The Sickest Generation and Back to School Programs

Happy Health KidsIn late summer, many offices sponsor a promotion for children and their health. This is often in the form of a backpack check-up, scoliosis and posture check, or a school supply drive. The idea is to link the new school year with children’s health to better promote clinic services, generate new patients, and of course, improve the health of the kids.

It’s been my experience that these events are usually only marginally effective. Still useful, I feel that the real opportunity is being missed.

You could be getting more families under care. How?

Educate your families and your community on:

1. The results you deliver. How the outcomes you generate with children’s health are extraordinary. Use written and video testimonials and endorsements.

2. What you stand for. Today’s children face more challenges to their health than their parents. In fact, our children today are sicker than earlier generations. Learn about this and make it your anthem, a flag you wave. Stand up for the kids in your community, and you will earn respect and allegiance of parents. Be their guardians in health.

3. Provide special promotions and events. These could be workshops, screenings, or a special day of services with donations going to a local charity.

4. Alliances and Partnerships. It would be a good idea to create alliances with midwives, doulas, biological dentists, acupuncturists, and other professionals who share a similar concern and goal for healthier children. Invite them to participate in your events. Have them contribute a short article in your newsletter – in exchange, you could do the same with them in their newsletters. Create partnerships.

5. Schedule an event every two months, or every month. Never stop.

Your leadership, based upon your awareness of the health crisis facing our youth, is the primary element that will drive the success of your kid’s programs.

Read the following from the ebook, The Sickest Generation and follow the link below to the entire article, and other resources to become even more acquainted with the challenges the next generation of children face.

  • American children have never been sicker. Over half (54%) are suffering from one or more chronic illnesses, with the late 1980s and early 1990s viewed as the gateway period that launched the decline.
  • Many chronic illnesses have doubled since that time. The “4-A” disorders—autism, attention deficit hyperactivity disorder, asthma and allergies—have experienced meteoric growth, affecting children’s quality of life and contributing to premature mortality. The spike in autism prevalence has been particularly dramatic, with prevalence as high as 3% (one in 34 children) in some regions. Pediatric autoimmune conditions also are on the rise.
  • U.S. children are far more likely to die before their first birthday than infants in other wealthy countries and life expectancy is falling, driven largely by rising death rates in adolescents and younger adults. Suicide is the second leading cause of death in teens, half of whom are reported to have at least one mental, emotional or behavioral disorder.
  • The proportion of public school children using special education services is skyrocketing, with estimates ranging from 13% to 25% of school populations.

Sincerely,

Ed Petty

To the ebook, The Sickest Generation and other references.

Children’s Health Resources

Happy Health ChildThe following are some sources of information regarding the health crisis affecting our children.

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The Children’s Health Defense is a powerful organization that is on the front lines in fighting corporate propaganda promoting harmful drugs for kids. They have many lawyers, including Robert F. Kennedy, Jr., working on exposing false information and corruption regarding children’s health.eBook Sign-Up—The Sickest Generation
Free eBook: The Sickest Generation: The Facts Behind the Children’s Health Crisis and Why It Needs to End Children are the key to a successful future and a prosperous nation, yet American children have never been sicker with a vast array of chronic illnesses. (Also available in Spanish.)

The Pharmaceutical Industry’s Front Men
By the Children’s Health Defense Team

The Medical Journals’ Sell-Out—Getting Paid to Play
By the Children’s Health Defense Team

Science Library
This database contains hundreds of peer-reviewed, published articles on environmental contaminants that are implicated in the rise of the childhood epidemics we are currently experiencing in the U.S. and other industrialized nations.

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Pathways is a long-standing publication with health articles that is free to members of the International Chiropractic Pediatric Association. Its website has links to many articles, a few of which are below:

Pathways to Family Wellness

Are We Making Our Children Sick?
http://pathwaystofamilywellness.org/Nutrition/are-we-making-our-children-sick.html

Natural Immunity
http://pathwaystofamilywellness.org/Informed-Choice/natural-immunity.html

Ear Infections in Kids: Natural Remedies to Ease Ear Pain and Enhance Function
http://pathwaystofamilywellness.org/Holistic-Healthcare/ear-infections-in-kids-natural-remedies-to-ease-ear-pain-and-enhance-function.html

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There are many books on children’s health, and it is fascinating to search to find them. Commit to buying at least one per month, reading it, reporting on it to a team meeting, and placing it in your Lending Library. Have your team members do the same! Here are three:

Books

A Compromised Generation: The Epidemic of Chronic Illness in America’s Children Paperback – September 16, 2010 by Beth Lambert

The Vaccine-Friendly Plan: Dr. Paul’s Safe and Effective Approach to Immunity and Health-from Pregnancy Through Your Child’s Teen Years Paperback – August 23, 2016 Paul Thomas M.D.

