Maintenance vs. Supportive Care for Treatment for Exacerbations

Posted on July 25, 2005 by Dave

The following article was written in response to a question from a client that had received a denial from an insurance company because the care was “maintenance”. Both the chiropractor and patient were fighting the denial without much success. With Medicare now requiring an “-AT” modifier, this subject is even more important for our clients. Here is the response in full:
Dear Dr. Smith,

Thanks for the fax and the information on this patient’s appeal. Very frustrating for you both I’m sure. The patient makes some great points in her email in that without care she will probably end up needing surgery or ongoing prescriptions for pain medications (is that maintenance care?). Here is a very long answer to your simple question.

To some degree, the difference lies in the eye of the beholder. If a patient is coming in every several weeks or once per month and is not getting better, but is just using chiropractic adjustments to maintain her present level of function and pain level, then by definition she is on maintenance care. Medicare and most insurance companies do not cover that.

On the other hand, if a patient has a chronic condition and suffers occasional exacerbations of that condition due to work or activities of daily living, that are alleviated and improved by chiropractic adjustments, that would not be maintenance care.

While a paid chiropractic consultant may disagree, your documentation generally will have to clearly show the difference in order to get continued coverage.

How the insurance company’s computer processes your claim is the first obstacle. They have specific parameters built into the software to detect and reject maintenance care. This starts with your diagnosis. If you are doing prolonged treatment using only a subluxation diagnosis, this is one of the red flags for utilization review. (I suggest you read A Doctor’s Guide to Record Keeping, Utilization Management and Review, by Dr. Gregg Fisher. It can be ordered by phone at 570-368-2413 and we were told it was priced at $59). Your onset dates (reported in box 14 of the claim form) should also be updated as you treat new problems or new incidents. The diagnosis should be updated to reflect what the primary complaint is at the time.

Obviously, if you bill 30 visits over a year and one half, and the last ten visits are once per month, and your diagnosis, treatment and onset date do not change the entire time, it “obviously” looks like you are providing maintenance care.

Your SOAP note and documentation may help you at this point. Once the computer identifies that your care is “maintenance”, you will need to submit documentation to support medical necessity. It is not sufficient to mark “exacerbation” on the SOAP and assume that they will cover it. What was the exacerbation? Camping on the weekend, gardening, snow shoveling, lifting the grandkids, starting the lawn mower – patients tell you when they come in what happened. This needs to be documented under the subjective section of your notes.

Your documentation needs to be consistent. On 2/23/05 your SOAP indicates “new injury” and “exacerbation”. Was there a new diagnosis and onset date? Did you do a brief exam for the new injury? You and I know what you are doing, and so does the patient, but your documentation has to support the need for ongoing care.

Per Medicare’s requirements:

“F. Necessity for Treatment

“1. The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by xray or physical exam, as described above.

“Most spinal joint problems may be categorized as follows:

“*- Acute subluxation: A patient’s condition is considered acute when the patient is being treated for a new injury, identified by x-ray or physical exam as specified above. The result of chiropractic manipulation is expected to be an improvement in, or arrest of progression, of the patient’s condition.

“*- Chronic subluxation-A patient’s condition is considered chronic when it is not expected to significantly improve or be resolved with further treatment (as is the case with an acute condition), but where the continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition, without expectation of additional objective clinical improvements, further manipulative treatment is considered maintenance therapy and is not covered

“*2 – Maintenance Therapy
Under the Medicare program, Chiropractic maintenance therapy is not considered to be medically reasonable or necessary, and is therefore not payable. Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy. For information on how to indicate on a claim a treatment is or is not maintenance, see §240.1.3

“Maintenance therapy includes services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.”

When you are billing Medicare with the “-AT” modifier, you are stating that the care was NOT maintenance. You will eventually get a routine random audit of your Medicare records and your documentation will have to support the level of care you provided.

Here is an excerpt from Dr. Gregg:

The following information is taken from A Doctor’s Guide to Record Keeping, Utilization Management and Review, by Dr. Gregg Fisher (Permission obtained.)

CHAPTER TWO — MAXIMUM IMPROVEMENT / MAINTENANCE CARE / SUPPORTIVE CARE
The information in this chapter is very important in today’s third party payment system. Some insurance companies may have a provision in their policies for supportive care but not for maintenance care. This is the case in Pennsylvania’s Workers’ Compensation law.

It is important to know the different characteristics of both so that you can document your treatment accordingly. Have you been told your bill was being denied because your patient’s policy did not cover maintenance care? If not, you are definitely in the minority. This is sometimes a common denial tactic on the part of’ the insurance carrier. Reviewers are sometimes asked to give an opinion as to whether treatment is supportive care or considered maintenance care. This chapter will show you the differences in both of these terms to allow you to better document your treatment. This chapter will also help you understand maximum improvement and how you determine maximum improvement.

WHAT IS MAXIMUM IMPROVEMENT?

Maximum improvement (Mercy): A return to pre-injury status or a plateau point where the patient fails to improve beyond a certain level of symptomatology or disability. End point of’ care unless there is documented evidence of a permanent injury.

The important point in this definition is a return to a pre-injury status and the end point of care unless there is documented evidence of a permanent injury. This does not necessarily mean that the patient may not need further treatment, but this means that the patient has reached a plateau where no further regularly scheduled treatment would result in a clinical progression. Some insurance coverages are only responsible for treatment to the point of MMI/MCI, so the declaration of a patient at maximum improvement may have an influence on who pays future medical bills.

HOW DO YOU DETERMINE MAXIMUM IMPROVEMENT?

Determining maximum improvement is sometimes asked during a review, But how can one accurately determine MMI (Maximum Medical Improvement)/MCI (Maximum Chiropractic Improvement) based solely on a records review? The answer to that is very easy. It is sometimes difficult to determine maximum improvement based solely on a records review, but we will cover some areas to key in on:

1. You will first look at the subjective and objective findings and analyze them. The doctor should have done progress examinations at least monthly to evaluate the patient. Look at the examination findings and compare to the previous month’s examination findings to see if there continues to be significant improvement or the findings are remaining static. For subjective improvement look at the history but also any outcome assessment forms that were used.

2. Factor in a reasonable healing time estimate with any documented exacerbations and complicating factors.

3. Has the length of time between visits increased? Does a gap in treatment of two, three, or four weeks result in no clinical deterioration? In other words, if the patient does not get worse with two, three, or four weeks between visits, they may be reaching or are at maximum improvement. Remember, the doctor may have a sufficient rationale for monitoring the patient at a two, three, or four week interval. (Monitoring a home-based exercise program for example)

4. Did the patient have any pre-existing conditions? If so, is the patient at their pre-accident condition even though they might have continued symptomatology?

Knowing when a patient has reached maximum improvement is very important. As you will see, maximum improvement is a part of the definitions for both maintenance and supportive care. How could you be performing maintenance or supportive care if you have not first declared the patient at maximum medical improvement?

WHAT IS MAINTENANCE CARE?

Maintenance /Preventive Care (Mercy): Appropriate professionally acceptable treatment usually for a chronic condition or after completion of therapeutic or supportive care, directed at a symptomatically stationary condition with anticipation of maintaining optimal body function, and usually provided on some routine or regular basis. Continued treatment after a patient has reached MMI, resolution, and/or stabilization of a condition would constitute maintenance type care in nature.

WHAT IS SUPPORTIVE CARE?

Supportive care (Mercy): Treatment/care for patients having reached MMI, in whom periodic trials of withdrawal from care fail to sustain previous therapeutic gains that would otherwise progressively deteriorate. Supportive care follows appropriate application of active and passive care including lifestyle modifications, it is appropriate when rehabilitative and/or functional restorative and alternative care options including home-based self-care and lifestyle modifications have been considered and attempted. Supportive care may be inappropriate when it interferes with other appropriate primary care, or when the risk of supportive care outweighs its benefits, i.e., physician dependence, somatization, illness behavior, and secondary gain.

Supportive care (NCRS): Supportive treatment is to be considered the continuation of therapeutic treatment once the patient has reached a point of maximum improvement, while experiencing some permanent impairment. Supportive treatment is considered appropriate when there is documented failure of clinical trial of withdrawal, appropriate alternate forms of treatment including home-based self treatment have been considered and/or attempted, and the supportive treatment does not interfere with any other primary treatment that the patient may be receiving.
WHAT ARE THE KEY DIFFERENCES BETWEEN SUPPORTIVE CARE AND MAINTENANCE CARE?

There are a few key differences between maintenance care and supportive care that distinguish the two. Maintenance care is typically rendered on a regular basis to help maintain optimal body function and usually when there is little or no active symptomatology or the symptoms have become stationary. Supportive care is not typically rendered on a pre-scheduled or routine basis. Supportive care is usually rendered on an “as needed” basis solely in response to symptomatic exacerbations. This may vary from case to case. The patient may only require treatment for a few exacerbations per year but the treatment required to treat these exacerbations is at the frequency at three times a week for two weeks.
WHAT ARE THE CRITERIA FOR SUPPORTIVE CARE?

CRITERIA FOR SUPPORTIVE CARE

1. The patient must be at Maximum Medical Improvement.

2. Objective evidence of a permanent injury. Ancillary diagnostic tests must correlate with clinical examination findings due to the false positive rates with some diagnostic tests.

3. There must be documented trials of treatment withdrawal that resulted in deterioration of a patient’s condition. A trial of withdrawal is having the patient go a specified period of time without treatment and then reexamining the patient to see if there has been a deterioration of their clinical status. The doctor would examine the patient and the patient would go one month or more months before they are reexamined, No in-office treatment is rendered during this time. The examination findings are compared to see if there was an improvement or deterioration on the part of the patient. This procedure can again be repeated. Failure of the patient to maintain previous therapeutic improvement would qualify them for supportive care if the other criteria are met. You may also release a patient from care and they continue to return to receive palliative care for symptomatic exacerbations. If the patient meets the other criteria, then they would qualify for supportive care. A conditional release (to be covered later) may also be used to show a deterioration of time clinical status without treatment and help justify the need for continued care.

4. Alternative treatments must have been tried.

5. Care is typically rendered on a PRN (“as needed”) basis in response to an exacerbation. The visits should not be prescheduled.

6. Frequency typically should not exceed one or two times per month but this may vary depending on the specifics of the case.

7. Supportive care does not interfere with any other primary care.

Since the typical frequency is one to two times per month, I would not recommend having the patient schedule every other week. If a reviewer picks up on this (and I’m sure they will), they may deny treatment because it is “prescheduled” and would be considered more of a maintenance type of care. Remember, supportive care is rendered in response to symptomatic exacerbations and is not pre-scheduled.

Long-term supportive care is treatment to return the patient to pre-exacerbation status and improve or maintain activities of daily living and/or work status. Mental attitude may be improved and time patient’s reliance on medication is decreased. Supportive care may also be rendered as a preventative to surgery. The doctor must understand the psychosocial involvement in chronic pain and avoid physician dependence as much as possible by advocating active involvement on the part of the patient.

WHAT IS A CONDITIONAL RELEASE?

A conditional release is when the doctor releases a patient on the condition that the patient does not experience an exacerbation of symptoms in a specified period of time. Recurrences of musculoskeletal complaints are commonly seen in practice, if you permanently release a patient and they suffer a recurrence one week after you released them, it may be difficult to convince the insurance company that it is still the same injury. The doctor would release the patient and specify a time frame, usually not more than 60 days. If the patient does not have a recurrence, they will be considered permanently released. A new injury would certainly not qualify. The recurrence would be only due to the patient’s activities of’ daily living and not a new mechanism of injury. The typical treatment would be relatively minor to resolve the patient’s recurrence.

For example, Mr. Smith’s subjective and objective findings have improved. Today he will he given a conditional release. If he has a recurrence of symptoms in the next thirty days he is to call our office and return for care. If he does not require care within the thirty day period, we will consider him permanently released from treatment of his injuries sustained on 1/11/91.

Using a conditional release will be a benefit to both the doctor and patient. I am sure that most of us have treated a patient and released them from care only to have the patient return for a symptomatic exacerbation. If this happens in the Worker’s Compensation or auto insurance system, there is a likelihood that treatment beyond when the patient was released will be denied by a peer reviewer. This scenario can be avoided by using a conditional release.

There is still some confusion on terms here between maintenance and supportive care. Dr. Gregg refers to supportive care as covered. Some insurance companies will still not cover supportive care per the wording of their policy (as it appears in your case). However, it still goes back to you documentation and billing practices. If you can clean those up, I think you stand a chance of getting this approved.

So, where would I go from here? I think you have to add a report to your records stating why you feel this should have been covered and adding information that may have been omitted from your notes (do not obviously change your notes). You will have to add this note and address the note in your appeal.

Please review your documentation and claim forms from the above perspective.

Now, all that being said, and assuming you have read this far, nothing in the above should stop or prevent you from providing maintenance care to your patients. Maintenance care is the heart and soul of chiropractic and vital for your patients and practice well-being. The fact that it isn’t covered by insurance is a fact of life. Come up with a maintenance plan for your patients so that they can pay cash or can purchase a wellness package. You don’t have to bill insurance or you can bill using the CPT code 99401. Usually this is denied, but it may help the patient with their deductible and may even be covered. Here is an example of one clinic’s policy on wellness care:

“The clinic will provide whatever services the doctor determines that you will need each visit (CPT code 99401 Risk factor reduction intervention provided to a healthy individual). This may include chiropractic adjustments, therapy and consultation.

“The fee for wellness care is $25.00 per visit and must be paid at the time of service. We accept cash, checks, Visa and Mastercard. We will not bill your insurance for this service, as wellness care is not considered a benefit of health insurance.

“If you develop a new condition, or are injured, or are in an accident. the doctor will decide if you can remain on the Wellness care program or if your case can now be billed to your health, worker’s comp, or auto insurance.”

Per the 2005 CPT code book, the 99401 code is used for: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes”.

I know for me personally, I’ve been adjusted for over twenty years. I usually get adjusted once every week or two. Often, it is for exacerbations of chronic conditions (driving many miles, sleeping in hotels, etc). Sometimes it is simply for maintenance (wellness) and prevention. Other times, like recently or when I first sought chiropractic care, it is for an acute condition or injury. I would guess 75% of the care I have received has been for conditions that insurance would cover, but it all goes back to how it is billed and how the documentation reads.

I hope this answers your questions.

David Michel

Get Outside to Promote in the Summer

Posted on July 18, 2005 by Edward Petty

It’s Summer. Get Outside!

Summer is a great time to promote your services.

Get a list of upcoming community events from the Chamber of Commerce and schedule a screening, talk, an information booth, your own participation, or just a visit. Be neighborly.

For example, local fairs or county fairs have been very good for special health screenings. There is often a run or walk as part of a donation program during the summer months which you and your staff can participate in it. We have seen offices proudly wear their office t-shirts, and recruit many patients to do the same.

Screenings still work, but they have to be well organized. Most importantly, the people doing the screenings have to want to be there and have fun doing them. Whether you do a screening, or run, or just show up with your friendly conversation and cards, there are many summer events for you to get out and do some networking.

Here are just some of the benefits:

Meet new people who can eventually become new patients or new referral sources.
Meet active patients and strengthen your relationship with them in a different setting.
See inactive patients and reactive them, or encourage referrals from them.
Get out get some sun and have some fun!

Overcoming The Challenges of Chiropractic Patient Education in the Pharmaceutical Environment

Posted on May 30, 2005 by Edward Petty

You may not know the extent to which your patients are being influenced to subscribe to the pharmaceutical model of symptom relief, but it is enormous. This short article gives some tips on how and why to combat it with effective chiropractic patient education.

Every now and then we send out information about our colossal health care system and the vested interests that profit most from it.

Why? Because it is within this macro-system that your patients, and their M.D.’s, are being bombarded by a constant stream of propaganda about “health” care solutions. It is good to know, and be reminded of, what you are up against in promoting your own services.

Our health care system and culture are under an all out assault by drug companies to sell their products. In 2003, roughly 15.7 billion was spent marketing drugs in the US, and this has been estimated to be increasing annually about 20% each year.1 Also in 2003, 4.8 billion dollars were spent in “detailing” physicians, which includes dropping off free samples at the doctor’s office, taking them to lunch, etc. Drug reps meet with individual M.D.’s an average of four times per month.2 Then, there is the estimated $750 million dollars drug companies have spent on lobbyists in the last 7 years to in influence Congress and Administration officials. 3

Why do they spend so much on marketing and lobbying? It pays. The pharmaceutical industry continues to be the most profitable US industry, with profit margins in the year 2000 nearly four times the average of Fortune 500 Companies.4

Driven by such marketing, “the value of the US pharmaceutical market is expected to top $330 billion in 2006…” “The US market will thus account for over 60% of the total Market Prognosis International market, up from 56% in 2001. US per capita expenditure on drugs will reach well over $1,000, which will be double the expenditure in Japan and three times that in the UK.” 5

Medical students, not yet caught up in the Medical-Pharmaceutical Complex, are protesting this kind of advertising. The American Medical Student Association (AMSA), the nation’s largest, independent medical student organization adopted, a policy at its annual meeting condemning drug industry-sponsored advertising and supporting medical school curriculum that prohibits pharmaceutical industry representatives from marketing to medical students. 6

Excellent service and care to your patients is the first step to successful practice. Good internal organization that supports this comes next. And effective marketing, both internally and externally comes third.

We consider patient education part of your marketing efforts, though it also has its clinical role as well. Marketing is especially important in chiropractic offices because of the leadership role you play in the health care system. Chiropractors and their staffs have been at the vanguard in natural health care for over 100 years.

Patient education is most effective, we feel, if it comes from a larger understanding of the health care system your patients are in. It works best when its mission is more than just to educate the patient, but to enlighten and motivate them into action. It has to counter the dominance of the medical-pharmaceutical forces bearing down on them.

The doctors we have seen who do the best at patient education have taken it on as a personal issue, as the medical students who protest drug reps. You and your staff have many opportunities to educate your patients: “table talk” in your adjusting rooms, in the reception area, during therapy, back care classes, report of findings, group report of findings, spinal care classes, newsletters, to name just a few. Pamphlets will help, but for it to be effective, it has to be personally driven by your passion and sense of leadership.

Once a month or so, we also recommend that you read an article or book relating to the this subject. The references below may be helpful in this regard.
1,2,3. New England Journal of Medicine, Meredith Rosenthal (www.therubins.com) 4. “Off the Charts: Pay, Profits and Spending by the Drug Companies”, a 38 page article found at www.FamiliesUSA.org Click here to go to article. 5. IMS HEALTH is a supplier of market research to the global pharmaceutical industry. www.ims-global.com/index.html Click here to go to article. 6. American Medical Students Association (www.amsa.org/news/release2.cfm?id=223

Form For Collecting “Med Pay” From Auto Insurance Carrier For Chiropractic Services

Posted on May 30, 2005 by Edward Petty

IRREVOCABLE ASSIGNMENT AND INSTRUCTION
FOR DIRECT PAYMENT TO DOCTOR
PRIVATE AND AUTO ACCIDENT AND HEALTH INSURANCE

Date:
To: (Insurance Agent)
Street Address
City, State Zip

Cc: Twin Palms Chiropractic Office
333 Oren Avenue
So. Grover’s Corners, WI 12345

From: (Patient Name)
(Patient Home Address) Cc: (Name of Attorney)
City, State Zip Attorney-at-Law
Street Address
City, State Zip

Re: Auto Policy (Policy Number)

DOI: (Date of Injury) Claim (Claim Number)

Attached Claims for Medical Services rendered by Twin Palms Chiropractic Office
To (Name of Insurance Agent) and (Name of Insurance Company),

I hereby direct and authorize you, as my Wisconsin automobile insurance carrier, to open a claim against the “medical payment” portion of my auto policy as I am entitled and to pay the reasonable medical claims incurred as a result of the accident of (date of accident or injury).

As per my policy and Wisconsin Statute, I direct you to pay medical payments for me as the policy owner, passengers of the vehicle I was driving and members of my immediate household This extends to those involved in the accident of (date of accident) including myself and : ________________________________________________

I hereby instruct and direct my insurance company to pay by check made out and mailed to:

Twin Palms Chiropractic Office
333 Oren Avenue
So. Grover’s Corners, WI 12345

for the professional or medical expense benefits allowable, and otherwise payable to me under my current insurance policy as payment toward the total charges for professional services rendered. THIS IS A DIRECT ASSIGN-MENT OF MY RIGHTS AND BENEFITS UNDER THIS POLICY. This payment will not exceed my indebtedness to Twin Palms Chiropractic Office or John Smith, DC, and I have agreed to pay, in a current manner, any balance for professional service charges over and above this insurance payment. In consideration forTwin Palms Chiropractic Office billing for services and not collecting from me at time of service, I understand that this authorization and direction is irrevocable for the accident of (date of accident). A photocopy of this Assignment shall be considered as effective and valid as the original.

I am aware that there may be other liable parties or insurers involved with this accident. Under Wisconsin Statute Ins 6.11, Section (3) Unfair Claims Settlement Practices, Subsection (a) 9, I am using the available medical payments portion of my auto insurance policy to pay for medically necessary care rendered by this clinic.

I also authorize the release of any information pertinent to my case to any insurance company, adjuster, or attorney involved in this case.

_________________________________________________ ____________________________________
Patient’s Signature Date

Patient Retention: Form for Determining Percent of New Patients Still Active After 3 Months

Posted on April 21, 2005 by Edward Petty

	Percent of NP’s Still Active After 3 Months
Number of NPs		NPs from three months ago still active	Percentage
October		January
November		February
December		March
January		April
February		May
March		June
April		July
May		August
June		September
July		October
August		November
September		December
Total		Total

EXAMPLE:

Percentage: NPs Still Active/NPs from three months ago = x 100.
Example: March 25 NPs still active from Dec. / December there were 30 NPs = 25/30= .833.
.833x 100 = 83.3%

	Percent of NPs Still Active After 3 Months
Number of NPs		NPs from three months ago still active		Percentage
October		January
November		February
*December*	30	*March*	25	*83%*
January		April
February		May
March		June
April		July
May		August
June		September
July		October
August		November
September		December
Total		Total

The Future of Chiropractic and What You Should You Do About It

Posted on March 16, 2005 by Edward Petty

THE FUTURE OF CHIROPRACTIC AND WHAT YOU SHOULD DO ABOUT IT NOW

Forecasted Supply of Selected Chiropractic Competitors

2002 2012 Percent Change

	2002	2012	Percent Change
Doctors of Chiropractic	61,000	70,000	15%
Physical Therapists	137,000	185,000	35%
Massage Therapists	92,000	117,000	27%
Acupuncturists	15,000	27,000	77%

Sources: Physical massage therapist numbers from the Bureau of Labor Statistics: Occupational Employment Projections to 2012. DC numbers and projects based on active non-redundant licenses. For further reference, BLS projections for chiropractors are 49,000 in 2002 and 60,000 in 2012. Projections for Acupuncturists are derived from Richard Cooper’s projections for acupuncturists from 2002 to 2015.

The above table was part of a new report predicting the future of chiropractic. Just published by the Institute for Alternative Futures, it offers 4 different scenarios by the year 2015, and recommends strategies doctors can take now to be prepared for the opportunities and challenges that await.

Their recommendations include the following:

Continue to strive for high standards of practice. “Empowered consumers and managed care plans will want to know more about what results to expect from your office.”

Some Marketing Action Steps: Provide Extra-ordinary service, and promote the results from outcome studies and patient surveys.

Develop greater integration with mainstream health care.

Some Marketing Action Steps: Work on and set up referrals sources, or alliances, with other doctors. Take advantage of recent opportunities with the VA and DoD. Provide pro-bono care in free clinics with other providers.

Anticipate and engage in consumer-directed care.

Some Marketing Action Steps: Look at your clinic as a retail business. Promote and advertise your good and effective work.

Prepare for the Future of Prevention & Wellness. One of the projected scenarios forecasts a “healthy life doctor”. “No aspect of health care has invented the business model for prevention and wellness. Chiropractors argue that they are closer to it than others and some (but only some) chiropractors do practice prevention.”

Some Marketing Action Steps: This is called “positioning” in marketing, and is a topic we will take up in more detail in upcoming newsletters. Medical doctors are NOT “Healthy Life Doctors”. People want health; just look at the number of books on the subject in any bookstore. This is the niche that chiropractors are in, and the sooner and more completely you own this area, the better. We believe that this is part of the new model for chiropractic, one that incorporates fitness, nutrition, and works with medicine as needed, yet retains its heritage, core services and principles. Do not make the mistake of abandoning “pain relief” as a major benefit of your services, just incorporate it into this model. Promote yourself as a “Health Doctor”, and provide services that are consistent with this concept.

Develop Geriatric Chiropractic. “One of the largest growth areas in healthcare will be geriatrics. The retiring Baby Boomers will look for alternative medicine that can help them to remain active and healthy.”

Some Marketing Action Steps: Promote yourself as a “Health Doctor”. Provide classes specifically for your elderly. For example: “Weekend Warriors: How To Maintain Your Knees And Shoulders Past The Age Of 50 Without Using Drugs Or Surgery.” Provide classes outside of your office to the elderly.

A Group Practice. Though not specifically recommended, this subject is referred to in their report. Most chiropractors are still solo. By practicing in a group you have more opportunities to fulfill the above recommendations and action steps. Associate doctor programs, partnership programs, multi-doctor, location, and discipline, we specialize in building and helping to susatain a prosperous group practice.

For help on implementing any of these recommendations, please drop us an email.

A very interesting article which you can find in full at: http://www.altfutures.com./

Spring Flower Seed Promotion

Posted on February 23, 2005 by Edward Petty

Flower Seed Promotion

A fun internal promotion is the Flower Seed Promotion used to generate patient referrals.

Spring is a happy time of year. Flowers bloom, life is renewed, and the activities of summer await.

Using this theme, you can encourage your patients to help their family and friends get in shape for summer recreation.

Attach a coupon to a package of flower seeds. You can attach the coupon with glue, a stapler, or plastic tape. Then, attach about 5 of these seed packages a poster. An example is below.

Spring Flower Seed Promotion

The coupon offers a free consultation, and exam, or screening, and or initial x-rays, and or 10 minute massage, and or flexibility testing, etc. Whatever you want to offer as a free health oriented service to the families and friends of your patients.

You may also want to place some of these posters around town, such as in laundromats, bookstores, etc. An example of the text for the coupon is below.

Valuable Coupon

To help you get healthier we are giving you a complete health examination and consultation all at NO-CHARGE!

(Please pass this offer along to a friend or family member if you are unable to use this valuable coupon.)

Please call us at (123) 456-7890 to schedule your appointment.

Offer good for anyone who hasn’t been in since 1/1/99 – Expires 5/14/99

name of office
location

(For active clients and member’s, a customizable version of this poster is available on your Member’s site.)

For more information about the Marketing Manager System interactive computer CD, click here.

(As with all promotions, be sure that you are in compliance with federal and state statutes.)

Monthly Marketing Managment Duties

Posted on February 22, 2005 by Edward Petty

Monthly Marketing Management and Coordinating Duties
[Note: This article has a special introduction from Marge, the practice marketing manager and coordinator who is featured in the Marketing Manager System Interanctive CD. For more information about this powerful marketing tool for chiropractors and their staff, click here.]

Marge, your Practice Marketing Manager

Greetings! Good job for making it through the month! I am sure that you and the entire team accomplished a great deal.

Here are your monthly duties. They include limited planning, and mostly coordinating ongoing activities. The planning we will do will be mostly special promotions, direct marketing projects that need specific scheduling. We won’t even question the recurring activities until the 3-month meeting. So, let’s take a look at how we did.

___1. Statistics. Get month ending statistics for “new patients” and “office visits”, and any other statistics that you are using.

___2. Sources. If available, determine the source of the new patients, which should be logged in your computer, or on the “New Patient Log” and “New Patient Tracker.”

___3. Planner/Calendar. Review the marketing planner or calendar, and check how each scheduled project for the past month did. Note if it was done, and if so, how effective the project was. Get the numbers if you can.

___4. Proposal and Plan. Work out a tentative plan of future scheduled activities as a proposal in preparation to the meeting with your doctor.

___5. