to affect our lives. His advice then is as true today as ever: “Seek out that particular mental attitude which makes you feel most deeply and vitally alive, along with which comes the inner voice which says, ‘this is the real me,’ and when you have found that attitude follow it.”

      Many, many people are afraid to follow their dreams. They are afraid of goals or at least resist them. They think goals take the fluidity and spontaneity out of life.  And they worry about how they will feel if they don’t reach them.

      But we need to remember that goals are not a blueprint; they simply provide a vision.

      Think about it in terms of a fishing line. A big goal, like a big fish, puts some tension on the line. You’ve got to have tension to succeed. You can’t catch a fish without it. If you line goes slack, you know you’ve lost a big one. If you yank too hard, you risk losing the fish and the lure as well.

      We teach our patients our chiropractic truth and values. We offer gentle but continuous pressure to gradually pull and lure them into referring, committed lifetime oriented chiropractic patients. But if you lose patience and jerk the line too often, you can lose the patient by not having systems and procedures that guide that patient. Constant dialogues, clarity, trust and soft tension on the line—those are the qualities that lead to the results and relationship we look to have with our patients.

      In your life you’ve got to go after your goals and dreams. Of course, for the passion and the persistence to be there, and to take ACTION and not think about it, they need to be aligned with who you are and not what everyone else thinks you are. They also need to be about what you what to accomplish. And yes, you will surely lose some.  But you can’t catch a dream without tension on the line.

      So be purposeful. Don’t be satisfied just dawdling along. We need to save people chiropractically…..If you don’t do it and take action, who will?