What is an Adjustment

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B.J. Palmer

What is an Adjustment by B.J. Palmer

An adjustment (“setment”) is one if not THE most exact in operation in the world; greater by far than ripping out an appendix, etc. It requires that “intuitive” sense of direction, proportion, distance, and ability to deliver just that and all that, and nothing more; a sense of fitness to do this one thing, which few seem to possess, which can be acquired if one is willing to pay the price in thought, study, development of mind and body.

I have spent 40 years to do what I can do today. The “follow thru” of an adjustment IS IMPORTANT, but not nearly as important as “the approach.” If the “approach” is natural, easy, perfectly timed and distanced, then follow-thru is The sportsmanship of adjusting subluxations is no different than the perfection in tennis football, baseball, or any sport where ONE gets this top, MANY drag behind, and MANY are way down at the tail of human endeavor.

The MIND thinks all action. As the MIND understands, the muscles deliver. I will spend no less than ONE HOUR studying a DISlocation before I adjust it. WHY? The mind THINKS all action, and the MUSCLES deliver. The more the MIND knows, the better will be the delivery of MUSCLES. I had a child-like that recently — 6 months old — a DISlocation to correct. It was done in a split fraction of a second. When your muscles come through, THEN they haven’t time to think action. Action must be formed IN THE MIND ahead of time.

(Page 844, Up From Below the Bottom, B. J. Palmer, 1950)

PDF Version for downloading: What is an adjustment by B. J. Palmer

The Future Belongs to the Best

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Time spent on business improvement projects in your "Goals Lab," or during down time. From GoalDriven.com (c)2021

A few years ago, a staff member at an I office visited confided in me and told me the following story:

“Our office was really slowing down last year. So, the doctor decided to take everyone out of town to a weekend practice management seminar. The speakers discussed really cool methods for doing our work. It was fun and we learned a lot. Plus, we also went over some great marketing ideas. We were all pretty excited when we returned to work after the weekend.

“On Monday, we agreed to get together at lunch to discuss how to implement what we learned. Some staff members were still dealing with patients, so our lunch meeting started 30 minutes late. Once we finally got together in the break room and started eating, we began a good meeting. We were interrupted with a few phone calls, and some patients started arriving early for their afternoon appointments. We had to cut the meeting short and didn’t get to discuss much of topics of the seminar, but we agreed to continue the meeting the following week.

“As it turned out, something always came up each week and… we never did meet again about the seminar.

“But we were still pretty pumped from the seminar and we had one of our best months ever. It was my job to clean the break room and, after a few months, I noticed that the binders of information we received at the seminar were still on the break room table, never opened. I stored them away for future reference.

“Now it is almost a year later, and everything is pretty much back to the way it was before we went to the seminar. The numbers are back down, some of us are a little burned out, and I don’t think we ever did implement anything from that seminar.”

—

Sound familiar?

I bet it does. I have seen it play out almost the same way countless times.

We are in the improvement business. We help people improve their health. We should be able to do the same for our business and for each other. In fact, if you are not constantly improving, your patients will seek practices that are.

In this new decade, apart from the many new events and changing tides of culture, technology, and mega-corporate influence, your future success is up to you. And it will be primarily based on the quality of your service and your outcomes – the experience your customers receive.

A report from a survey by Microsoft underlines this:

“As customer expectations continue to climb, it becomes more challenging for brands to set themselves apart from the competition. Markets are increasingly crowded, and both price and product are being steadily overtaken by customer experience as the number one brand differentiator” (Microsoft 2018, State of Global Customer Service Report).

More than any other short-term marketing tactics you may be using, only the best offices will thrive in the long run. And those will be the offices that are working on consistent improvement. Mediocrity could get you by in the past. But now, the future belongs only to the best.

But I have noticed that most offices just do not spend enough time consistently on improving their performance. After studying this for some time, I have observed a number of obvious and even hidden barriers that prevent us from working on improvement. I will explain what these are in a later article, but the following steps can help you ensure that you work ON your business to improve it, not just work IN it.

Your Improvement Clinic – Your Goals Lab

  1. Time spent on improvement doesn’t cost. It pays! Some business owners are concerned that time spent on improving the business or staff is too costly. It can be if the training or planning is poorly done. But remember that:
    a. Better team efficiency generates better revenue.
    b. Better trained and focused team members generate better revenue.
    c. Better outcomes generate better revenue.
  2. Head Coach. As the owner and CEO, you are also the Head Coach. How your team does – the business – is in large part based upon your coaching.
  3. Give it a name. In my new book, The Goal Driven Business (to be launched on July 4th of this year), I use the term Goals Lab as it is a location where you can go to work on getting to your goals faster. It could be your breakroom, a restaurant, a park, the reception area – anywhere really. You can call it your Practice Field, Improvement Dojo, or Mystic Garden! Just consider it a place and time that is separate from your time with patients.
  4. What gets done.
    a. Team meetings for communication, review, coordination, and planning.
    b. Team training and practice.
    c. One-on-one training and practice.
    d. Personal training, study, meditation.
  5. Schedule these routinely – weekly, monthly, quarterly, and as needed.
  6. No interruptions, no calls, 100% attention present.
  7. Be challenging. You don’t get better unless you question what you have been doing to see how it could be better.
  8. Go over this with your team. Let them know that they, too, are coaches. And players as well. So, improvement is a team activity, one that requires responsibility and professional discipline.