How to Raise a Healthy Child in Spite of Your Doctor: One of America’s Leading Pediatricians Puts Parents Back in Control of Their Children’s Health Mass Market Paperback – May 12, 1987
by Robert S. Mendelsohn MD

Tent Poster – In the Arena – Roosevelt

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.

The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”   ― Theodore Roosevelt

For a printable copy of this tent poster email us.

Insurance Network Participation and Getting the Best Bangs for Your Buck

Have you ever . . . Wished there was an easy way to make sense of the array of insurance networks out there? Should I be in? Should I opt out? Here’s a guide for you and your staff to follow to help you decide whether pursuing a specific insurance contract, and staying in, is worth your time and investment:

First, determine which companies you are in network with. Do you have a contract? What are your provider obligations? Are you getting reimbursed what the contract’s fee schedule says it will reimburse? Do you have a profile set up with the national Council for Affordable Quality Healthcare (CAQH) universal provider database and is the information current, and reviewed quarterly? There is no charge to create and maintain your profile in this credentialing database.

Second, make sure you know if you are currently enrolled in Medicare and if you are a participating or non-participating provider. Are you also currently enrolled as a provider in your state’s Medicaid program?

Third, audit your patient demographic. Run a report in your practice management software. What percentage of your reimbursement is coming from insurance? What percentage is coming directly from patients? Which payers are you mainly seeing patients from? Are you finding that patients are requesting you be in network with a certain company? Who are the main employers in your area insured with? Are you enrolled as a provider with the Veteran’s Administration in your area?

Fourth, develop a spreadsheet called “Insurance Networks” to help you and your insurance department keep the information organized and up to date.

Once you have a grasp on the above, you’re ready to determine if you need to pursue network participation with additional companies. Treating this like a sales or business venture, you’ll want to have insurance companies coming to you and requesting you be in their network. Remember, it is to their benefit and their obligation to keep their paying policyholders happy. Patients should feel free to call their insurer requesting you be on their plan. Patients have done this, and outcomes have been successful. Why? Because the worst phone call an insurance company can receive is from an upset policyholder who can’t afford to see their favorite doctor who is helping them (that’s you!) because the doctor is not on the plan.

Things to consider prior to enrolling in a plan include:

  • What is the reimbursement rate?
  • What percentage of the approved charges are taken out for contract discounts?
  • Is there a fee to join?
  • What are your provider obligations?
  • Do they want you to participate in their workers compensation, PI programs? (In our experience, opting in to the WC and PI products means no steerage to you, and cut reimbursements).
  • Are there pre-authorizations required prior to care? Is there a visit limit?
  • What is the initial credentialing and re-credentialing process?

Now, you are on all the plans that are making your pocketbook and your patient happy. What do you need to do to maintain your in-network status? You will need to notify a payer with updated clinic information anytime there is a change in information you submitted at enrollment. This includes phone number change, address change, adding a new provider to the office.

You will also need to make sure you are tracking re-credentialing timeframes for each insurance company. Typically, the recredentialing process for commercial payers is every three years but since your enrollments with each payer fall on different dates, your re-credentialing due dates will vary. Your Medicare re-credentialing is every five years. Re-validation with Medicaid programs is typically every three to five years, depending on your state’s standards. For example, it is every three years in WI and every five years in MI. Many of the larger commercial payers such as Blue Cross, Humana, United Healthcare/Optum Physical Health, use CAQH to approve your re-credentialing. Those who do not will send a written communication via mail or email letting you know your recredentialing is coming due and will include the applications and instructions. Make sure to track these dates in your insurance spreadsheet.

We’ve just touched the surface of network plans and credentialing. Email me for assistance with how these processes work for your practice. You may reach me at lisa@pmaworks.com
Happy Credentialing!

Lisa
“Increasing your collections through better billing and documentation”

The Best That Ever Was?

Just imagine… imagine that you have SO many patients that you need to move to a larger office to accommodate them all.

A few years later, once again, you are seeing more patients than your office can hold, so you build the office of your dreams – a custom designed 19,000 square foot clinic. And the patients keep coming, so you bring on other doctors. Some days, you and the doctors see 600 visits.

Since patients travel to see you from all over the world, you build a motel next to your office. You also set up a limousine service from the nearby airport to your office.

Could you do this?

Clarence Gonstead did. Here, in Wisconsin, from the 1920s to the early 1970s

What made him so successful?

He was an expert. He was a master at his art. He was committed and focused on his craft and his outcomes.

A founder of a chiropractic college would later say that Dr. Gonstead was not a “commercial chiropractor.” He didn’t focus on management or marketing – just chiropractic. (As a management consultant, I can only wonder how expansive his operation would have grown had he had managers as dedicated and competent as he was!)

He was focused on results and said: “Our future will be our results.”

