Category Archives: Chiropractic Economics

Affordable Care Act and Chiropractic: A Teleclass with Dave Michel

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What is the Affordable Care Act and how will it affect you, your chiropractic business, and your patients?

In this timely teleclass, Mr. Dave Michel outlines the basics of the ACA and demystifies it’s myths and complexities.

Learn how it can affect you and your patients.

Ordinarily reserved for our Members Only confidential site,  we are making this teleclass broadly available for listening and download since this is such an important and timely topic,

 You can listen or down in two formats for your convenience: MP3 or WAV.

2013-04-18 12.30 Surviving, Striving and Thriving Through the Affordable Care Act – 50 minutes (mp3)

2013-04-18 12.30 Surviving, Striving and Thriving Through the Affordable Care Act – 50 minutes. (wav)

 

Faster To Tomorrow

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Road to Your Chiropractic Goals in 2013

It comes at you fast. 

The New Year. Like a fast train, you know it’s coming, and suddenly, it is already whizzing past you.

Actually, each year it comes by faster.  You may not have yet fully had a chance to finish all of last year’s work, or set your chiropractic goals for the New Year.  But nothing slows down the advance of this New Year – and before you know it, it will be spring.

And come summer and fall, what will you have changed in your practice? Probably not as much you would have hoped for.  Why? Because change is coming at you so fast it’s almost too much to keep up.

And it’s not just you that is experiencing change – our whole world is changing. Faster and faster.  The political noise and tumult we hear constantly are just the symptoms of the conventions of the old grating up against the realities of the new.

Ray Kurzweil, whose predictions have been mostly correct over the last 20 years or so, predicts that by 2045 we will have computers that will be able to teach themselves so fast that the speed in which they learn will reach infinity.  This is a very rough description of the Singularity he describes in his book. (The Singularity Is Near: When Humans Transcend Biology)

           “An analysis of the history of technology shows that technological change is exponential…  There’s even exponential growth in the rate of exponential growth…  The twenty-first century will see almost a thousand times greater technological change than its predecessor…”     – Ray KurzweilSingularity

In other words, change is changing exponentially.

This New Year of change is faster than ever before.  But if we move way out beyond all the hue and cry of chiropractic philosophy, “evidence based” chiropractic, “injectables”, politics in and out of the profession, the rah-rah and rock and roll, there is a quiet universe waiting of healing and success which we may only get glimpses of.

In my opinion (IMHO) … it is a world which you, the chiropractor, have always been in. It is not a matter of reaching your goal as a healer. You are already there. Science in fact is catching up to what  D.D. Palmer talked about as the 19th Century rolled naively into the 20th.  Bruce Lipton, a professor in biology who once taught medical students at a medical school here in Wisconsin, after his research and similar epiphany, now teaches chiropractors at a chiropractic college.  He gave a wonderful presentation at Life West Presentation in San Francisco in 2012. I was there and heard him. (Spontaneous Evolution by Bruce Lipton)

Bruce Lipton

Bruce Lipton with Ed Petty
Ed Petty and Bruce Lipton

But the truth is, you, as a chiropractor, are already there. You have already ridden the wave and, to some degree, are on the other side of the Singularly.  You may not  fully realize this, the full power and truth of your profession, and I certainly don’t pretend to.  Well, maybe you do since you are reading this, but probably most doc’s don’t fully appreciate what they have with chiropractic.   But the Innate power defined and used by chiropractors is there. How else do you think it has been able to survive and persist over these 120 years through the teeth of vested interests and vicious and covert attacks – that still persist? (see Doctored, the Movie.) It is certainly not because of the great skill and effectiveness of your national or state organizations (not to discount the good work they have done here and there.)

 And this brings me to the point of this article: you have got to upgrade the architecture and skills of the management of your office.  So, while the healing aspect of your profession is, and has been, way ahead of the times, in many cases your management is not.  Military control of your staff, robotic scripts, referral gimmicks and other relics from the 60’s and 80’s have no place in the future.  Dr. Noope left the building a long time ago.  (Who remembers him?)

For you to succeed, your management and marketing has to be way ahead of the curve. The world is changing so fast that if you are not keeping up, patients will look for chiropractic offices that are.  It is that simple: lead from the future, or perish as an amalgamation of P.T., massage, and G.N.C.

It is now 2013 and by now you may have, or should have set some chiropractic goals for 2013.   The challenge now is getting there. This is also our challenge as Petty Michel & Associates consultants and coaches as well.

This year, our goal is to get you to your goals FASTER.

Faster to the future and faster to your goals. It is a challenge, but we have been developing newer and faster approaches that can help you (and your team) get more done quicker.

We want to help you get to tomorrow’s goals – faster and once there, help you stay there and enjoy the ride.  “Get There Faster and Stay There Happier.”  Yep, them’s our goals!

As the world speeds up and changes faster each day, we can whine about how we are being left behind, stoically assert our principles and pretend everything is just the same, or embrace the changes and in fact drive them forward ourselves.

On February 1st we will be announcing new management technologies to get you to your goals  faster and funner.  Or Funnier.

In either case, please stay tuned.

A Short History of How Everything Else Has Cost You Hundreds of Thousands of Dollars and (nearly) Killed Your Dreams as a Chiropractor

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When you started your chiropractic practice, you took on 2 roles: “Doctor” and “Everything Else.” As your practice grew, you became busier in your role of doctor. That is what you wanted. That was good.

But as your practice grew, your role of “Everything Else” also got busier. This was a distraction from your role of doctor, so you delegated front desk, billing and therapy duties. You still kept the role of “Everything Else.”

As your practice continued to grow with more staff – your role of “Everything Else” expanded geometrically.  This concerned you.

You didn’t think about it much because you enjoyed being a chiropractor and loved your patients, but when you were very busy, you made more money. You could take a vacation with your family, put money aside for your kid’s education, and pay off debts.  Sometimes, you could see yourself producing even more, helping more people, and being even more prosperous.

These dreams didn’t last long. Your role of “Everything Else” became more demanding.  There were more “everything else’s” crying for attention.  There was too much to do and soon you saw your patient volume dropping. Patients were dropping out of care and new patients became scarce. You had lost control.

Other doctors who were experiencing lowered income blamed insurance companies. Or the economy. Or the modern culture.  All you knew was that it wasn’t fun anymore and there was just too much work to do. Work that wasn’t chiropractic.

The fact is, you were never too sure of this role of “Everything Else” and never really liked it all that much. You didn’t have any training in it like you did as a doctor.  And when all of the “everything else’s” starting coming at you, you felt like things were getting beyond your command.

You experienced some staff turnover and now with patient volume down, you didn’t need as many staff. Gradually there was less to do in your role of “Everything Else.”

This cycle may have occurred to you a few times: numbers up, then more stress, then back down. A roller coaster.

  MONTHLY OFFICE VISITS And here is where you may be now.

If you were to add up the amount of revenue you could have made had you stayed at your highest level, or been able to go even higher were it not for your role of “Everything Else”, you might be surprised how much this “Everything Else” role cost you. Hundreds of thousands of dollars.

= = = = = =  =

If this is your story so far, don’t go away. The last chapter hasn’t been written. In fact, your next one might be completely different. Here is an introduction to it:

You read about the chiropractic Executive Freedom Package and started it.

You discover that the “Everything Else” role is really the role of the business executive. It is the role of the CEO.

You realize that all major businesses have an executive and that there are certain skills and tools as a CEO to be learned. These skills have to do with leadership, management, and marketing.

So you learn these skills and get coached on them.  In time, you get better and better at applying them.

You find a staff member and give her the role of chiropractic office manager. You get her continuously trained and give her lots of your less important CEO duties. As she gets better, you give her more.

You get someone to help you coordinate all the marketing. You give him continuous training.

You have staff meetings and get the team on board with managing the office.

All the “everything else’s” are organized into systematized procedures and delegated to your team.

Numbers go up. Your team continues to improve. They are happy about this as they are sharing in the management of the office and its success. Now that all the “everything elses” are packaged up into nice neat systems, you have time to focus more on patient care, future planning,  personal studies, and other pursuits.

You are now a better leader, better manager, and a better marketer, and your business continues to grow. Your team is happier, more people are getting served, and you make more money.

If someone had only told you about the role “Everything Else” and what it really was all about years ago you would have avoided losing so much money and wasted time.

On the other hand, now that you know what the secret is, you are on your way out of the rut you have been in and on your way to greater freedom.

You can learn more about the “Everything Else” role and how to create the business structure that puts you in command with our new chiropractic business Freedom Package here.

 

Electronic Health Records and Chiropractic

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There is more and more attention being placed on the topic of Electronic Health Records. For those of you who are not familiar with this subject, you can find basic information on the web sites of CMS (Centers for Medicare and Medicaid Services) and of course, Wikipedia.  There are other sources, but reader beware: many have ties to software companies (and their advertising and promotional distributors) that are trying to make a case for buying expensive software now.

Here is a Q&A with Dave Michel and one of our clients regarding this subject which may be helpful in understanding what is going on:

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Dear Dave,

Dr. H wanted me to e-mail you with some of our questions and concerns. We are hearing a lot of different things the more people we talk to about it. We are hoping that you can shed some light on the situation. Here are some of our questions:

Is the deadline for reimbursement this October 2011? Or do we have until October 2012?
There is no deadline at this point. It is not a requirement and, even if it is, there will be an exemption for small offices (usually less than 10 FTEs).

Is there a checklist of things that need to be completed in order to be compliant? Do we need to have digital x-ray in order to be compliant?
Yes, there is a checklist. If you google CMS EHR Incentive you will find a couple on the CMS website (skip software vendor websites …). Digital x-ray is NOT a requirement.

Is it a tax credit or would we receive a reimbursement check? Will it just cover the EHR software or will it cover equipment upgrades/replacement as well?
Beginning May 2012, you would be possibly eligible for up to $18,000 per year in incentives paid as a check to each provider. The limit would be based on 75% of your prior year’s Medicare reimbursment. IF you are “an eligable provder” and you have demonstrated “meaningful use”.

How much should we expect to spend on this process? And how much will we get reimbursed? Is it a percentage or the exact amount? And is it a guarantee?
Great questions. EHR software for chiros ranges between $2.5 – $27k. Add to that the cost of conversion in your office (thousands) and the reduced efficiency (eg if the new program adds 2-3 minutes to each patient encounter). This is going to be a big process.

Dr. H  wants to know “what happens if we don’t become compliant?”.
Nothing. Yet …

Thank you so much for taking the time to answer our questions.
No problem! Bottom line (if you haven’t picked up on this so far …): I am not a fan of any of the EHR programs currently out there. They either add too much time to each patient visit or they produce a SOAP note that would not pass an audit / records review. There is NO guarentee that Big Government is going to be mailing out $44k checks to each provider for doing something that will really not improve the heath care delivery system

Most of what you have seen are from companies marketing their products (seminars, EHR software, etc). There is NO mandatory deadline (yet) to convert to EHR and so far, I have not received confirmation from CMS that chiropractors will receive any money or incentives to convert to EHR. I do have a letter in to CMS to get an official word and will let you know. It does not make sense to me that CMS will give each chiropractor $44,000 to convert to EHRs when the CMS program is going broke. But I will let you know.

For questions about EHR, feel free to contact Dave at Dave@PMAworks.com

The 6th Fear

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Chiropractors:  I think it might be time for a pep talk…

Have you been keeping up with the news lately? It’s hard not to.

Egypt, Tunisia, and now Libya recently had swift moving revolutions that resulted in regime change – all in the last few months. And other Middle East countries are also rumbling with protests.

Meanwhile, back in the States, our federal government doesn’t seem to have enough money and our representatives are threatening with a government “shutdown.” And next door here, in the Middle West, Wisconsin, there are thousands of people protesting around our state capital.

That’s a LOT of commotion!

So, how’re your patients doing with all of this? Are they worried? Is their pay getting cut? Are they loosing their jobs? Do they have jobs?

And how about you? Are you staying up watching the news, reading about it, discussing it? Are you worried? How is your income?

We need to be accurately informed about current events, of course.  Unfortunately, we sometimes become so distracted that we can loose sight of what we are doing and let our businesses suffer.

A few years ago when the stock market plummeted, I received phone calls from doctors who were worried. One, who had been doing very well, was thinking about selling her office entirely. Another doctor who also had been doing well, let his practice numbers nose dive as he become mesmerized by the “news”, and was worried about racial riots and internment camps.

There is no doubt that economic conditions have been changing. But it has been our experience that if you constantly work on improving your services and in developing your business, and yourself, you will do just fine. (Good coaching helps too!)

BEST EVER
Last year, many of the offices we had the privilege work with had their best year ever. Most of them, in fact, had been in business for 15 to 25 years. I can think of 3 just off hand that have hit the “waiting list” category. They have reached near capacity with so many patients that they have to schedule new patients 1 week out. Horrible, I know, but very cool too.

DOING RIGHT
Success in this environment can be had. You can have it. You may have to change your past mode of operation, but you too can achieve it. It can be obtained by doing the right things, and doing those things right through a process of constant improvement. We call this the Practice Development Process.

BEING RIGHT
But to get what you want, you have to not only improve what you do, but improve who you are. You have to improve your outlook, your skills, and your personal habits. Success has much to do with how we view the world and what we put our attention on. As one old time doctor mentioned to me years ago, “success is an inside job.” By “inside”, he was referring to one’s thoughts and attitudes. He could talk: he and his doctors were seeing over 2,000 visits per week for years.

WORDS OF SUCCESS DURING TOUGH ECONOMIC TIMES
We have been going through what has been called the Great Recession.  Many patients are worried about their jobs and their money.

Napoleon Hill wrote “Think and Grow Rich” in 1937 during the Great Depression as a result of studying and working with successful leaders, including President Roosevelt.  It continues to be a best seller, perhaps the most popular motivational book of all time. In it he says:

“It is true that all thought has a tendency to clothe itself in its physical equivalent. … “The people of America began to think of poverty following the Wall Street crash of 1929. Slowly but surely that mass thought was crystallized into its physical equivalent which was known as a depression.”

THE 6TH FEAR
The thought that creates this depression, according to Hill, is fear. Hill talked about 6 types of fears, the worst of which is the fear of poverty. The other 5 were criticism, ill health, loss of love of someone, old age, and death.

“The Fear of Poverty is without doubt the most destructive of the 6 basic Fears.“

Hill states that one of the symptoms of fear of poverty is procrastination.

DO IT NOW
So, this is a pep talk to encourage you that there has never been a better time to grow your practice and expand your business.

Your patients need your leadership to help them with their own fears so that they can become more productive. By improving their health and educating them on the chiropractic lifestyle, their chances of succeeding in their lives increases. You and your team help them, their families and the community. You make a difference.

So, do it now. Increase your promotion. Stream line your procedures. Work on team training and improve your service. Plan your expansion for this year.  Schedule a technique class. Read more. Work out more.  Get enlivened with your purpose as a chiropractor.

New office? New doctor? Why not? People need chiropractic care now more than ever. And chiropractic has never been more popular. Even the quarterback for the winning football team of the Super Bowl gets regular chiropractic adjustments. (Naturally, since his dad is a D.C.)

Work with a practice building coach and get in the game – to win!

As Napoleon Hill says:

“Do it now! can affect every phase of your life. It can help you do the things you should do but don’t feel like doing. It can keep you from procrastinating when an unpleasant duty faces you. But it can also help you do those things that you want to do. It helps you seize those precious moments that, if lost, may never be retrieved.”

Fight the fear and the procrastination by just doing it. And soon, you too will be achieving your best ever again.

#  #  #

P.S. Napoleon Hill was a chiropractic patient.  One report has it that B.J. Palmer was his chiropractor. Both men thrived during tough economic times. Here is an interesting story about Hill and chiropractic. LINK

Old movie of Nap Hill. 7 minutes. LINK