Category Archives: Chiropractic Economics

The Silent Recession and What to Do About it in your Chiropractic Healthcare Practice

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farmer in a field of obstacles

The article addresses challenges faced by chiropractic practices in 2024, attributing some of the struggles to broader economic factors like a “Silent Recession.” Small businesses, including clinics, saw a 30-40% revenue decline, with inflation and rising operational costs outpacing Medicare and Medicaid reimbursements. Insurers’ tactics, such as requiring prior authorizations, denying claims, and delaying reimbursement, have also complicated financial operations. Additionally, many patients face financial strain due to inflation, high interest rates, and rising living costs, further affecting clinic revenues.

To counter these challenges, the article offers solutions focused on improving clinical and administrative practices. Clinicians are encouraged to focus on the fundamentals of their care, adopt a purposeful approach to healing, and invest in ongoing training to enhance patient outcomes. Administrative support is emphasized, suggesting that a strong organizational structure and team training are critical for long-term success. The article also highlights the importance of staying independent, noting a trend of independent medical practices being squeezed out by governmental policies and rising inflation.

The author encourages chiropractors to remain resilient and continue fighting for their independence in the face of these challenges, implying that larger industries may have a vested interest in eliminating smaller practices. The message ends with a call to action for chiropractors to stay strong and prepared for 2025.

Read the Full Article Here:  https://www.goaldriven.com/post/the-silent-recession-and-what-to-do-about-it-in-your-chiropractic-healthcare-practice

Use the Learning Pyramid for a Better ROI in Your Chiropractic Healthcare Practice

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three generations of women cooking in a white kitchen

Don’t complain. Just train

“Over the long run, superior performance depends on superior learning.”
— Peter Senge

As the Clinic Director of your chiropractic and healthcare practice, you instinctively know that if you are not continually improving the service to your patients and potential patients, they will go to practices that are.

In fact, if you do not provide the BEST outcomes and service in your area, patients and potential patients will look for other practices that are the best, or at least better than you.

The BEST health care practice wins in the long run.

So, how do you get to be the best?

By constant improvement!

This was the concept the Japanese pushed in the 1970’s with their cars. They called it Kaizen.

Speaking of Japan, there was a study that showed how many hours employees trained over a 6-month period. Japan spent an average of 364 hours, Europe averaged 178, and the U.S. a paltry 42.* I discuss this more in my book, The Goal Driven Business. (pg 156)

The formula for improvement is simple: study and train.

The purpose and goal of training is improvement. This is why professional athletes and musicians constantly train. They do this for improvement and, ultimately, to bring about a good return on their investment.

Improvement has a definite ROI! A study by the Associate for Talent Development found that companies offering comprehensive training programs have 218% higher income per employee compared to those without formalized training.*

But what are the best methods for training — reading, listening, podcasts, seminars?

USING THE LEARNING PYRAMID TO TRAIN YOUR CHIROPRACTIC TEAM

The Learning Pyramid* illustrates the percentage of knowledge retained through various learning methods. Here are the typical percentages associated with each method:

  1. Lecture: 5%
  2. Reading: 10%
  3. Audio-Visual: 20%
  4. Demonstration: 30%
  5. Discussion: 50%
  6. Practice by Doing: 75%
  7. Teaching Others: 90%

This model emphasizes active participation in the learning process. Teaching others or practicing by doing, leads to higher knowledge retention rates compared to passive methods like listening to lectures or reading.

If you take your team to a seminar, do it for camaraderie and the sense of being part of something bigger. It can be motivational. But then, ensure that they take notes from one of the presentations and then teach it to the rest of the team at the next staff meeting.

Another angle is to have team members select a chapter from a book you all are reading (from your Lending Library!) and then have them teach it to the rest of the team a month later.

Train on your procedures every month. For example, you could demonstrate how you would like a patient to be positioned on a therapy table. (Get it recorded for future reference!) Then, have a staff member demonstrate the procedure back to you. You can also pair people and role-play the procedure. Do this for any of your office procedures. For those of you in group practices, doctors can practice their procedures.

BALANCING INFORMATION WITH PRACTICAL APPLICATION

The idea is that there are two sides to the learning coin: the information side and the practical application side. You can’t learn how to throw a fastball from reading a book. You must find a baseball and someone brave enough to catch your pitches and practice throwing hundreds of times. However, a book may have useful information on improving your throwing technique from those who have done it more than you.

It is best to go over the idea of training and improvement with your team first so they understand what you are doing and why.

Keep training fun. Your manager should ensure that training occurs every month.

And like Clarence Gonstead said:

“Practice. Practice. Practice. Never stop.”
“Our future will be our results.”

Keep training,

Ed

P.S. Who was Clarence Gonstead, D.C.

References:

ROI on training. An Evidence-Based Look at the ROI of Investing in Training (mentorgroup.us)

Clarence Gonstead https://www.gonstead.com/

The Learning Pyramid the learning pyramid – various percentages of retention. (thepeakperformancecenter.com)

========================

If your practice-building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.

Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.

the goal driven business by edward petty

The Goal Driven Business
By Edward Petty

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Why You Should Have a Turnkey Chiropractic and Healthcare Practice

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keys in a door of a goal driven turnkey chiropractic office

The Practice Development Scale

If you were going to buy a practice, wouldn’t you prefer it to be “turnkey?”

If you were to work as a chiropractic doctor or provider in another clinic, you’d want it to be “turnkey,” right?

Or, as a support professional and assistant, I bet working in a turnkey office would be your preference.

WHAT IS A TURNKEY PRACTICE?

The term “turnkey” implies that the necessary operational elements of a practice are in place so that all the owner or practitioner has to do is “turn the key,” and the practice just goes!

A turnkey practice is so well organized that the stress level is low, the revenue is high, and the service outcomes are excellent.

Consider a scale of 1-5, where 5 is a turnkey practice, and 0 is an insolvent practice.

SCALE OF PRACTICE DEVELOPMENT

___5: Turnkey Practice

  • The practice is fully equipped and operates at close to full capacity. It is ready to be sold, to bring on additional providers, or just happily and profitably cruise.

  • There is a strong, established patient base ensuring regular revenue.

  • Administrative, billing, scheduling, and management systems are highly efficient.

  • The practice is financially robust, accumulating income over expenses each month.

  • The practice has a trained and established manager who ensures the seamless operation and continuity of all systems and procedures.

  • Staff are highly skilled, well-trained, and capable of independently managing the practice. Morale is high.

  • The business owner spends just a few hours each month on administration.

___4: Well-Established Practice

  • The practice is well-established and runs well.

  • There is a large, loyal client or patient base.