Your car mechanic can’t work on your car when you are driving it down the freeway. You can’t see patients while they are driving their forklift at work or cooking dinner for their kids at home. You need a separate time and place dedicated to work on improvement.

Your goal is to create an expert office that generates expert results and gives your patients the best experience they can receive from any other comparable health care business.

Imagine your business being so good that patients not only drive in from across town, or even across the state, but fly in from all across the country to receive your services. Imagine that there is such a demand for your care that you even build a motel next to your facility to accommodate the out-of-towners.

Well, there was a Doctor of Chiropractic who was just that good. His name was Clarence Gonstead. His advice?

“Practice. Practice. Practice. Never stop.”

Ed

Ed Petty - author

What Do You Think of When The Phone Rings?

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This New Year has reminded us of a powerful fundamental principle in practice management and marketing.

It started with an office out West. 2020 was a bad year for them. There was COVID, of course, but there had also been repeated staff turnover and other issues. A once busy office in an upscale mall, it had seen better days. The doctor, staff, and I just could not find a way to get the office going like it once was. New patients had decreased to a trickle. We tried one thing and then another – nothing worked. With little fanfare, sometime in late fall, the lead doctor finally resolved a long-term personal challenge that had been haunting him for years. Not much seem to change in the office, but when I got the numbers for January and plotted them, they were literally off the chart. Somehow, doing nothing really that different, the office saw its highest number of new patients since it began, over 20 years ago.

Just last week, we had another reminder. Over in another part of the country, an office had been struggling with some recent procedural changes, and December and January (last month) saw its lowest new patient numbers in years. Ordinarily a high volume two doctor office, the first week of February wasn’t looking any better. We got together on a conference call to sort things out. Then, the team got together for a comprehensive meeting with doctors and staff and worked out confusions and log jams, focused on the mission and its WHY. Just a few days ago, the second week of February, they reported their highest number of new patients in months.

What does this tell us?

A few years back I wrote an article that I think explains this phenomenon.

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

What Do You Think About
When the Phone Rings?

You are sitting there, trying to finish your notes. You hear your phone ring. You are a bit behind. Maybe slightly irritated by an arbitrary denial of an insurance company and you haven’t yet planned out tonight’s evening with the family, spouse, or friend.

The phone rings again.

What are your thoughts? What are your feelings?

Do you kinda wish it wouldn’t ring? Is it a bit of an interruption? Do-you-just-want-to-answer- the – dang-phone-to-stop-the-ringing-so-you-can-get-back-to-your-work?

Essentially, your thought is “Stop.” It is: “Don’t call me.” “Phone, don’t ring, don’t interrupt me!” I am sure this has happened to you – even if ever so slightly or subconsciously.

Now, imagine if your front desk has these thoughts when the phone rings?

To some degree, even the most devoted and hard-working staff can reactively feel put upon by phone calls. Or, in fact, by walk-ins. Or, in fact, by any patient encounter. I have seen this happen on the front desk when the doctor was busy with patients. But remember, this can happen with even the most ethical team member, including you! I have seen doctors do this often. (Extreme examples: “Oh, only two patients coming in on Saturday, go ahead reschedule them. It is MY office, and I can do what I want.”)

Our thoughts can and do determine our behavior and affect how we treat others. Our environment mirrors our thoughts.

Going back to your front desk, realize that the staff on the front desk have tremendous control over the office, nearly as much as the doctor does. The front desk can be a magnet for your patients and attract or repel them.

When the phone rings, you want your front desk, and all staff, including yourself, thinking “YES.” “Call me. Phone – ring now!” “I can hardly wait to talk to this person and see how they are. I am interested in them and how they are doing. I want to help get them to come in for care — and their family too.” “They must be really really cool and nice if they are calling us.” “I WANT to know more about them.” “I am grateful for their call and appreciate the effort they made in calling us.”

These are good thoughts. These are positive thoughts that can help bring in more patients.

You can practice this with your staff at a team meeting.

For example, someone acts as the prospective patient calling. The person acting as the front desk assistant should answer the phone with the attitude of really not wanting to talk to the person. Act it up. This can be funny. Try it a few times.

Then, do the same rehearsal with the front desk assistant positively anticipating the phone call, wanting the phone to ring, and then eagerly answering and talking to the prospective patient.

Keep the role-playing brief. You can and should do it again. It should be fun and act as a reminder to one and all that we should want to meet new people, talk to existing patients, and look forward to phone calls. We can always dismiss the occasional telemarketer or wrong number.
This can also be rehearsed in other types of patient encounters, from taking the new patient back to the exam room, sitting down to do a financial consultation, or checking a patient out and collecting their payments.

And speaking of how our environment does mirror us, here is a little trick you can use. Get a real mirror, about 4 inches by 4 inches, and put it at the front desk counter so that the team member can see it. You can write something on it like: “Are My Teeth Showing?” “Am I Smiling?” And staff, you can also put one of these in your doctor’s office on any day that he is feeling grumpy. It applies to us all.

So, the next time the phone rings, smile. Be interested and curious in who is taking the time to call. Make your thoughts happy so they help create an office that is brilliant, colorful, and full of happy patients.

Ed

The Morale Virus: What doctors say and how they are combating it

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Over the last few months, I have been noticing a particular phenomenon in offices that I don’t think I have seen before… maybe ever. It is like noticing a slight hand tremor that you never knew you had or a buzzing sound from outside that has become increasingly loud and annoying.

2020 was a long year, a stressful one. And you all have been in the thick of it. Daily, seeing more people in one day than most providers see in a week – or more.

My old football coach, Johnny Pappa from Davis, made a big impression on me as a young freshman when he said: “When the going gets tough, the tough get going.” In my then youthful life, I had never heard such profound words. They still apply – especially to you. You are tough!

But stoicism has its limits. The cognitive dissonance can finally get to you.

One doctor expressed to me extreme frustration about two young and very healthy patients, who exercised, got adjusted, ate well, took their vitamins, but decided to discontinue taking their outdoor walks for fear of COVID.

Another doctor, venting his dismay, told me that he couldn’t bear to watch the medical bureaucrats talk about masking and vaccinations as the only remedies to COVID when he knew of so many methods that have been demonstrated to ameliorate the virus. “People are frightened and told to stay at home, don’t socialize, wear a mask if you go out, and wait for the vaccine. That’s it? That’s all you got for people? This really shuts people down.”

One doctor I talked to who, after dealing with depressed and suicidal patients, many of them vets, has become depressed himself. Another wonders what the hell is happening to our chiropractic colleges – have they all been taken over by medical bureaucrats? Is chiropractic finally squashed?

Your good nature can become frayed, your patience worn thin, and regardless of your professional composure and your disciplined countenance, the stresses can have an affect. I mention this because most of you are tough as nails – you have successfully dealt with many types of stressful situations in the past, as a doctor, professional, and for many of you, a business owner.

Morale Virus

So if you are feeling a bit off, recognize that you might be affected by a contagious “Morale Virus.” The Morale Virus is what I call the social sickness that occurs as an emotional response to continual fear-baiting. Frightened, your patients are told they can’t do this and shouldn’t do that.

The Morale Virus is not caused by hardship itself. It is caused when you are pushed into a corner and given no way to fight back. You tend to give up. (Or go stark raving mad!) (Reminds me of the movie, One Flew over the Cuckoo’s Nest when the star, McMurphy (Jack Nicholson), says: “You guys complain how much you hate it here, and then don’t even have the guts to leave! You’re all crazy!”)

There has been a constant assault of bad news emanating from officials and authorities. Yes, and I know the media plays a part — it is mostly owned and controlled by just a few rich people and corporations who have their own agenda — namely, more money. But still – no one buys boring newspapers. Sensation sells the news, and we, the consumers, buy it. We listen and read the “news” that riles us up and confirms our bias. Social media does the same, times ten.

Dirty Laundry (Song by Don Henley) 

I make my living off the evening news
Just give me something, something I can use

People love it when you lose. They love dirty laundry
We got the bubble-headed bleach-blonde who comes on at five

She can tell you about the plane crash with a gleam in her eye
It’s interesting when people die, give us dirty laundry

Morale Virus Disinfectant

Here are some ideas on how you can fight back, disinfect your office from this disease, and better help your patients regain their spirit of hope, kindness, and free enterprise. And yours as well.

Good Vibe Year

One doctor we work with likes to anchor her practice around a yearly theme. For 2021, she is calling 2021 the year of Good Vibes and has events planned to support this philosophy. And just to reinforce the idea, she has T-Shirts made that say Good Vibes. (And by the way, she has a bustling two-doctor office.)

Study. Acquire More Knowledge. Teach

Fear is often a byproduct of lack of knowledge – so arm yourself with the facts.

For example: Roommate 1: “Oh my god! (A panic shout is heard.) The television isn’t working and the game is on. What will we do?” (Drama ensues.) Roommate 2:(Calmly) “Check the remote for new batteries.”  Roommate 1: “Ah, that fixed it, thanks.”

Study, use critical thinking, avoid bias – your own and others. Go to the sources – research studies and from people who are actually working on what you are studying. Then, please educate your patients and clients on how to be happier and healthier. And educate your team, help them increase their knowledge. Arm them as well. Doctor comes from the Latin to docere – “to show, teach, cause to know.”

Leverage Point

What area in your office, if changed, will produce the most significant effect?

Obviously, first and foremost is the doctor. Each day should be a trip to the playground, the ski slope, the baseball field, the dance floor. Ideally, each day is a fresh opportunity to accept the privilege of helping as many people from suffering as possible, to teach them, and have fun doing so.

In most offices, I would also say it is your front desk. The front desk’s power is so poorly recognized in most offices that at least 20% or more production is lost. A vibrant, aggressively friendly, caring, mission and goal-oriented front desk can and will boost your volume – this week. Front Desk team members may need more support and less admin (billing) duties. They may need a better understanding of the mission and how your office is helping people.

Entrepreneur Harder

During cultural upheavals and shifts, entrepreneur businesses remain and often thrive. New opportunities open up. More established and larger companies are weighed down by dogmatic rituals, have high overhead and many vice presidents, and vast networks of suppliers. Change is difficult. But not for the entrepreneur. Most entrepreneurs are all too “change-happy.” You can adapt, innovate, and overcome quicker than companies who are afraid to or can’t. So what if in-person care classes are out for now? Get everyone on a Zoom class, give them a secret word. Test them when they come in again and if they answer correctly, give them a gift – a bottle of Vitamin D or a lunch at another patient’s business.

Stay Out of the Weeds

One doctor told me that her solution was to “stay out of the weeds.” To stay in her lane and just keep helping people and not get caught up in the storms of controversy. I suggest that this is the best course of action. You want news? Sensational news…? Just listen to your patients and staff and community. But stay on the fairway and don’t get sidetracked, mentally or in real life.

Goals

Stay with your goals. Goals are agreements that you made with yourself, and usually others. If you stay true to them, they will lead you out of the den of the morale sickness. Staying true to your goals is a point of integrity. Your goals are not in the weeds – they are straight ahead. Figure out new and better ways to get there or resurrect old ways that worked. Fall down 7 times, get up 8. Each day and each week — begin with the end in mind.

Your goals are in three categories:

  1. Financial. This includes marketing and production.
  2. Service. Developing individual and team expertise with constant improvement..
  3. Purpose. Your higher purposes, those goals outside of work that are greater than this week and that are most meaningful need to be integrated into your work-life.

The Future is Bright and Roaring!

We have seen harsher times. The past is easily forgotten, and we think we are in the worst of times. Well, the 1918 flu was much worse than COVID. Plus, we were sending our young boys to suffer in horror and die in the trenches in Europe in the Great War. But society prevailed and soon ushered in the Roaring 20’s, a time of economic growth and cultural freedom.

Prepare to roar!

Carpe Deum (Seize the Day)

Ed

Ed Petty - author

This is such an important subject, I encourage you to share it with your team and colleagues:  To print out a hard copy

New Year = Coding Changes.

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As we leave the crazy year of 2020 and enter a fresh 2021, here is a summary of  Coding changes taking place that impacts your clinic operations and bottom line:

I. CPT Code 99201 is being deleted effective 1/1/2021

A. Documentation for CPT Codes 99202 through 99205 will be required using criteria of Medical Decision Making OR Time element to determine the level of coding.

o Medicare requirements remain the same for medical decision-making criteria using P.A.R.T. (Pain, Asymmetry/misalignment, ROM decrease, Tissue tone changes) OR diagnostic imaging with documented report of objective findings.

B. CPT 99211 (re-exam) is not being deleted but not used very frequently, and some payers do not pay chiros for this code. You may still bill 99211 when a CT licensed in history-taking and exams performs a re-exam.

C. The 2021 treatment plan model will be the same as 2020:

o Number 1 documentation priority Medicare is looking for: Goals (time or distance element, for example ADLs or specific exercise)
o Number 2 element = duration of care (for example 24 visits)
o Number 3 element = frequency of care (Example – 2X/week for 12 weeks)

II. Changes to ICD-10 codes relevant in chiropractic

1. The following codes have been Added:

A. Arthritis of temporomandibular joint

i.   M26.641 right
ii.  M26.642 left
iii. M26.643 bilateral
iv. M26.649 unspecified

B. Arthropathy of temporomandibular joint

i.   M26.651 right
ii.  M26.652 left
iii. M26.653 bilateral
iv. M26.659 unspecified

2. Deleted ICD-10 Codes:

A. M92.50, M92.51, and M92.52 deleted. (Juvenile osteochondrosis). Use M92.8 or M92.9 instead
B. R51 (this headache code deleted). Here are two specific codes added, to use instead:

i. R51.0 Headache with orthostatic component, not elsewhere classified
ii. R51.9 Headache, unspecified

III. Medicare 2021 Reimbursement on covered CMT
Please note a significant reduction in reimbursement across the board for select specialty physicians and surgeons. Here is the chiropractic fee schedule:

Referring back to the exam discussion above, you may want to consider raising your E/M code fees. However, be advised insurances will not reimburse at your full fee, and Medicare as well as most Part C plans as of this writing do not pay for exams performed by Doctors of Chiropractic. These charges are patient responsibility.

Questions? We’re here to help!

Call 920-334-4561 or email lisa@pmaworks.com

Cheers!

~Lisa Barnett
Increasing your collections through better billing and documentation.

References:

New Medicare ABN-effective 1/1/2021

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Medicare has released a new ABN which will be implemented starting January 1, 2021.  There are two versions, an English and Spanish version.  Click the link to download now.

ABN English

ABN Spanish

Remember . . .
The ABN is required for your Medicare patients to sign when:

They transition from Active Treatment to Maintenance or Wellness Care.

The ABN is voluntary when:

It functions as your financial policy, and the patient is still on Active Treatment.

GUIDELINES:

  • Do not have the patient sign an ABN at every visit, per CMS.
  • When the patient presents with a new episode/injury, the current signed ABN on file is nullified.
  • When the patient transitions back to maintenance/wellness, have them sign a new ABN.
  • The signed ABN is good for one year.
  • The patient/guardian should be the one to choose between Option A, B, or C, with the staff. explaining what each option entails. This prevents potential doctor liability down the road, i.e., the patient or guardian states to Medicare that they were forced or pressured into choosing a certain option.
  • Use an AT modifier when billing Medicare for Active Treatment (ABN not required).
  • Use a GA modifier if the patient chose the option on the form to bill Medicare, and an ABN is on file. Then the Medicare remits can be forwarded or are crossed over to the Medicare supplement plan for possible payment.
  • Use a GZ modifier when billing Medicare for maintenance/wellness care but an ABN is not on file. (The most common reason is the clinic got busy and missed having the patient sign it).
  • The ABN is not used with Part C/Medicare Replacement plans. Only use for Medicare Part B plans.
  • You may begin using the new ABN in December. The new one will be required as of 1/1/2021.

Questions? I am here to help! Contact me at lisa@pmaworks.com, or call 920-334-4561

Lisa
“Increasing your collections through better billing and documentation”

Wisconsin License Renewal Requirements – 2020

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REMINDER:  Wisconsin License Renewal Credentialing Requirements

*Please Note:  Due to the pandemic, usual and customary continuing education requirements are waived this biennium.   However, even if you did not complete your hours, you still need to renew your license.

A review of the usual requirements follow:

Doctors of Chiropractic (DCs):

  • Continuing Education: Forty (40) hours minimum of state board-approved courses; four (4) of the 40 in nutrition
  • Maintain Current CPR

Starting now and prior to December 14th, renew online: https://online.drl.wi.gov/UserLogin.aspx

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses

Starting now and prior to December 14th, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticTechnician/CE.aspx

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses

Starting now prior to December 14, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticRadiologicalTechnician/CE.aspx

TIP:  Keep your transcripts and file them safely, in the event of a continuing education audit.

Approved course listings can be found here:
https://dsps.wi.gov/Pages/Professions/Chiropractor/CE.aspx

All licenses (DC, CT, CRT) expire on December 14, 2020, at midnight.

Questions?

Contact Lisa Barnett
PM&A Consultant
920-334-4561

GENERAL MARKETING STRATEGY — December 2020

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marketing for prefessionals Time to prepare for the New Year’s marketing.

But before we leave 2020, here are a few tips to help you round out this crazy year and lay the groundwork for a fresh, New 2021.

For December, work “internally” with your existing network, including your active and inactive patients and your external referral sources. But prepare for external marketing for the New Year now.

INTERNAL

The Team – Your First Line of Marketing
Every member of your office is a marketer – everyone sells health. 2020 has been one heck of a year. Why not acknowledge your staff as Health Hero’s with a pin, a certificate, or plaque, perhaps with a bonus if there are any funds available? You all deserve many “thank you’s.”

Holiday Cards and Letters to your Patients
Send cards and letters to both active and inactive patients. Recognize their good efforts to improve their health during this peculiar year and tell them that you look forward to helping them and their family stay healthy in 2021.

Health Never Takes a Holiday
Post a sign in your office in December that “Health Never Takes a Holiday” and schedule patients through December to January. We have a customizable poster on our Member’s site, and sample posters here.

Keep the Conversation Going.
Send out regular emails to patients. Email is more effective than social media, according to many studies, but social media has its place too. Assign email and social media posting to someone. A simple four-paragraph informal health tip from the doctor shows that you care and help improve your patient’s health. It is better that your patients hear from you than from the local chain store pharmacist.

Poinsettia Giveaway
Some offices have done well by giving away free poinsettias, or another holiday plant, one per family. Include a gift certificate with the plant for family members or friends. (See Member’s site for gift card samples.) Make a special arrangement with your local florist for a discount.

Patient Education
Now, more than ever, provide health tips for your patients to combat the heavy advertising of COVID-related reports. Stress is amplified by a lack of knowledge. Good education can help lessen the fear and help keep your patients stay healthier and happier. Plus, educated patients remain with you longer and refer more. There are many approaches that work, including: table talk, newsletters, whiteboards with “Patient Education Prompters,” and short five-minute weekly video health tips. The more you teach, the more you reach.

