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.

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?

How Gratitude Can Improve Chiropractic Clinic Performance

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“Gratitude is not only the greatest of virtues, but the parent of all others.”
 Cicero (106-43 B.C.)

Those Greeks were pretty smart, and Cicero’s statement is just one example.

According to an article in Psychology Today, gratitude is a sentiment we’d all do well to cultivate.  “Feeling thankful and expressing that thanks makes you happier and heartier–not hokier.”

But more than that, when gratitude is expressed to others, many benefits occur.  A simple “thank you” goes a long way in improving the morale and ultimate performance of others. Of course, it has to be genuine. Counterfeit praise is easily seen through and can do more harm than good.

According to Tom Rath, co-author of How Full Is Your Bucket, “Gallup polling has revealed that 99 out of 100 people say they want a more positive environment at work, and 9 out of 10 say they’re more productive when they’re around positive people.”

He points to research that shows when a work team has more than three positive interactions with managers for every one negative interaction, it is significantly more likely to be productive.  The point is not to keep managers from correcting or reprimanding, but just to express more praise.

To improve your gratitude attitude, consider the following actions:

1. In your personal life, you can list the kindnesses of someone you’ve never fully thanked.  According to Lauren Aaronson in Psychology Today, if you read this letter aloud to the person you’re thanking, you’ll see measurable improvements in your mood. She refers to studies show that for a month after a “gratitude visit” (in which a person makes an appointment to read the letter to the recipient), happiness levels tend to go up. In fact, according to her references, the gratitude visit is more effective than any other exercise in positive psychology.

2. In your practice life, list the positive contributions of each team member.  Once each day, take just a moment to recognize your team member’s action and express it to them. Your communication does not have to be lavish, just a short 3 second notice of something good followed by a “thanks for the report, Dr. Smith” is all it takes.

One chiropractor I worked with years ago seemed to always be in a bad mood. He was quiet and basically ignored his staff. His opinion was that he paid them to work, they should work hard, and that was it.  But, his office wasn’t doing well so he called me in.  I made several visits to his office, each time simply improving the communications between he and his team. I coached him on listening to each staff member and to simply acknowledge them for their contributions.

A few month’s later, we saw his practice grow.  I remember this because he was always complaining to me that I was not doing anything for his office! (Sheesh!) His constant complaining and lack of appreciation was the real problem yet he just didn’t see it.

This concept is not new, of course, but it is worth remembering now and then. More studies that validate the practical aspects of this as a management tool are covered in the above referenced book.  But beyond management, like Cicero says, it is just an all round good virtue to cultivate.

For a motivational tent poster with the above quote, click here.

And … thank you for taking the time to read this!

Note: If you feel you need some instant appreciation yourself, try this. (Will need speakers or earphones.)

The Four-Handed Chiropractic Office

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We once knew of a dentist that was able to see hundreds of patients each week. Just himself.

How?

He had four hands. Actually, he had about 40 hands.

Four-handed dentistry became popular in the 1960’s and is a procedure that utilizes a dental assistant at the chair side of the patient with the dentist.

The two extra hands of the assistant allows the doctor to do the essential work on more patients. It is actually more than just adding two more hands. It includes all aspects of cooperation and coordination, allowing for maximum production through improved efficiency.

But his success was due to not just having extra “chairsides.” He had everything delegated, had separate departments in his office systematized, and had manuals for each department from which he constantly trained his staff. And, he had a fast and efficient management system to keep it all going. This permitted him to work with patients and develop the personal rapport that helped to keep them coming back to complete their treatment programs and refer their family and friends.

All of this leads to a key concept: capacity. Capacity is the ability and “room” to produce. Four-handed dentistry increases the capacity for the dentist to serve more people.

The reason why many offices stop growing is that, simply, they run out of room. It could be that there is not enough physical space or not enough effective staff. It could be poor patient, staff, and paperwork systems that clog up the flow so badly that even a can of Drano or a visit by the Rotor-router man couldn’t fix.

And, sometimes, even our mental capacity can get “filled-up.”

A well-organized office allows you to leverage your abilities and create more production. It also opens up the room to produce.

Imagine trying to play a football game on a 10 yard by 10 yard field. This is what many of us are trying to do, yet we just don’t know it. If you are having a hard time growing your office, you may have unseen capacity constraints holding you back.

A four-handed chiropractic office would be an office where there were many “hands” efficiently doing all the work, allowing the doctor(s) to focus only on those key actions necessary to treat patients and run the office.

Give this some thought and we will SOON show you some specific examples and what to do about capacity restraints in your office. Stay tuned…

P.S. If you know any doctors or marketers who would enjoy this article, just send them an email with this link: http://www.pmaworks.com/main/Four-Handed_Chiropractic_Office.shtml
P.P.S. E-mail addresses are never shared.

You are free to use the material from these articles in whole or in part on your web site or eZine (email newsletter) as long as you include the attribution below and also let me know where the article will appear.

“This article is by Ed Petty of Petty, Michel & Associates. Petty, Michel & Associates web site is a comprehensive resource on practice development for chiropractors. For free marketing resources and valuable development tools visit http://www.pmaworks.com”

Randy Pausch

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Randy Pausch
Last Lecture

Carnegie Mellon Professor Randy Pausch, who is dying from pancreatic cancer, gave his last lecture at the university Sept. 18, 2007, before … a packed McConomy Auditorium. In his moving talk, “Really Achieving Your Childhood Dreams,” Pausch talked about his lessons learned and gave advice to students on how to achieve their own career and personal goals.

Summary of lecture from the Wall Street Journal.   Viewing time  4 minutes 39 seconds.

Link, or watch below:

Full Lecture 1 hour 39 minutes