  • Administrative systems are efficient.

  • The practice is financially stable.

  • Staff members are trained and experienced.

  • The owner spends a few hours each week on administration.

__3: Growing practice

  • The practice is showing signs of growth.

  • The client or patient base is stable and increasing.

  • Administrative systems are more organized.

  • Financial health is improving.

  • Staffing is more stable, with ongoing training.

  • Owner works hard each week

___2: Basic Operational Practice

  • The practice has the basic elements required for operation.

  • There is a modest, gradually growing client or patient base.

  • Basic administrative systems are in place but may be inefficient.

  • Financial stability is tenuous but improving.

  • Staff are present but may lack competence or numbers.

  • Daily admin operations are dependent on the owner

___1: Struggling practice

  • The practice is operational but faces significant challenges.

  • There is a small, inconsistent client or patient base.

  • Administrative systems are inefficient or nonexistent.

  • Financial difficulties are prevalent, with cash flow issues and potential debt.

  • Staff may be minimal, overworked, or inadequately trained.

  • Owner stressed by dealing with administrative tasks

___0: No Practice / Insolvent

SELL, CLONE, OR CRUISE

Once you have achieved turnkey practice, you can sell it for the highest price.

Or, you now have the option to add another provider profitably. There is no limit – if you develop each provider to a turnkey level before adding more.

But the third option is just to cruise and have fun seeing patients with a great team supporting you and the practice. This option allows you to continue helping your patients while integrating your personal life with your practice life.

In a subsequent article, I will list the key roadblocks, some of them hidden, that can get in your way from creating a turnkey practice. I will also show you how to get to a turnkey practice faster.

But just knowing this scale will give you a map to better chart your course to success.

Keeping the end in mind,

Ed

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If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.

Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.

goal driven business www.goaldriven.com
The Goal Driven Business
By Edward Petty
goal driven business buy now button

How to Add Extra Services to Your Chiropractic Healthcare Practice

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two men discussing chiropractic therapy equipment

Avoiding Hidden Expenses in Scaling Your Practice

Do you want to improve your income and the quality and quantity of your services?

One strategy is to add a therapy machine — or another one — to your practice. You could also bring on another provider. This could add more services per visit and more visits per week, improving your income and the outcomes you get with patients.

Makes sense, right?

In theory, yes. In real life, not so much.

Properly implemented, more services from machines or providers can improve the quality and quantity of outcomes and improve the bottom line. However, the implementation must be done correctly. And often, it is not.

I have seen chiropractic clinics with the largest room in the office filled with therapy equipment that was rarely used. I have had heated discussions with doctors who would buy more equipment when they were not using what they had just purchased. And if the equipment is used, often there is insufficient staff or resources elsewhere: no one running the front desk department, marketing is sporadic, and patient treatment and financial plans are rarely or poorly done.

This gets even worse when hiring associate doctors. You have heard the stories, so I won’t elaborate. Group practices can work well, and we recommend them. In fact, I don’t know of one chiropractic management company with more combined experience working with associates than we have. Multiple-doctor clinics are one of our specialties. But they have to be done correctly, and they rarely are.

Let’s look at three principles to help you implement additional services correctly.

1. FOCUS AND IMPROVE YOUR CORE SERVICES

More therapy and more providers will not take the place of quality and well-organized services.

By expanding your services, you can dilute your unique selling proposition!

Starbucks did this back in 2006. They kept introducing new products, which devalued their primary brand. The baristas had difficulty keeping up with all the new products. They had to become fast-moving technicians rather than friendly conversationalists with the customers. Their statistics decreased until they simplified their services and focused on their core values and services. *

Before you add machines and providers, focus on your core services and improve those, which will also enhance your bottom line.

2. SIMPLICITY

More services can add more complexity. Richard Koch is one of the researchers I quoted in my book, Goal Driven Business. He says: “Because business is wasteful, and because complexity and waste feed on each other, a simple business will always be better than a complex business.”

A therapy unit, for example, even if it is “unattended,” requires supervision by the staff and you. And who will do it if it requires someone to apply the therapy? You can see the extra expense once you work out the details and the math.

Complexity can hide overhead. So, when adding more services, beware of adding complexity and keep the services as simple as possible.

3. LARGE BUT SIMPLE CHIROPRACTIC HEALTHCARE BUSINESS

A larger business provides more services and can generate more income. While Richard Koch recommends simplicity, he also supports growth:

“Because scale is normally valuable, for any given level of complexity, it is better to have a larger business. The large and simple business is the best.”*

Add more services to your practice, but keep these three points in mind:

  1. Improve what you have. First, focus on and improve your skills and those of your team. Invest in your team and yourself. This will enhance your bottom line and your services. Your goals are expertise and mastery.
  2. Keep it simple. Always work towards simplifying your procedures and your patient’s experience.
  3. Scale. Add services and scale your business. But first, plan it out ahead of time, examine the extra time, effort, and costs involved, and manage it well. (You can have us help!)

Keep expanding — but keep improving first. And keep it simple.

Ed

References

*https://hbswk.hbs.edu/item/starbucks-lessons-for-premium-brands

* The 80/20 Principle (Richard Koch)

—————————————————-

If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.

Find out what they are and how to sail to your next level by getting and implementing my new book, The Goal Driven Business.

goal driven business building methodology

The Goal Driven Business,  By Edward Petty

goal driven business buy now button

Ask Lisa – Introduction

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Lisa Barnett practice appraisals credentialing and

Lisa J. Barnett

HI!

I’m Lisa with Petty, Michel and Associates.

I’ve been with this wonderful company for nine years and have worked in the chiropractic profession for 17 years.

Do you need help with:

• credentialing new providers and/or your tax ID?
• debugging complex insurance issues?
• documentation/insurance audits?
• practice appraisal?

Would you like these projects completed without you or your team spending time doing it on your own?

Let me do it for you!

Contact me. Because some practice issues shouldn’t wait.

lisa@pmaworks.com

920-334-4561

Find out more about me here

== == ==

“I Give PMA Two Thumbs Up!
Lisa was incredibly helpful and created huge value and peace of mind when she came face to face to my clinic and looked over everything. There are core competencies when it comes to dealing with Medicare and Petty Michel and Associates knows the process and what Medicare will be looking for if you get a notes request or an audit request.

PMA proved to be a huge value and I am thrilled they were able to help my clinic become compliant, which makes seeing Medicare and Medicaid patients more enjoyable and less worrisome. I give PMA two thumbs up.
—
Matt Kingston D.C.
Madison Chiropractic Solutions

Are You Looking at All Your Statistics?