Donation Drives
Holiday time always brings an increased demand for helping those less fortunate. Within your office set up a collection area for any of the following programs and promote it in your newsletter. There are also other times of the year where donations are welcomed and needed. These can be scheduled throughout the year. Here are some sample donations:

  • Coats for Kids
  • Food for Families
  • Toys for Tots
  • Blood Drive
  • School Supplies
  • Animal Shelter $25 in exchange for first day services.

Also, you can support drives at local churches or gyms. EG “Free first-day services for every donation a member of YMCA makes to the homeless fund.”

Giving Tree/Angel Tree
The Giving Tree/Angel Tree Project is a great way to bring community awareness to your office. It is a simple project that can assist your patients to help others where they might not otherwise have the opportunity to do so.

EXTERNAL

Show Appreciation to External Referral Sources
Send a Holiday Card to any business or individual outside of your office who referred a patient to you or helped you with your marketing. Make sure you include a card of thanks and perhaps a fruit basket or other small gift. Let them know that you are looking forward to another year working together for better health.

Internet
Review your website with your Internet company. Set up a consultation with someone to review how well it is drawing new visitors. Make plans for improving traffic and conversion for the first three months of 2021.

Sample Plan for Special Events
January. Video series about improving the immune system: 10 Proven Shortcuts to Improving Your Immune System: 15-minute video every Friday. Include guest providers. PROMOTE these.
February. Valentines. Have a Heart gift certificate. Donation Drives.
March. Saint Patrick’s Day – Leprechaun Appreciation Day – A special kid’s day.
April. Earth Day. Community Clean-up Drive. Include external alliances to help.

100’s More Marketing Ideas
For 100’s more marketing ideas that have worked, if you are active with PM&A, go to our Member’s site, www.pmamembers.com. If not, we still have many effective marketing procedures right here on this blog.

Meet with Your Consultant
All offices are different. Some need fast action direct marketing — others benefit most from long term development of their external network. Meet with your consultant to make plans for the first part of 2021.

MARKETING MANAGEMENT

In over thirty years of marketing practices, I have found the following two factors to be the most important:

Someone to Coordinate
It is essential that you delegate someone to coordinate your marketing as a project manager. Too often, marketing does not get done because, well, no one person is responsible. This is a major cause of the Practice Roller Coaster. While your entire office and everyone in it, staff and doctors, have marketing roles, one person aside from the doctor needs to ensure each project and procedure is implemented.

Goals and Attitude
Commitment to your goals and the right attitude undercuts everything. How strong is your desire to fulfill the mission of your office? Does the WHY? of your business enliven you each day, and are you happy about it? (Yahoo! Can’t wait to get to the office to see my next patient!!)

Of all the projects and procedures mentioned and the hundreds not mentioned, your drive to your goals and your attitude about achieving them is the most fundamental component to marketing success. Work and improve on this each day.

Ed Petty

Bonus Article: Health Tips from Mercola.com

Selling the Invisible — Patient Education: An Inexpensive Marketing Procedure with a Big Return

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[Link to a checklist of patient education procedures below.]

Educate your patients!

There are so many reasons why — let’s look at a few of them. Then, I will show you how your team can implement your patient education procedures.

1. Selling the Invisible. Unlike buying a refrigerator, your patients are purchasing something they can’t see.

They are receiving a service for which there are no concrete, tangible references for them to judge whether the services were excellent, complete, or long-lasting. Outside of immediate relief from their symptoms, they may wonder if you provided a great service, shortchanged them, or are recommending more than they need.

On the other hand, you know the length, breadth, and depth of what you provide. Virtually, you can see the outcomes, know the measurements, understand the symptoms and know what they point to. But to your patients… it’s all an illusion. They have to trust you and what you say.

Typically, once the symptoms are relieved, many patients believe that the condition is resolved. But through education, your patients can understand how your treatment recommendations are a pathway to fully resolving their condition.

2. Beyond Your Services – Your Patient’s Optimal Health. Beyond your services and the treatment program you suggest, your patients will benefit from general health knowledge. Health is a lifestyle, including exercise and nutrition, but the healthy way of living is distorted by unrelenting drug advertising and propaganda.

Low-fat diets, diet soda, statins and other drugs are still an accepted part of the conventional health model. Pharma is increasingly pouring billions into advertising — $328.6 billion in 2016 from $116 billion in 1997.(1 ) In addition, there are untold sums spent on lobbying your elected officials and paying for their election expenses.

Health reality is being manufactured for corporate profits rather than for personal and family health and longevity. Your patients and neighbors in your community don’t have a chance without your calm teaching of the facts on how to achieve a healthy and long life.

3. Customer Education — From a strictly commercial point of view, other businesses are seeing the advantages of customer education. According to learning industry analyst John Leh, “In a world where customer success increasingly determines overall business success, customer education has become an imperative.”(2)

Studies support the idea that customer education pays off. According to studies by ThinkJar, a customer strategy consultancy, “Customers are thirsty for more information and knowledge.”(3) And a study by Eisingerich and Bell conclude that customer education improves the trust in the company.(4)

Major businesses are investing large sums in educating their customers, and a leading customer education platform, Skilljar announced it has raised $33 million in funding. That is a significant investment! Their goal is to provide tools to companies to better onboard, engage, and retain customers at a large scale.

So if you want healthier patients and a healthier community, and if you would like to generate more profit, simply spend more time educating your patients. It is not that expensive! But as with most value-added programs in a practice, projects rarely start, and when they do, they are abandoned almost as soon as they begin.

To avoid this, use a checklist!!

Download the Patient Education Checklist for some ideas on what you can do to educate your patients. Assign a team member this checklist and give them 1-3 hours per week to work on selected projects and report on them at your meetings. They can take on the role of Patient Education Coordinator and help everyone on your team up their game in patient education.

The more your patients know, the further they (and you) will go.

Ed Petty

1. Consumer Reports, January 14, 2019 
2. Avramescu, Adam. Customer Education: Why Smart Companies Profit by Making Customers Smarter.
3. Interview with Kolsky, Foundoer of ThinkJar. Huffpost, 10/15/2015
4. Andreas B. Eisingerich, Simon J. Bell, February 1, 2008 
Photo from UCLA

Selling the Invisible – a favorite book of mine by Harry Beckwith

AMA Releases New Reimbursable CPT Code Relevant to Chiropractic During Pandemic

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Here is some new information from our insurance expert Lisa.

Th AMA just released CPT Code 99072 which is relevant to chiros for the reimbursement for cleaning supplies, hand sanitizers, wipes, sprays. ect.

To read the article of the recent release please click here CPT Assistant Guide Coronavirus Sept 2020

What we know:

99072 is a special services billing code, used for additional supplies, materials, and clinical staff time over and above those usually included in an office visit or service.  The code captures practice expenses during a Public Health Emergency such as:

  • Checking patients for symptoms upon arrival
  • Time involved in applying/removing PPE
  • Performing additional cleaning of exam rooms, equipment, supplies
  • Three surgical masks
  • Cleaning supplies such as hand sanitizers, disinfecting wipes, sprays, cleansers.

FAQ

Q:  What is the reimbursement for this code?

A:  Reimbursement information is not available at this time.  We will continue monitoring future communications regarding reimbursement.

Q:  When is this effective?

A:  Immediately.

Q:  How much should I charge?

A:  This all depends on what you paid for the supplies, what you pay your staff per hour, and taking into account how much time you spend on the additional activities.  Our estimated calculation comes out to around $4-$5 per billing encounter, but this is an example estimate.

Again, we will post more information relevant to chiros as it becomes available.

Questions in the meantime?  Email Lisa at lisa@pmaworks.com.

Sincerely,

Your Allies and Advocates at PM&A

Do You Want More New Patients? Use a Checklist! Here is How.

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Around the year 2000, I published the Marketing Manager System. It was initially a series of binders (3) to help chiropractors with their marketing. I received many compliments and positive reviews from both doctors and staff on how it helped them. Palmer Chiropractic College ordered a few hundred of the binders.

A couple of years later, I converted it into a software program and sold it as a CD package you could install on your computer. After a couple of years, I had to shelve the product. I was not set up to stay current with the constant changes in both software and the Internet.

Still, the information is sound, and it continues to work. Much of it is on our PM&A Member’s site, and though the graphics are somewhat outdated, the fundamentals still apply.

One of the motivations for publishing the Marketing Manager System was to solve a simple marketing challenge almost every practice we worked with had. In fact, the problem was so simple that it is almost embarrassing to explain.

We would get a call from an office requesting “something” to “get their new patients up.” “Got an ad that is working?” would be a typical request.  And we would often hear this after working out an effective marketing plan that had been working for months at generating more new patients.

“What happened to your new patients? They were doing very well, even increasing,” we would ask. But when we checked if they were still implementing the marketing plan we had worked on, the usual answer was “no.”

We would go over the action steps on the marketing plan with them. “Are you still doing X?”  “Umm, no, guess we forgot about that.”  “Are you still doing Y?” “Oh yea, well, the staff member in charge of that took on another role so she couldn’t do Y anymore.”

You get the idea.  What worked gradually gets abandoned.

So, I came up with the Marketing Checklists. These were a comprehensive list of marketing procedures, several hundred all told. They were a compilation of marketing procedures that we had used or had seen others use effectively. The idea was that by using the Marketing Manager System, the office would put together its own customized marketing checklists using ours as a template and reference.

This brings up the subject of checklists. In 2009, a surgeon named Atul Gawande wrote a book about checklists called The Checklist Manifesto. Here is a relevant section from his book:

“What is needed… is discipline. Discipline is hard — harder than trustworthiness and skill and perhaps even than selflessness.

We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals.  We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything–a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps–the ones that even the highly skilled professional using them could miss.

Good checklists are, above all, practical.”

By the way, I cover this in my new book, the Goal Driven Business scheduled to come out in early 2021. I have learned how to make these checklists more practical and, well, Goal Driven!  (I plan to update all of the Marketing Checklists into their new Goal Driven version next year.)

So, from the archives stored away since 2000, enclosed is one of the 13 marketing checklists from the Marketing Manager System. This one is on Patient Referrals.  It lists just a few procedures you can use to help generate more patient referrals. Of course, there are many more, and I recommend you make your own checklist and review it every 3 – 4 months.

And that is the key: keep marketing procedures that are working – working.

To help you do this, list them on a checklist and review the checklist regularly to ensure that they are still occurring. Use the checklist like an assessment. Look at each successful marketing action and ask: “Did this get done all the time, some of the time, or oops! Hardly at all.” Make sure all marketing duties are assigned. Then, where needed, improve them.

Stay Goal Driven and help your patients do the same!

Ed

Download the The Marketing Checklist on Patient Referrals.

Momentary Affluence — or Is the Tide Turning for True Health?

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Over the last few months, we have noticed that offices have continued to grow – some even breaking their previous records!

Why is this?

I have heard from doctors and office managers that patients may be hesitant to visit medical offices and prefer seeing chiropractors, acupuncturists, and other health-oriented offices instead. Are they just afraid of the COVID at medical centers, or are they truly seeking to improve their health and immune systems?

What have you heard?

I am going to guess that your practice is filling back up as well.  What should you do to augment your growth, sustain it, and even increase it?

RETENTION AND REFERRALS

You want to think about retention and then generating more referrals – from patients and from community members. Consider the following:

  1. First, don’t take this growth for granted. Each patient is unique and special and important. Provide world-class service and deliver world-class outcomes. In the end, this will ALWAYS be your #1 marketing tool.
  2. Educate. I can’t stress this enough. Please… Inform While You Perform. Factual information is one of the reasons patients see you. You are independent. Your strings are not pulled by Merck, Pfizer, or WHO. You can refer patients to information on your services, on Vitamin D, Zinc, and yes, Quercetin. They can trust you for the unedited and unspun truth about health.
  3. Communicate. Newsletters, workshops via Zoom, or in the office, outdoor events (staying in compliance with local ordinances – as you see fit!) – keep the conversation going. Maintain and improve the relationship with your patients.
  4. Capacity. Do you need another provider? Another team member? Don’t overextend yourself, but also, don’t stand in the way of your growth.
  5. Partner with other providers and businesses. Medical doctors are discovering that health solutions they have for COVID are being suppressed. The braver ones are speaking up. Doctors of all kinds, now more than ever, can share the same goal and help each other overcome similar challenges. Businesses as well, want practical solutions for their employees.
  6. Make a List. Make a list of patient retention and referral generation procedures that have worked for you and review them often. In upcoming newsletters, we will brush off some lists from our old Marketing Manager Systemsm that has hundreds of marketing procedures. You know many of them, but it always helps to be reminded!

You can also take your marketing a step further…

IT’S NOT WHAT YOU SELL, IT IS WHAT YOU STAND FOR

As a more aggressive approach, you may want to be more vocal in promoting better health in all its aspects, from what we eat, breathe, to the kind of health care we seek.  In this regard you could take on the role of Health Rebel, or even Health Outlaw!

Your unique selling principle (USP) should include your noble purposes that sets you apart from comparable alternatives.  Consumers are looking for businesses that take responsibility for social and environmental issues. And, according to several studies*, this is especially true for the younger generation – Generation X – those born in the 1990s. Speaking out for better health in your community and against toxic pollutants, for example, is not only a noble purpose but – if genuine, has practical marketing benefits.

There really are two sides in our health culture – one for optimal natural health of the planet and of our bodies, and the other as advertised by corporations.

Your community is bombarded with thousands of advertising messages each day, many of them promoting drugs and COVID hysteria fears.  Advertising is a form of population control, which is an advanced science, and which may be used increasingly to motivate your community to consume more vaccines, including for COVID.  Yale University, as reported by Mercola, is testing advertising messages to shame, embarrass, anger, and otherwise motivate people to take the vaccines.

And the campaign has already started. According to USA today, it is patriotic to get vaccinated.

And it is not just the push for vaccines. Corporate medicine has been discrediting natural health remedies, including chiropractic, nutritional supplements, and certain medical practices such as chelation for years.  And outside of health care, we can see advertisements for the cancer-causing Roundup (with glyphosate), “foods” with toxic ingredients (e.g. aspartame), and the suppression of information about mercury, hexavalent chromium (as in the movie Erin Brockovich), and other toxins currently in our drinking water.

This is really your time. This is a contest for health independence from corporate tyrants that have set up laws to escape liability for their actions.  But those of you in the chiropractic profession are used to the fray. Now, you are not alone. Other doctors are also experiencing suppression and personal and professional retaliation and are joining the fight.

The sales of organic food and supplements continue to increase. And based upon your practice returning to pre-COVID levels, the tide just may be shifting towards true health.

But only with all of our help.

Helping you to help more people,

 

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

Tent Poster – Castles in the Air – Walden

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“I learned this, at least, by my experiment: that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.  … If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.”         

Henry David Thoreau Walden

For a printable version of this tent poster click: Castles in the Air-Walden