According to people who have studied exceptional performance, there are definite ingredients needed to become an expert, all of which are available to you. And by the way, “natural talent” is not one of them. Let’s look at each one:

  1. Deliberate practice.
  2. Coaching and training.
  3. Commitment to being an expert.
  4. Support from family and friends.

 

  1. Deliberate Practice. Knowledge is fine, but it is skills that are needed. Skills are acquired through a specific type of practice, which Anders Ericcson calls “Deliberate Practice.” This is not just going through the motions of hitting a golf ball, for example, if you are a golfer. It is going beyond your comfort zone and making mistakes and learning better methods.
  2. Coaching and Mentoring. Ericsson points to Tiger Woods for an example of the importance of coaches and mentors. Tiger’s father, Earl, an avid golfer himself, was a teacher of young boys and had a passion for sports. He started training Tiger at an “unthinkably early age.”
  3. Commitment. It is obvious but often overlooked, that to be an expert, you must want to be one. Deliberate practice and study require work and is not comfortable. Tiger used to train 13 hours a day, according to one of his coaches, Hank Hanley. (Golf Digest)
  4. Support from Family and Friends. Support can bolster individual efforts to succeed. Tiger’s dad was Tiger’s champion, as was Brett Favre’s dad, Irv, the famous football quarterback. Parents, spouses, and friends can play a major part in helping to bring about expertise in others.

It doesn’t matter what method of adjusting you use, or if you are a dentist or a chef or a cello player. It does matter if you are an expert. Achieving a high level of skill is not always fun or easy, but the rewards are worth it.

Tiger Woods was recognized as the world’s top-ranked golfer in the first 10 years of the 21st Century. He then fell into a slump with domestic issues and physical injuries. But with continued training, he came back to win his 5th Master title and 15th Major title at the Augusta National Golf Course just last weekend! (By the way, Tiger also praises chiropractic for his success!)

I have seen the ads, and I am sure you have as well, on how you can be a laptop chiropractor, travel the world, and make “six figures.”

I love the Internet and laptops and do travel the world and have nothing against being wealthy. But you are a doctor, a provider of service and outcomes, and if what you deliver is not exceptional and extra-ordinary, then the world will pass you buy.

There has been a great “shake-out” occurring in commerce. We have seen it happen with retail – where now the Internet and Walmart dominate. The store on Main Street is shuttered. This will be happening to the service industry as well. Only the very best will survive. Don’t fall for schemes that promise to get rich with easy effort.

What should you do?

You should become the best in the world.

You should work tirelessly, like Tiger Woods and Clarence Gonstead, to become the world class masters.

And as Clarence Gonstead said,

“Practice. Practice. Practice. Never stop.”

Sincerely,

Ed

PS
If you have the time, I encourage those of you who use Dr. Gonstead’s method, and even those who don’t, to come by his clinic in Mount Horeb and listen to some of the stories of those who worked with him directly.

And especially… bring your team.

“My Time with Clarence Gonstead DC”
4 Speakers who Learned and worked with Gonstead

Link to a poster on Facebook

Time and Place

  • Friday, April 26th, 6:30 PM (Free!)
  • Gonstead Clinic of Chiropractic
  • 1505 Bus. Hwy. 18-151 E, Mt. Horeb
  • (608) 437-5585

Also, during the weekend, the Gonstead Methodology Institute is sponsoring a “GCSS Knee Chest Extravaganza.”

Link to more information.

Trizetto Moving to the Cloud

I wanted to pass along the following communication from Trizetto to help you with a smooth transition.

Please share it with your insurance and billing team so they can plan accordingly. Remember, claims will not go, and EOBs will not be accessible during the time-frame of 11:59 p.m. CST on March 14, 2019 until approximately 11:59 p.m. on March 17, 2019.

If you are not a Trizetto/Gateway EDI client, you can disregard the information below.

Sincerely,

Lisa Barnett

“Increasing your collections through better billing and documentation.”

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

Important Message from Trizetto Electronic Claims Submitter

RE:  Microsoft Azure® Migration

Dear Valued Client,

In order to ensure the most secure, reliable and highest performing platform for our services, TriZetto Provider Solutions, a Cognizant Company, will migrate data from our St. Louis data storage facility to the Cloud-based Microsoft Azure® platform.

Why Are We Migrating?

A cloud-based data center will align data transport security protocols to industry standards while also providing significantly enhanced information security and opportunities for growth. We believe the benefits of this migration far outweigh the costs, and that our clients will benefit greatly from this transition. Benefits include:

  • Increased speed
  • Consistent, reliable storage capabilities
  • Higher levels of security

How Will Your Organization Be Affected?

The transition of data will have a direct impact on our clients. Because of the migration, clients will experience an extended outage starting at 11:59 p.m. CST on March 14, 2019 until approximately 11:59 p.m. on March 17, 2019. During this time all applications will be inactive and no incoming transactions will be accepted for processing.

TPS is working diligently to ensure a seamless transition. We have chosen to put this project into effect over a weekend to minimize impact to our clients. We apologize for any inconvenience this may cause.

If you have any questions or concerns, please reach out to our customer service team at 800-556-2231 or physiciansupport@cognizant.com. Thank you for your patience and support during this time.

-TriZetto Provider Solutions

Goals, Games, and Groundhog Day

 

It is a New Year and already we are knee-deep in its work.

But it is a NEW YEAR and it is important that you take time out to make new plans and then review them often.

Life Works in Cycles

Each year in Wisconsin, the leaves fall and then the snow falls. But by July the strawberries are ready for the pickin’. Every month, we can see the full moon. Each day, we can see the sunrise – if it is not cloudy.

In human endeavors, we seem to follow this natural rhythm of following cycles. After we finish the 9th grade, we are ready to begin the 10th grade. We are excited to finish when we get out of school for the summer, and then again, eager to start the new grade when we begin again in the fall.

These are all cycles.

What would happen if you stayed in the 9th grade, year after year? How would you feel?

Yet, in our work life we fall into the trap of doing the same thing over and over and over. This is not the first unique and special patient you have ever seen…this patient is a customer just like all the others — just another case. Today is not the first day of the rest of your life, it is just like yesterday which is the same as a long line of days that go on and on. And on…

We get beaten down by the tedium, working endlessly for some forgotten purpose, as if the assembly line we were on never stopped and was always the same.

This is a major cause of stress.

Groundhog Day Syndrome

You can’t do one thing forever, like in the movie “Groundhog Day.” In it, the main character visits a town in Pennsylvania where everyone watches to see if a groundhog can see its shadow. This is traditionally on February 2 (This year, it is on a Saturday.) The only problem is, for this character, the day keeps repeating and repeating, the same each day. It drives the character to suicide, but even that doesn’t work. Finally, he falls in love and wins the girl and has a new life.

Anything in life that begins, it seems, must end. It can start again, but it must end so that a new iteration can be created. It is the cycle of life.

Goals and Games

This is an important factor in what is called Gamification. With the advent of computer games, design elements are added in to make the game fun, challenging, and motivational.

But games are nothing new. Baseball is a game. It has a season and games and innings. It has cycles. Games have been part of human behavior since the beginning. The Olympics started in 776 BCE.

One aspect of games that can be overlooked is the fact that they are just an activity for play. Play is something we do naturally as toddlers. As we grow older, this activity becomes structured into organized sports and games, but at the core is the desire to have fun. To play.

We can lose this sense of play when what we do has no end and no beginning. Persistence is a good quality, but it can lead to an enforced dullness that buries our enthusiasm.

It is important to keep in mind that in business, as in sports, keeping the perspective of play is more effective than bearing down on one’s duties with serious gravity. Practices that incorporate some of the components of a game into their operations are more productive and have a better time.

What are your goals for 2019? For the 1st Quarter? For this month… or for today? Higher numbers? New team members? Community wide outreach program? New training and greater knowledge?

As soon as you make a goal, you start a new cycle and begin a new game. Try to win. But you could lose. Either way, don’t get too serious about it and just be grateful to be able to be in the game.

Set new goals and play. Play — to win. Have fun. Smile a little more!

Health Account Savings Plans: Assisting Your Patients To Stay on Their Treatment Plan

Welcome to your best chiropractic year!

Commercial health insurance carriers such as United Health Care and Anthem BCBS can offer their customers, who are also your patients’ employers, two different health account savings options:

  • Health Reimbursement Arrangement
  • Health Savings Account

An employer can also directly offer the benefit of their employees signing up for a Flexible Spending Account.

Let’s dig into each one!

What is a Health Reimbursement Account? (HRA)

A Health Reimbursement Account (HRA) is an account that your patient’s employer funds to help the employee pay for covered healthcare services. The patient cannot put monies into an HRA, as the account is owned by the employer. This includes paying for services (chiropractic office visits) that apply to the patient’s deductible. The patient can begin using their HRA on the first day of the plan year. Since the patient’s employer controls the fund, the employer has the ability to make the rules on when and how the patient can use the money. Additionally, there are coinsurance-only HRA plans available, whereby the patient’s employer will pay only coinsurance amounts.

The patient does not have to pay taxes, state or federal, on HRA monies, so it is a tax savings. The HRA cannot earn interest as it is not a personal bank account.

How do you, Doctor, get paid? Once claims are submitted to the insurer, the insurance carrier will pay, as long as the patient has funds in the account. You will typically, but not always, receive two EOBs/remittances for the same DOS. This is usually due to that first charge going to the patient’s PCP and then getting denied and forwarded to the employer. Referrals from the patient’s PCP to your office is not a requirement tied to an HRA.