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As one year ends and another gets ready to launch, I look back at our clients’ numbers and see that, for the most part, everyone’s numbers went up.

And these are not new offices. Their increases were not because of a snazzy ad campaign or a motivational seminar. Their numbers increased because of their hard work, courage, sacrifices, and love. I am sure the same is true with you and your practice as well: because of the wonderful improvements your patients experience, as a byproduct, your numbers for this year also went up.

But maybe not. Maybe not this year.

Maybe your practice numbers did not go up?

Well, you may not be accounting for all of your positive outcomes. For example:

** Our goal with one office was not to increase their numbers, but just to keep them from going down the drain. The successful outcome was no bankruptcy! Positive numbers did not go up, but negative cash flow numbers did not occur.

** One business owner I worked with, whose numbers had gone up for a few years, but had recently dipped, was able to take a vacation for the first time ever. In fact, because of additional providers, was able to leave for a few weeks. Practice numbers did not go up, but vacation and personal statistics did!

** One practice owner saw her numbers go down. She had her third child and would have gone down further had it not been for the work we did on bringing on another provider who she deftly managed. Family numbers went up!

We do manage by the numbers as these are objective and because so much conventional management is done through emotion, bias, new but dumb ideas, or other weird standards.

But not all accomplishments show up on the standard practice scoreboard. You would need a different set of statistics and a different scoreboard for family, personal, and organizational outcomes.

• Maybe you spent time training in a new clinical technique.
• Maybe your staff spent extra time training and becoming more proficient.
• Maybe you were able to see more of your child’s activities.
• Perhaps you and your spouse finally went on that vacation.

Business building can be understood by the Law of the Farm (Also Law of the Harvest). As Steven Covey says:

“The only thing that endures over time is the ‘Law of the Farm.’ You must prepare the ground, plant the seed, cultivate, and water if you expect to reap the harvest.”

I like this analogy because it shows that so much is involved in producing what finally ends up in your grocery store.

Yes, you reap what you sow. But the sowing itself is an accomplishment that needs to be recognized and acknowledged. If you keep building and nurturing all aspects of your business, including your skills, your people, and your procedures, both in and out of the office, and stay aligned with your mission, your production numbers will improve.

You might take some time this month to look at all the gains you have made that might not show up on the bottom line.

Celebrate ALL your positive improvements in 2023, and prepare for a prosperous 2024.

Stay Goal Driven,

Ed

How to Grow a Chiropractic and Health Business

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How to grow a chiropractic business

I was recently invited to my son’s wife’s family’s apple butter cookout. Yep, that’s right, cooking apples over an open fire. It’s a tradition.

It is also apple harvest season up here in the northern Midwest. You got yur Honey Crisps, Honeygolds, Snowsweet, Fuki, Jonathans and others. Lots o’ apples!

Harvest time.

I bring this up because, well, it applies to your office. Here’s how:

THE LAW OF THE FARM

There is a metaphor called the “Law of the Farm” or the “Law of the Harvest.” Stephen Covey refers to this in his book, The Seven Habits of Highly Effective People. (I include a link to a short video below)

The concept comes from the observation that apples come from farmers farming. An apple orchard requires tender, loving care over the entire year from growers who plan and carry out disciplined regular work to ensure a bountiful harvest.

Aside from occasional droughts or freezes, if your harvest is poor, it is not because of the “apple spirits,” or that maybe you had a bad childhood. It is because one or more of the necessary preparatory actions needed to produce the apples were not done.

There are no shortcuts. Getting angry with the apple trees does not help.

YOUR CHIROPRACTIC AND HEALTHCARE PRACTICE IS LIKE A FARM

The Law of the Farm, or the Law of the Harvest can be applied to your practice in the following ways:

  1. Long-Term Planning. Just as a farmer plans their crops well in advance, a business should set clear goals and strategies for the future. This includes defining your mission, the key values of your team that determine its culture, the outcomes, and production goals.
  2. Investment and Resources. Just as a farmer invests in seeds, land, and equipment, you must invest in your resources wisely. First and most important, invest in your people, including yourself: training, coaching, and hiring. Marketing, in one form or another, is always a necessity. Updating software and equipment, occasionally, or the décor of your office is also an investment.
  3. Consistency and Diligence. Sticking to what works is vital. This is why I recommend job checklists as part of the Goal Driven System. It takes discipline to keep doing what works, but consistency brings about confidence in your patients and your team. Daily tasks and routines are like tending to crops regularly.
  4. Patience and Adaptation. Just as a farmer must wait for crops to grow and adapt to changing weather conditions, chiropractic practice owners must be patient and adaptable. Success may not come immediately, and you will face unforeseen challenges. Being able to adjust strategies and remain patient when unexpected failures occur is critical.

Looking at your practice as something you need to grow to produce excellent outcomes is a useful exercise.

Patience can be tough to master as a business owner when you have invested everything on the line. But if you have done your preparation, as all farmers must do, most of your concerns are for naught.

The Law of the Farm is a principle from which you can draw many associations to your practice. As an exercise, you might discuss this with your team: How can we apply the Law of the Farm to our practice and improve our service?

APPLES DO NOT COME FROM THE GROCERY STORE

Similarly, happy patients, completing their chiropractic or healthcare treatment program, being relieved of pain, healthier, and referring others do not come from the new well-advertised social media ad campaign. All the shiny new ads and promotions don’t make up for the Law of the Farm.

There are no shortcuts.

You reap what you sow — and nurture and take care of.

We are all farmers!

Ed

PS I also discuss this in The Goal Driven Business, #15 Goal Driven Principles, page 262 Be a Farmer: Grow Your Business and Your Customers

Watch this short video about the Law of the Harvest.

https://resources.franklincovey.com/mkt-7hv1/law-of-the-harvest-2

What gets measured gets done

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Your Goal Driven Analytics Scoreboard

Sometimes you can’t see the forest for the trees.

Sometimes you think things are worse than they are.

But then again, sometimes you think things are going better than they are. And then, BANG! Poop hits the fan!

What is the best way to determine how your business is doing?

Your Scoreboard

Your numbers are the best indicator of your Key Performance Indicators. They are your dashboard. Your Google maps. Your altimeter, as you take your business off the runway and up towards your goals.

In our consulting work, too often we see major management changes based on a minor error, hearsay, or emotions. This can have long-term devastating results.

On the other hand, improvements that show up on the stats can be ignored if no one is watching them.

One office we worked with continued to see an increase in new patients referred from a local gym. But amidst the busyness of the daily patient care, they hadn’t noticed. Since we closely monitored their numbers, I saw this increase in new patients from a local business on their New Patient Tracker. After discussing this with the doctor and manager, they finally took action to strengthen this valuable relationship. Last I heard, they are continuing to get referrals from this location.

You can miss the good things — as well as the coming crash. Numbers help you predict what needs fixing before things get ugly and what needs reinforcement to keep the good times going.

Ultimately, statistics tell you if you are moving towards your goals or away from them.

Unfortunately, most offices do not keep clear and consistent track of their numbers.

As a result, business owners do not get the information they need to manage their business properly. Software can spit out reports which can help, but they are not enough. And usually only partly used, if at all.

Here are some fast tips for your stat analysis scoreboard:

  • Key numbers. Monitor numbers week-to-date and month-to-date, especially new patients, visits, charges, and collections.
  • Individual providers. If you have multiple providers, find some way to measure their production. This can help both of you manage performance.
  • Percentages. Use percentages, such as visits divided by new patients, to give you an idea of how long your patients are staying with you.
  • This year to last year. You should be able to compare this year-to-date with last year-to-date.
  • Line charts. We use line graphs plotted over a couple of years. These clearly show what is trending — up or down.
  • New patients. Track the sources of your new patients as well as the types of new patients.
  • Weekly reports. Have someone in your office give you a daily, or at least a weekly and monthly statistical report.

Keeping statistical analysis in place has proven so valuable for offices that many clients have asked us to keep providing their stat analysis for them years after completing an intensive service with us.

While this is not a major service we offer, we realize how useful it is in our Goal Driven System of management.

Therefore, we have decided to start offering our Goal Driven Analytics program as a service to more offices.

We are only taking 5 new clients on this program for now, first come, first serve.   It is moderately priced and, as most of our clients can verify, managing by the numbers is invaluable. To learn more about the program, we’ve posted some more info, with the link below. If interested, just reply to this email, and we can set up a time go over the details.

But whether we provide you with your statistical analysis or you set it up yourself, I can’t recommend a more valuable management tool for managing your business profitably. Not only is it effective, but it is fast!

Your analytics scoreboard will help you smoothly navigate to your goals.

To your greater prosperity,

Ed

More info on the Goal Driven Analytics Scoreboard.

Brutal Economics: A hidden expense.

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You have more expenses than you’ve probably considered.
 
Your biggest expense, like that old poster you have had in your reception room since 2012, has become invisible.
 
What is this big expense?
 
Well, one of the goals we work with in the Goal Driven System is the Full Capacity Goal.
 
This goal can be easily overlooked as we are focused on patient care, reimbursements, staffing schedules, vacations, and a thousand other tasks that require our attention.
 
The reason the use of goals is so effective in practice management is that they help you see the Vital Few from the Useful Many. (These terms are often used in reference to the Pareto Principle of 80/20.) The Vital Few are those factors (20% or less) that produce 80% (or more) of the results.
 
If you are not operating at close to full capacity, you are wasting money.
 
For example, if you could see, 160 patients in a week, given your schedule and good support, at $65 per visit, that would equal $10,400 per week. On a monthly basis, this would work out to be 640 visits and about $41,600 in revenue. This would be 100% Full Capacity.
 
You know from experience that your expenses are a lot higher than most realize. First, there are fixed expenses that you must pay out regardless of the performance of your business. And after everything and everyone is paid, after all accounts are settled, what is left over is yours.
 
At 70% capacity, that is not much. At 50% capacity, that is nothing.
 
Of course, you don’t focus on stats and money when you deal with patients as a doctor and as care givers.
 
But as a business owner, you must.
 
Numbers, analytics, Key Performance Indicators –– these make up your scoreboard and give you the best feedback to help you manage the performance of your business.
 
We carefully analyze our clients’ numbers each month and encourage they do the same. We also plot them on graphs and charts to notice trends. These are our x-rays.
 
Lately, we have realized that there is one number that gets overlooked in the hustle and bustle of business management. That is to what degree the office is operating at its full capacity.
 
In Goal Driven Analytics, we have been testing a “business capacitometer.” It displays, much like a speedometer or tachometer, the percentage of full capacity that the business is operating.
 
But you can easily do the same. Here is how:
 
  1. Weekly Visits. Determine the maximum number of visits you could see comfortably each week if you were reasonably supported with software and staff. ______
  2. Full Capacity Goal. Multiple this by 4 (I know, 4.3 is more exact): ___ This is your Full Capacity Goal.
  3. Percent of Full Capacity. At the end of the month, divide the number of visits you saw by your full Capacity Goal and you will get the percentage that shows you how the efficiency of your practice. E.G. You FCG is 800 and you saw 600 = 600/800 = 75%
Work towards maintaining 90% or above. Find the capacity constraints and remove them.
 
This is also very helpful if you have multiple providers – other associate chiropractors, massage therapists, other services, even your rehab or therapy departments. After agreeing on what volume would be full capacity, each month they can see their level of performance.
 
Last note: It is not about the statistics. While stats are your best indicator, remember … it is not the stat that is important — it is what they represent. A helped person!
 
Seize the Future,
 
Ed

 

Faith Demands to Make a Difference

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GoalDriven.com - Faster to a Better YearDecember 30, 2021

A year ago, who knew what the next 12 months would be like?

Yet, here we are today.

As the New Year is just before us, again, one can only wonder at what the future holds. Is this the “New Normal?”  How far will it shift in the next twelve months? For you, your patients, and your business?

Whathe goal driven businesstever new realities lie ahead, we are ready to help you and your business. We will be launching a new approach to practice and business building with the theme of Faster to Your Future in January. It is based upon the book the Goal Driven Business.

 

But just before we start the New Year, I wanted to pass along a message of encouragement.

It often amazes me that with all the wars, both “hot” and cold, the greed, the fear, and tyranny, with all of mankind’s utter insanity over the centuries, we are doing as well as we are. Somehow, as Abraham Lincoln predicted in his first inaugural address in 1861, “…the better angels of our nature…” came through and prevailed. Whatever challenges we may have, his were enormous. He was facing a nation divided, secession of the southern states, the policy of human slavery, civil war, and a world of other conflicts.

But in the end, there is something about the Innate Goodness of Life that seems to propel mankind forward towards a better future, however slightly. I think that the more we trust in the Better Angels of our Nature, and in the Goodness of Life itself, the more sure our road will be toward a better year for us all and a happier future.

“I have one life and one chance to make it count for something . . . I’m free to choose what that something is, and the something I’ve chosen is my faith. Now, my faith goes beyond theology and religion and requires considerable work and effort.

My faith demands — this is not optional — my faith demands that I do whatever I can, wherever I am, whenever I can, for as long as I can with whatever I have to try to make a difference.”

― Jimmy Carterjimmy carter supervising

So with this, we look forward to working with you to help make 2022 both prosperous and rewarding.

With admiration from all of us at Petty Michel and Associates,

Ed

The Merry-Go-Round: Planning for a Prosperous Practice in 2018

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Progress in practice is made by steady persistence and passion.

In Angela Duckworth’s new book, she calls this “Grit.”

Think of evolution, think of growing crops… think of growing children!  Whether it is child development or practice development, growth is achieved through steady and unrelenting nurturing and adjusting according to circumstances.

I recommend you take some time to do some planning before the New Year gets in high gear. January and February are good months to do this.  Do it by yourself – and do it with your team. But…

Don’t reinvent the wheel… Just make it go faster with less effort.

 The Vital Few

A few of our actions are always more productive than most of the other actions that we do. Unfortunately, we can get distracted and spend far too much time on activities that, in retrospect, just don’t give us that much of a return.

The “vital few” actions that have helped you the most will be camouflaged, even countered, by the “trivial (but useful) many.” This is a term used by Nathan Juran, famous for his approach to business and quality improvement and the Pareto Principle.

And, I would like you to consider this: In many respects, your business has succeeded in ways that – perhaps – you have not yet recognized.  Therefore, I don’t recommend abandoning all you did last year and start chasing the newest “shiniest” procedures that seem appealing.

The key is to dust off all your actions from 2017 – review everything you did — and see the great things that worked and the victories you and your team achieved.

Then, just find better approaches to do more of this!

Diamonds in Your Office

The idea of having diamonds in our backyard, a story made famous by Russell Conwell (1843 – 1925) of the 1800s, applies. There are many variations, but it goes something like this: there once was a man who wanted more wealth, so he sold his house and left in search of diamonds. Years later, penniless, he happened back to his village where he roomed at a shelter for the poor. The shelter was supported by a grant from a local resident. In inquiring who the resident was, the diamond searcher discovered that it was the person to whom he had sold his house.

One day he paid a visit to his old house, now renovated into a beautiful estate. He talked to the new owner who told him that he had become rich. He said that when he bought the house, he needed to do some digging in the backyard where he discovered thousands of diamonds.

The moral of the story is obvious: you already are rich – you already have the diamonds. You just need to polish them.

Many of the components of your future success are already in your office. But we overlook them, or use them once and then forget about them, like teenagers looking for the next new article of clothing to make a fashion statement.

As entrepreneurs, creatively – we are all looking for that next dopamine high… and seek the next new “shiny” thing.

You have a show on the road. Just make it better. Make it fresh. Set a new standard, and make a new game to “level up!” Add a few new things here and there, but keep doing what is working.

Looking for Your Diamonds

Review what has been working for you. Reaffirm it and keep at it. Look at what hasn’t worked that well and fix it so that it does, or drop it like barbell that you have been holding over your head for too long.

By yourself, and later, with your team, here are some areas to look into:

____1. Review Your Mission Statement. Does it apply? How? Does it need to be customized? Beyond your mission, what is your WHY? Does the mission satisfy this?
____2. What Are Your Outcomes? For example: “People relieved of pain, healthier, educated so that they can and will continue to improve their health… and refer others?” You can also define Minimal Viable (Valuable) Outcomes, e.g., “A patient who accepts care.” Etc.
____3. How Is the Office Vibe? This is determined by your values and how everyone is living up to them. Are these values posted for all to see and check how they are “measuring up?” Are they defined? Do we need to add more, change some, delete some? Should we better define each value? Should we add:

• Trust. Are we worthy of trust with our patients and ourselves?
• Mission Oriented. Do we help each other cheerfully achieve our mission – each day?
• How well are we living up to these?
• How can we live up to these better?

____4. How Were the Numbers? Up, or down?

• When the numbers went up, what did, or didn’t we do? How can we improve upon this?
• When the numbers went down, what did, or didn’t we do? Should we improve or discontinue those actions?

____5. Individual. What can each one of us do professionally this next year to improve our ability to contribute to our team and its mission?

Some of this should be on simple, brief checklists and memo’s. Add it to your Practice Playbook. Document it so that it can be referred to for training and coaching in the future.

Merry-Go-Round

Imagine that your practice is a merry-go-round, the kind you find at children’s playgrounds.

It takes a lot of energy to push it and get it going. But… once it is moving, it takes less effort to gradually get it going faster. And faster! And faster…

Take some time to review how you are pushing your merry-go-round. What procedures worked better for pushing it faster? Focus on these… Makes these better.

Go faster… and push less.

And as you do, watch those, including yourself, hold on tighter and smile bigger.

Enjoy the ride!

With admiration,

–Ed

Changes to ICD-10 Codes That May Affect Chiropractors

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We know all too well how keeping abreast of all the changes in the insurance world can sometimes be overwhelming for your practice so we wanted to simply help you out by sharing some recent information regarding ICD-10 codes.

ChiroCode Institute recently published the changes to ICD-10 Codes that are going into effect October 1st.  While there are thousands of code changes, we have listed below the codes most relevant to chiropractors.  To download a printable copy of this list click here [ICD-10-Changes-Oct-2016]

  • G56.03  Add   Carpal tunnel syndrome, bilateral upper limbs
  • G56.13  Add   Other lesions of median nerve, bilateral upper limbs
  • G56.23  Add   Lesion of ulnar nerve, bilateral upper limbs
  • G56.33  Add   Lesion of radial nerve, bilateral upper limbs
  • G56.43  Add   Causalgia of bilateral upper limbs
  • G56.83  Add   Other specified mononeuropathies of bilateral upper limbs
  • G56.93  Add   Unspecified mononeuropathy of bilateral upper limbs
  • G57.03  Add   Lesion of sciatic nerve, bilateral lower limbs
  • G57.13  Add   Meralgia paresthetica, bilateral lower limbs
  • G57.23  Add   Lesion of femoral nerve, bilateral lower limbs
  • G57.33  Add   Lesion of lateral popliteal nerve, bilateral lower limbs
  • G57.43  Add   Lesion of medial popliteal nerve, bilateral lower limbs
  • G57.53  Add   Tarsal tunnel syndrome, bilateral lower limbs
  • G57.63  Add   Lesion of plantar nerve, bilateral lower limbs
  • G57.73  Add   Causalgia of bilateral lower limbs
  • M21.611  Add   Bunion of right foot
  • M21.612  Add   Bunion of left foot
  • M21.619  Add   Bunion of unspecified foot
  • M21.621  Add   Bunionette of right foot
  • M21.622  Add   Bunionette of left foot
  • M21.629  Add   Bunionette of unspecified foot
  • M25.541  Add   Pain in joints of right hand
  • M25.542  Add   Pain in joints of left hand
  • M25.549  Add   Pain in joints of unspecified hand
  • M26.60   Delete  Temporomandibular joint disorder, unspecified
  • M26.601  Add   Right temporomandibular joint disorder, unspecified
  • M26.602  Add   Left temporomandibular joint disorder, unspecified
  • M26.603  Add   Bilateral temporomandibular joint disorder, unspecified
  • M26.609  Add   Unspecified temporomandibular joint disorder, unspecified side
  • M26.61  Delete  Adhesions and ankylosis of temporomandibular joint
  • M26.611  Add   Adhesions and ankylosis of right temporomandibular joint
  • M26.612  Add   Adhesions and ankylosis of left temporomandibular joint
  • M26.613  Add   Adhesions and ankylosis of bilateral temporomandibular joint
  • M26.619  Add   Adhesions and ankylosis of temporomandibular joint, unspecified side
  • M26.62   Delete  Arthralgia of temporomandibular joint
  • M26.621  Add   Arthralgia of right temporomandibular joint
  • M26.622  Add   Arthralgia of left temporomandibular joint
  • M26.623  Add   Arthralgia of bilateral temporomandibular joint
  • M26.629  Add   Arthralgia of temporomandibular joint, unspecified side
  • M26.63  Delete  Articular disc disorder of temporomandibular joint
  • M26.631  Add   Articular disc disorder of right temporomandibular joint
  • M26.632  Add   Articular disc disorder of left temporomandibular joint
  • M26.633  Add   Articular disc disorder of bilateral temporomandibular joint
  • M26.639  Add   Articular disc disorder of temporomandibular joint, unspecified side
  • M50.02   Delete  Cervical disc disorder with myelopathy, mid-cervical region
  • M50.020  Add   Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
  • M50.021  Add   Cervical disc disorder at C4-C5 level with myelopathy
  • M50.022  Add   Cervical disc disorder at C5-C6 level with myelopathy
  • M50.023  Add   Cervical disc disorder at C6-C7 level with myelopathy
  • M50.12  Delete  Cervical disc disorder with radiculopathy, mid-cervical region
  • M50.120  Add   Mid-cervical disc disorder, unspecified
  • M50.121  Add   Cervical disc disorder at C4-C5 level with radiculopathy
  • M50.122  Add   Cervical disc disorder at C5-C6 level with radiculopathy
  • M50.123  Add   Cervical disc disorder at C6-C7 level with radiculopathy
  • M50.22   Delete  Other cervical disc displacement, mid-cervical region
  • M50.220  Add   Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221  Add   Other cervical disc displacement at C4-C5 level
  • M50.222  Add   Other cervical disc displacement at C5-C6 level
  • M50.223  Add   Other cervical disc displacement at C6-C7 level
  • M50.32   Delete  Other cervical disc degeneration, mid-cervical region
  • M50.320  Add   Other cervical disc degeneration, mid-cervical region, unspecified level
  • M50.321  Add   Other cervical disc degeneration at C4-C5 level
  • M50.322  Add   Other cervical disc degeneration at C5-C6 level
  • M50.323  Add   Other cervical disc degeneration at C6-C7 level
  • M50.82   Delete  Other cervical disc disorders, mid-cervical region
  • M50.820  Add   Other cervical disc disorders, mid-cervical region, unspecified level
  • M50.821  Add   Other cervical disc disorders at C4-C5 level
  • M50.822  Add   Other cervical disc disorders at C5-C6 level
  • M50.823  Add   Other cervical disc disorders at C6-C7 level
  • M50.92   Delete  Cervical disc disorder, unspecified, mid-cervical region
  • M50.920  Add   Unspecified cervical disc disorder, mid-cervical region, unspecified level
  • M50.921  Add   Unspecified cervical disc disorder at C4-C5 level
  • M50.922  Add   Unspecified cervical disc disorder at C5-C6 level
  • M50.923  Add   Unspecified cervical disc disorder at C6-C7 level

ICD-10 Reference:

Gwilliam, Evan M, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA, ChiroCode Institute

If you have any questions regarding these changes Petty, Michel and Associates would be glad to help guide you in the right direction.  Please email to services@pmaworks.com or call us at 414-332-4511.  We are here to help!

The Importance of Compliance in a Chiropractic Office – HIPAA, Covered Entity, OSHA, HITECH

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Lisa J. Barnett

Lisa J. Barnett

HIPAA, Covered Entity, OSHA, HITECH – – Compliance. What’s happening in the world of compliance and why do you as a chiropractor need to be educated and remain in the know? Find out below . . .

First and foremost, according to the Health and Human Services (HHS), chiropractors are included in the covered entity category, and this is regardless of whether or not you have received Electronic Health Records incentive monies. Covered entities are required by federal law to comply with all areas of protected health information and employee safety standards. Impact of non-compliance? In February 2016, a covered entity was fined $239,800 for non compliance.

Further, according to a March 2016 survey among small practices designated as covered entities, 60 percent of the 900 plus professionals surveyed are still unaware of pending compliance audits, and 58 percent have not appointed a securities/privacy officer in their practice. Audits to our profession are forthcoming, and we cannot opt out. Keep reading on how to safeguard yourself and your practice. Also keep in mind that it takes approximately 40 to 50 hours to develop and secure a compliance program.

The three main areas of compliance you need to be aware of, educated in, and be an active participant include: HIPAA, OSHA, and IT Securities.

Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act (HIPAA) law of 1996 was enacted to improve the portability and accountability of health insurance coverage, and it brought individual privacy rights to patients and requires that we notify them of their rights. It also serves to eliminate fraud, waste, and abuse in healthcare. The focus here is to safeguard your practice by securing personal (patient) health information (PHI) and personal identifiers, be it paper or electronic (ePHI). This can include data encryption, secure messaging, compliant Cloud storage, compliant software, and unique password setups. One of the areas I assess when I visit a clinic is locating where the patient paper files are kept and if they are well out of viewing from others.

Your HIPAA requirements to be compliant at the clinic level include:

  • Designating a compliance/privacy officer whose primary responsibility is to ensure compliance with the regulations
  • Establishing and implementing at least annually, training programs for all employees and doctors.
  • Implementing appropriate policies and procedures to prevent intentional and accidental disclosure/release of PHI or ePHI. Encrypting your data for example will lower your chances of ransomware or cyberattacks.

OSHA
The United States Occupational Safety and Health Administration (OSHA) Act was signed by President Nixon in December 1970. It is designed to protect worker safety and promote healthy work environments. Some of you Docs have been involved in workplace safety and onsite workplace assessments in factories. Kudos to you! You were advocating OSHA’s mission by: Educating your client and their employees on workplace safety by conducting posture and ergonomic assessments, and finding the best ways for workers’ compensation patients to get back to work and continue contributing safely and appropriately within their restrictions.

At the clinic level (can be delegated), your requirements to meet OSHA requirements include:

  • Displaying the required workplace safety and employee rights posters for all employees to review
  • Establishing annual training for yourself and your employees. Local fire departments usually are able to conduct these trainings and are willing to include other participants.
  • Developing a written emergency plan in case of fire, severe weather, etc.
  • Drawing up an exit plan and post for employees and patients to see. See example below:

evacuation map

  • Developing written procedures (universal precautions) to minimize risk exposure to bodily fluids such as blood, vomit, saliva.
  • Obtaining Safety Data Sheets for disinfectants used at the clinic, as well as if you process X-rays.
  • Have handy your Quality Assurance X-ray manual, follow it, and ensure it is accessible to those who take/process X-rays.
  • Ensuring ergonomic workplace assessments are conducted at the clinic and documented. This could include posture screenings for your employees and requiring stretch breaks – for you, too!

Information Technology (IT) Security/HITECH

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of HIPAA and the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Section 1176(a) of the Social Security Act was revised during this timeframe to allow for significant monetary penalties up to $1.5 million for breaches/violations of protected health information. However, an interim revision (later known as The Omnibus Rule) set prohibitions on enforcing such significant monetary penalties if it was found in investigation that the covered entity did not know and with the exercise of reasonable diligence would not have known of the violation. In these cases, the breaches were punishable under the lowest tier of penalties, and further, prohibited the imposition of penalties for any violation corrected within a 30-day time period, as long as the violation was not due to willful neglect. A final ruling in January 2013 reiterates all of the above standards.

Your responsibilities to get IT Securities compliant include:

  • Assigning a securities officer
  • Conducting a risk assessment
  • Ensuring your EHR vendor and billing clearinghouse are HITECH/HIPAA compliant
  • Ensuring every vendor you work with has signed a Business Association Agreement with your office and you have those Agreements on file. These need to be updated at least annually.
  • Ensuring the clinic’s computer systems are backed up regularly, have virus-checking software, firewalls, and encrypted operating systems
  • Establishing securities policies and procedures, including on your social media networks.
  • Creating a disaster recovery plan
  • Creating a policy and procedure of notification, in the event of a data leak or leak of PHI/ePHI

Impact of non-compliance? Another covered entity was fined $25,000 for posting patient information online.

Feeling overwhelmed? We can help. Contact me on how you can get an initial Compliance Assessment and a Medicare Documentation Assessment with a Report of Findings sent to you, for a ridiculous low price of $299!*

References:

  • nueMD Cloud-based health information technology, http://www.nuemd.com/webinars
  • HIPAA Journal, http://www.hipaajournal.com/
  • United States Health and Human Services, http://www.hhs.gov/hipaa/
  • United States Occupational Safety and Health Administration, www.osha.gov/
  • Federal Register/Rules and Regulations Publication Vol. 74 No. 209
  • Federal Register/Rules and Regulations Publication Vol. 78 No. 17
  • Emergency Exit Diagram: www.steamwire.com business continuity templates

*Mileage cost may apply.

Medicare in Your Chiropractic Office: Is Your Documentation In Order?

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Lisa J. Barnett

Lisa J. Barnett

Have you ever thought you could be both a great documenter and repeatedly educate your patients on their innate intelligence . . . if you only had the time? Keep reading on how to both bulletproof your documentation for a potential audit and maintain the energy of our profession’s principles.

Let’s help build your ammunition.

First . . . did you know that the US Health and Human Services advised Medicare to target chiropractors to curb questionable and inappropriate payments, projected at $280,000,000? Seriously! And clinics are, as I write this, being audited. How do I know? Because we’re receiving phone calls and emails asking, “What do I do? I received a letter from Medicare.” As a result, I’m traveling around to help chiropractic offices prepare.

To insure yourself and what you’ve worked hard for, make sure your documentation (that is, every single note in the patient’s file/your EHR software) is citing the following information:

  • History Obtained at Initial Visit:
    • Symptom(s) causing patient to seek care
    • Family history if relevant
    • Past health history (general health, prior illness, injuries, hospitalizations, surgeries, current medications)
    • Mechanism of trauma
    • Quality and character of symptoms/problem
    • Onset, duration, intensity, frequency, location, radiation of symptoms
    • Aggravating or relieving factors
    • Prior interventions, treatments, medications, secondary complaints
  • Initial Visit or New Onset
    • History (as stated above)
    • Description of the present illness:
      • Mechanism of trauma (how did it happen?) For example, getting out of bed, twisting, gardening.
      • Quality and character of symptoms/problem
      • Onset, duration, intensity, frequency, location, radiation of symptoms
      • Aggravating or relieving factors,
      • Prior interventions, treatments, medications, secondary complaints
      • Symptoms causing patient to seek care. Symptom(s) must be related to the level of the subluxation documented.
    • Evaluation of spine/nervous system through physical examination.
      • PART: pain and tenderness, asymmetry/misalignment, range of motion abnormality, tissue, tone changes
    • Diagnosis: Primary diagnosis must be a subluxation, including the level or identified descriptive term of location, i.e., condition of the spinal joint involved, direction of position assumed by the named bone.
    • Treatment plan, to include the following:
      • Recommended level of care (duration and frequency of visits), specific goals, objective measures to evaluate treatment effectiveness, date of the initial treatment.
      • Though not a documentation requirement, this is where you will educate the patient face to face, as to their subluxation and what will happen if they don’t get it corrected, as well as educate them on their innate intelligence.
  • Subsequent Visits:
    • Review of chief complaint, changes since last visit, systems review if relevant
    • Physical Exam
      • Exam – area of spine involved in diagnosis
      • Assessment of change in patient condition since last visit
      • Evaluation of treatment effectiveness.
      • Though not a documentation requirement, this is a perfect time to re-educate the patient on chiropractic principles.
      • Documentation of the presence or absence of a subluxation
      • PART: pain and tenderness, asymmetry/misalignment, range of motion abnormality, tissue, tone changes
    • Documentation of treatment given on day of visit (technique(s) used and areas adjusted)
    • Progress or lack thereof, related to goals and treatment plan (is the patient meeting goals?)

Let me be clear: The above documentation requirements are not PM&A’s. They are Medicare’s.

Other Tips:

  • Your subjective findings in initial visits/new onsets should tell a story about what happened, how it happened, and when it happened.
  • The Visual Analog Scale (VAS) is not sufficient documentation as your sole objective tool. Use additional tools to measure objectives findings.
  • See below for a typical VAS:

VAS-Lisa

  • You should self-audit your documentation on a regular basis.

In closing, get out there, do what you do best to attract and help anyone with a spine, and follow the above documentation requirements to armor yourself in the event of an audit by Medicare and other payers. Need help staying relaxed and focused, and getting paid? Give us a call. That’s why we’re here.

Sincerely in Chiropractic,
Lisa

Lisa is now providing a no charge initial consultation regarding your Medicare documentation. You can contact at (920) 334-4561 or by email at Lisa (at) @ pmaworks.com

More information on Lisa[LINK]

Download a printable copy of this newsletter [June newsletter]

Download a customizable copy of the Checklist: [Medicare Documentation ChecklistDOC]

Print Checklist (PDF)[Medicare Documentation Checklist-PDF]

 

David Michel to Speak at Moraine Park Technical College – 4/8

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IMG_0688-1

David Michel will be speaking on Friday, April 8th from 9:30 – 11:30 at Moraine Park Technical College in West Bend.

His topic “Overview of Medicare Billing for the Chiropractic Specialist”  is open to the chiropractic public with limited seating for around 50 people.  If you or your staff are interested in attending please let David know so he can inform Dr. McLean.

David can be reached at dave@pmaworks.com

Medicare Changes: National Government Services LCDs: Effective 12/1/2015

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*This notice specifically pertains to those offices where the Provider of Medicare is NGS:  CT, IL, ME, MA, MN, NH, NY, RI, VT, and WI.

 

For those of you who have NGS as their Medicare provider (states listed above), we wanted to make sure you were aware of a new policy which has some big changes, mostly positive and where you could get more information about it.

The NGS(National Government Services) recently published the new Chiropractic Medicare Policy which will go into effect on 12/1/2015

For more information on the chiropractic medicare policy visit:

L66315 Chiropractic Services Policy

Sincerely,
Dave

10 Practice Development Strategies for Chiropractors in 2015

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[If you think that you could make more money selling pharmaceuticals, injecting patients with vaccines and promoting flu shots in front of your office, these recommendations are not for you. For those matters, you might want to ask Palmer Chiropractic College or the Wisconsin Chiropractic Association for their opinions.]

What strategic moves should you be taking now to make sure that you have a better year in 2015 and in years to come?

After reviewing current literature and statistics, and based upon my observations and experience, I have put together a report which makes a number of recommendations that can be helpful to you. I have also included an extensive list of references for your further study.

The report contains a lot of information and so it is only for the serious practice executive. It will be a useful resource for you to refer to while you implement some of the suggestions I offer. Reading time is about 15 minutes. It offers new views on practice marketing, management, and leadership, with 25 specific recommendations.  To go straight to the main course, go here:

Here is a shorter version:

Executive Summary – 10 Strategies to Prosper and Flourish in 2015 and Beyond

1. Know Your Environment. The Medical-Pharmaceutical industries are spending more to dominate the market place. Their efforts are becoming more pervasive in reach and more covert in manipulation. At the same time, wellness statistics continue to grow. More people are turning to organic foods and are focused on wellness.

2. Marketing Positioning. My recommendation is to embrace the popular movement towards natural health and own it. Be its champion. You are the Healthy Life Doctors. This is your niche.

3. Unique Selling Proposition. Stay committed to your core services, but articulate your Unique Selling Proposition to your specific market niche(s). Not everyone is your patient. Select certain markets that are already reaching for your type of services: people fed up with drugs, baby boomers who want to stay healthy, mothers who want to avoid drugs for their children, athletes, employers who want healthy employees, etc.

4. Get More For Less. Watch your economics but don’t get stuck in a scarcity mindset. Central to economics is a return on investment -ROI. Invest in yourself and especially in making your support team expert professionals. Learn and apply the Pareto Principle (how 80 percent of your results come from just 20% of your efforts).

5. Insurance or Cash? Yes! Take insurance but don’t kowtow to the Insurance Cartel. There are millions of people who want help and can pay for it and are just looking for a solution. You have to let them know that you have their solution.

6. Shift from Personality Driven Practice to Team Driven Business. The successful offices of the future will be team driven and systematized. Each team member has to be an expert as a specialist, as a team member, and as a marketer. And each should try to achieve this as well. The doctor will delegate most marketing and administrative details to others.

7. Shift from Solo Practice to Group Practice. For those of you who are ready, you should join forces with other doctors in a group practice. This has not had a lot of success in the chiropractic profession as it has in other professions, but the time is right now to band together synergistically as brothers and sisters. There are many good reasons to do this now. However, it has to be set up — and maintained — correctly.

8. New Role: CEO and Leader. Why do CEO’s get paid so much? Because they can make such a positive difference in the business. Up to now in your career you have taken on administrative and marketing projects mostly from the role of doctor, or perhaps owner. The CEO role probably has not been emphasized. Shifting to the role of CEO changes everything. Growing a business becomes easier, you have more time available, and you make more money.

9. Seek Out and Integrate Your Greater Purposes with Your Business. The power for your office, and you, comes from those things that mean the most. This would include your family and your spiritual pursuits. But our world is smaller and we live in a networked economy and culture. Your office, in its own right, has to be a leader in your community and environment and contribute in some way beyond its walls. This also includes having a voice in your professional organization. Your greater purposes also include your personal hobbies. Since you are not working on an assembly line, many of these purposes should be integrated into your work.

10. Get an Executive Coach. Why does corporate America spend over a billion dollars on executive coaching? Because the return of investment proves to be at least 7 times, and in some cases, 10-49 times cost. Executive coaching doesn’t cost – it pays.

An executive coach is different from a clinical coach. An executive coach will help you be a better CEO – a better leader, marketer and manager who builds a team driven business which allows you to delegate most non clinical duties.  He or she will help you sort out what tasks will produce the greatest positive effects for your business, and help you get those tasks done. He or she will be your partner, counselor, confident, coach, teacher, drill instructor, and friend.

The future has never looked brighter, but the challenges are not slight. This makes your success all the more important – and sweeter.

Ed Petty

 

Anthem Chiropractic Network Reductions

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

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

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

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

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

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

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

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

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

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

Sincerely,

Ed

Dave Michel’s Letter to patients: Anthem Termination Letter

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

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Good Grief!

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

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

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

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

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

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

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

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

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

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

Which is nice!

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

Your Biggest Chiropractic Bill Each Month

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

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

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

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

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

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

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

It is YOU.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ed Petty

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