There is only one account set up for all covered dependents on a plan. The employee does not report the HRA monies to the IRS.

Takeaways:

  • Get in good standing with your community’s businesses and industries so chiropractic can stay included on their coverage and benefits, and you can get those referrals!
  • Billing Tip: Make sure you are posting to the most recent, newest remittance.

Health Savings Account (HSA)
A Health Savings Account is a savings plan set aside for taxpayers who enroll themselves in a high-deductible health plan. They can be offered by your patient’s employer as an employee benefit, or the patient may elect to sign up independently. The benefit here is that the funds are not subject to tax liability upon deposits. Moreover, if there are monies left in an HSA, they can roll over into the next year. When your patient’s health plan offers this type of plan, they are provided with a debit or credit card to make their eligible health service purchases. Both the patient and their employer can contribute to the fund. The patient must report this account to the IRS when they do their taxes.

Takeaway:

Health Savings Accounts are not owned by the patient’s employer. All taxpayers with high-deductible health plans are eligible and must report this account to the IRS when doing taxes.

Employer-based Flexible Spending Accounts (FSA)
An Flexible Spending Account is a special account the patient puts money into to pay for certain out-of-pocket expenses such as medical related, dependency related, and a limited dental and vision plan. This arrangement also has a tax-free benefit. The list of all eligible expenses can be found on the IRS website at: https://www.irs.gov/newsroom/irs-plan-now-to-use-health-flexible-spending-arrangements-in-2019

The employer owns this account.

A frequently asked question I get is, does an FSA cover massage?
Answer: Yes, it does with the ordering physician (chiropractors included) writing a note of necessity for the massage therapy.

When there are monies left over in the account at the end of the year, the employer has two options they can offer their employees:

  1. The patient can set aside the monies and use it up to two-and-a-half months into the new year, or
  2. The employer can allow the employee to carry over up to $500 from one year to the next.

Takeaway:
There are several eligible out of pocket expenses that an FSA will cover. Click on the IRS link for more information: https://www.irs.gov/newsroom/irs-plan-now-to-use-health-flexible-spending-arrangements-in-2019

SUMMARY
If your patients struggle to keep their appointments due to financial concerns ask them if they have one of these savings accounts that might be able to supplement payment of their care and keep them on their treatment plan.

Oh, one further heads-up to our profession just finding its way down the pipeline . . . you may have or will be receiving a letter from a TriWest Family Alliance group out of Arizona promoting their billing services on behalf of VA offices. This letter is being distributed nationwide. Please note we have researched this, and credentialing and contracting with this group is optional. If you already have a contract with your VA, you may continue treating VA patients as usual. There is no change in their referral of patients to you, or the preauthorization process.

If you have any further questions, don’t hesitate to reach out to either myself or Dave.

Please feel free to forward this article to your insurance department.

Adios for now!
Lisa

“Increasing your collections through better billing and documentation.”

Yearly Goals…Be a Homesteader

Practice and Business Goals Petty Michel

Sometime back in the late 1800’s, my great great grandfather homesteaded land in Oregon. The way I understand it, he found a plot of land he liked in the southern part of the state. This was his goal. He and his wife then settled on it.

You too can be a homesteader.

You have a chance to stake out your own plot in 2019. You can define where you want to be in the future… and then work it so that it is yours. And if you don’t, well, you will still be somewhere, just not where you want to be.

Life is this river and it just keeps rolling, and we are on it. We are not leaves floating rudderless. We have some choice about where we want to be 12 months from now. We can set a course and navigate and sail or row or jump out and paddle ourselves to where we want to be.

This is why we set goals and a course of action. We don’t want to wind up broken and dead on the rocks, or stuck idle in a rancid stinky lagoon that goes nowhere!

But when you do set goals for your business, or even for your career, they are often too lop-sided. They are not holistic. You might say that they are symptomatic. We may only shoot for the amount of money we want to make. This isn’t bad, it just isn’t enough. It is too superficial.

If you want to make more money, you have to see more people. If you want to see more people, you have to take better care of them. To do so, you have to improve your services. To do this, you have to improve your expertise and the expertise of others who see your patients. Lastly, you can’t be an old grouch, unhappy with a poorly managed personal life.

You are in the business of improvement! To improve people, you also have to improve your business. To improve your business, you have to improve the professional skill of each member of the business. Lastly, each member of the team has to work on self-improvement.

Make these into your goals.

DRIVE each other to achieve these goals.

Be GOAL DRIVEN!!

IF this is done, how could you – or anyone lose? Everyone wins.

So, to keep it simple, see the attached worksheet. Set your goals for each area, and every three months, ESCAPE to a place where there is no interruption, your “laboratory,” to confront how you did and make any necessary adjustments to your plans and continue your journey to your yearly goals.

Yearly Goals Worksheet — Link

Set aside 2 or more hours at the beginning of the year and the beginning of each new quarter (3-month period) to review your past and set new goals.

To do this, you must get away. Turn off the phones and remove ALL distractions. You are going to your Goals Laboratory and humbly review the past and boldly make new plans for the future.

You will fall off the rails, so every three months, you will have already scheduled time to review your failings and triumphs and reset. You can now get back on track and re-plan and go forward to the next three-month marker.

Use the worksheet to help you have a Goal Driven year.

Good travels and Bon Voyage.

— Ed

Yearly Goals Worksheet

Medicare, Yada, Yada, Yada: Fraud, Waste and Abuse Training.

OK, I admit it. Medicare is not the most glamourous topic to write about, nor does much of it pertain to our world of the chiropractic profession as we know it. However with that said, I am doing due diligence for you and fulfilling my duty to inform you of the necessary requirements a Covered Entity must follow (that’s us included!) to keep the Office of Inspector General off our backs and to help you take preventive measures so you’re not sending back reimbursement money you earned from providing patient care.

Because . . . based on my observations in the field – and this is a review for those of you who read our PM&A articles and utilize our library- how many of you know, for example, what a Part C Medicare plan is? How many of you know that all Part C providers are required to undergo annual Fraud Waste and Abuse training?

Second example: How many of you are aware that Medicare, starting in April of this year and going into April of 2019, is sending all of their beneficiaries new ID cards in an effort to do away with social security numbers for the sake of safeguarding identification?

So how do my two examples above directly impact you, your practice, and your bottom line?

Let’s circle back to the first example. A Part C Medicare Plan is known as a Medicare Advantage Plan. It oftentimes covers more services than a straight Medicare plan does. HMO/PPOs such as Humana and Blue Cross Blue Shield have developed their own Medicare Advantage Plans and offer them to their policyholders, your patients. A patient who signs up for an Advantage Plan must also be enrolled in Medicare A (hospital), and Medicare B (outpatient provider services). Medicare Part C providers to date have been required to, annually, undergo what is called Fraud, Waste and Abuse Training. Let’s take each of the three words and define them from the Medicare and Medicaid world.

  • Fraud is known intent to deceive in order to collect money from the Medicare program illegitimately.
  • Waste is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of office and/or practice resources.
  • Medicare Abuse includes practices that result in unnecessary costs to the Medicare program such as over or underutilizing services. You are probably familiar with the Quality of Care initiatives such as MIPS/MACRA and the EHR incentives, implemented to help combat abuse. Common types of abuse include:
    • Billing for unnecessary services
    • Overcharging for services or supplies
    • Misusing billing codes (upcoding) to increase reimbursement*

*Downcoding is also a misuse of billing codes. Stop doing it. Although not intended to increase reimbursement it is a red flag to Medicare, and your services will be questioned as to if they were “medically necessary.”

Back to the training . . . I urge you now to complete this training by the end of December. It is intended for doctors and staff. Download the PowerPoint below, read thoroughly and after completion have each staff and doctor sign off to attest, they read through the PowerPoint. The sign-off can be as simple as logging signatures and completion date in a notebook or a spreadsheet. It is not necessary to print out the PowerPoint. Oh, and many insurance contracts require this training as a contract obligation to be part of their network as well. You can access Medicare’s training PowerPoint here: Fraud, Waste and Abuse

Referring back to the second example of new Medicare cards. You can review our previous article and checklist here: New Medicare Beneficiary Indentifiers to be Assigned Your Patients

Your staff should be asking Medicare patients for their new cards, making a copy, and making sure the address in your practice management program matches the address the Social Security office has on file. If there is a mismatch like the patient has moved and not updated their address, you will have problems getting reimbursed. Make sure your Insurance Profiles in your programs have the new Medicare IDs.

Stay tuned for more helpful articles like this. If you have any questions on the above, contact me! I’m here to help.

Lisa Barnett
920-334-4561
lisa@pmaworks.com

And remember . . .
“The Future Will Be Our Results” (Clarence Gonstead, D.C.)

How to Deliver Goal Driven Extra-Ordinary Customer Service (Part 2 of 2)

“Our future will be our results.”     Clarence Gonstead, D.C.

How do we overcome these barriers to extra-ordinary service?

Let’s first define “service.” Service in a professional service firm or professional practice includes two categories:

A. Outcomes. These are the results from the provider.
B. Customer experience. This comes from what the customer experiences as they move along their pathway through your business.

Let’s begin with your goals.

1. Define and Commit to Your Highest Goals.

To create world class outcomes and service, you first need to review your most senior goals. Then, you have to ensure everyone understands them, agrees to them, and commits to doing everything possible to achieve them.

Setting purposeful goals over a lunch meeting does not take into account the sacrifice and effort that will be necessary to achieve them. You may commit to your own goals, but like New Year’s resolutions to go to the gym, you get distracted and discontinue after a few weeks. Some of your team may say they understand the goals – even agree to them – but in fact are only passengers along for the ride.

So, you should review and recommit to your goals each week. Be insistent, allowing for shortfalls now and then, but not compromising in the long run. Be true to your goals or make new ones. Spend time on these three:

a) Mission
This is the purpose of your office. It should be short and to the point and should include something about excellent service and outcomes and helping as many as possible.
b) Core Values
These are the standards for professional behavior and performance. List what values you consider most important in providing health care.
c) Patient Outcomes
Define where you are taking your patients. Relief care only? Or are you taking them further to better health and wellness?

Be true to your goals.

2. Outstanding Outcomes Come from Expertise

Because of your clinical skill, you can produce wonderful outcomes. But can you do even better? Here are some masters in their field as examples of professionals that never stopped improving their craft:

Music: Pablo Casals

Pablo Casals was a cellist – regarded as the best that ever lived. He was born in 1876 in Catalonia, Spain. In 1963 he was awarded the Presidential Medal of Freedom by President John F Kennedy, and in 1971, two months before his 95th birthday, he performed for the United Nations and accepted the U.N. Peace medal.

Casals was talented, but he practiced daily. There is a story about Casals and his training regimen:

He [Casals] agreed to have Robert Snyder make a movie short, “A Day in the Life of Pablo Casals.” Snyder asked Casals, the world’s foremost cellist, why he continues to practice four and five hours a day.

Casals answered: “Because I think I am making progress.”

Food Preparation: Chef Jiro Ono

If you want and value good sushi, Chef Jiro Ono is your guy. He was 92 at the time of this writing. He still works in his small restaurant in Tokyo that holds only 20 people at a time. The waiting list can be over a year. Still, at his age, he works on perfecting every aspect of the sushi, from selecting the exact right fish early at the fish market, to the exact texture of the rice. And every night he considers how he can improve on that day’s production. He is considered the foremost sushi chef in the world. (Jiro Dreams of Sushi, David Gelb 2011 documentary, Wikipedia)

“Once you decide on your occupation… you must immerse yourself in your work. You have to fall in love with your work. Never complain about your job. You must dedicate your life to mastering your skill. That’s the secret of success…… Even though I’m eighty-five years old, I don’t feel like retiring.” Jiro Ono (Jiro dreams of sushi, 2011)

Health Care: Clarence Gonstead

Clarence Gonstead was a chiropractor, born in 1898 and grew up in Wisconsin. In 1923, Dr. Gonstead graduated from Palmer Chiropractic College and began practicing. In 1939, he built a new chiropractic office in Mount Horeb, Wisconsin.

Because of the growth of his practice, a new Gonstead Clinic of Chiropractic was completed 1964. It was a two-level facility with 29,000 square feet. In 1965, adjacent to the new clinic, a full-service motel was built. Gonstead’s reputation as a remarkable chiropractor had spread beyond the United States and he had patients flying in from all over the world. To assist these patients, he set up a limousine service between the Madison, Wisconsin, airport and the Gonstead clinic about 30 miles away. Patients with their own private planes could fly in and land at Gonstead’s personal airport located next to his home on the outskirts of Mount Horeb.

With no marketing, his practice grew so that that he was seeing over 250 patients per day, working six-and-a-half days a week. He often treated his last patient at 2:30 in the morning.

Gonstead studied and improved his craft. He was not, as a founder of a chiropractic college would later say, a “commercial chiropractor.” He was focused on results and said: “Our future will be our results.”

Eventually, he began teaching others his system which is now recognized around the planet as one of the most effective and popular forms of chiropractic technique. He encouraged other chiropractors to study and to “Practice. Practice. Practice. Never stop.”

So, be like Jiro, Pablo, or Clarence! Use “deliberate practice” and look to see how you can improve your skills and methods so that your customers can achieve their goals faster and better.

Never stop improving your craftsmanship.

3. Delegate Administrative Duties to a Goal Driven Team

It is almost impossible to focus on excellent patient outcomes and run a growing business at the same time. You need a strong support infrastructure. This means professional team members that are trained and motivated to apply procedures that are both simple and effective.

Chiropractic works. Not having a smooth-running support structure is the primary element that is in your way from developing your practice to its full potential.

This has been the major focus of our work over the last 30 plus years. We have found that the better the support, the better the outcomes and the happier the doctor and staff.

Improve your people and systems.

4. Create an Upbeat and Supportive Work Environment

“If you go into any organization that’s customer-facing, you can tell in five minutes when the employees are feeling abused. They retaliate on the customers.”   Jeffrey Pfeffer, professor at Stanford University

The way the employees are treated directly affects the service that they will provide to the customer.

Sure, work can be stressful at times. Maybe someone snaps at someone else. This happens in any high-performance activity. But as long as we all share the same mission and values, we can address our personal slights to each other and move on.

It is everyone’s responsibility to create a cheerful work environment for each other. If you are having fun, so will our patients.

Smile more — and make work fun!

5. Give Your Patients Information. Educate Them!

“If I’d asked customers what they wanted, they would have told me, ‘A faster horse!’.” Henry Ford.

Of course, you give people want they want – what they consider urgent and important.

But people didn’t want a faster horse, they just wanted faster transportation. Horse, car, airplane… they wanted to get to where they wanted to go – faster. They just didn’t know about how simple, fast, and easy a Model-T was.

You must show them through education that you have what they want and need.

Most offices provide relief. That is what the patient is aware of and willing to pay for. But since you are providing a product that is not tangible using procedures that are invisible, your customer may have a difficult time understanding anything beyond the “quick fix.”

They may know they want more but lack the understanding of what is available.

I know I need to pay my taxes, but what I really want is to pay as little as possible. I also would like to contribute to my children’s education. With some education, my accountant could make me aware of different strategies that would take me to my full goal.

“Customers are thirsty for more information and knowledge,” according to studies by ThinkJar, a customer strategy consultancy.

To deliver your best and complete outcomes, you need your patient’s motivation to do so. It is a path and a partnership that you travel together.

The better that they understand their condition and your unique remedy, the easier it will be for you to help them achieve the best outcome possible.

The more they know — the further they’ll go!

6. Making the Patient’s Experience Extra-Ordinary

Making the patient experience “WOW” takes a team effort.

If studies show that customers discontinue a service mostly because of a lack of interest on the part of the service provider — and your own personal experience validates this fact, then the solution is simple. Just be genuine and interested in your patients. Be empathetic. Take the time to be totally present, in the “now,” and have “present time consciousness.” You only have 1 patient, and that is the one you are with, or about to see.

Then, when you practice with your team at team meetings, focus on this: the level of honest interest, curiosity, and care.

Practicing scrapes off the “barnacles” that attach to us all as we soldier through our work days. Here are some training tips for working on improving customer service with your team:

a) Review the Customer’s Journey

Lay out the pathway to and through your services. Do this with your team.

This begins even before your patients contact you. Who are they? Mom’s, seniors, kids? What brings them to you? What other solutions have they tried before they came to you? Get to know them and empathize with their condition.

b) Flow Chart

Then, list the sequence of actions, or a flow chart of what occurs from first contact through their first service and leaving. Drawing this out with your team will expose many areas for improvement.

c) The Walk-Through

Against this flow chart, you and your team can now look at where you can add more benefits for your customers.

I have found that practicing a “walk-through” reveals many hidden plusses – and embarrassing weaknesses, in service. The doctor or a team member takes on the role of a customer. They then travel some portion of the patient pathway with the usual team in their roles, acting as if they are dealing with an actual patient.

You are guaranteed to find areas where service can be improved.

d) Add More Value

Bain Consulting, an international management company, identified 30 different elements of value relative to consumer needs in an extensive study. They categorized these customer values into four categories:

    • Functional values, such as quality, variety, time efficient, simplicity, reduces effort, and reduces cost.
    • Emotional values, which included entertainment and fun, aesthetics, rewards, and attractiveness.
    • Life Changing values which included affiliations, community, and greater purpose.
    • Social Impact. An industry example was Tom’s shoes, a shoe company that donates a pair of shoes to underprivileged for every pair purchased by a customer.

In their research, Bain noticed that the companies that had the highest ratings on the most values had more loyal customers than the rest. They also found that these companies had faster revenue growth than others.

Good service pays. Great services pay even better!

With this in mind, look again at your flow chart and notice where you can add more value to your services. Start with the direct service to your customer, the “functional” areas of your business. For example, how could your customers receive their services:

  • Faster
  • More conveniently
  • Less expensively
  • With less effort
  • With greater simplicity
  • Receive child care while in the office
  • And also acquire a understanding their condition and their care program

In the next category that Bain used, what kind of “emotional” values could you add, including:

  • Fun and entertainment
  • Rewards
  • Design/Aesthetics
  • Attractiveness
  • Reduced Anxiety

The next two categories relate to higher purposes. “Life changing” and “Self-transcendence,” including:

  • Affiliation/belonging – Create a wellness or health club, have patient barbeques and get togethers.
  • Social Impact – Schedule yearly events to help the less fortunate, clean-up drives, and health and environmental causes.

In the years to come, Customer Service will take the lead in all your marketing efforts and will be the factor that sets you apart from comparable alternatives.

Edward Petty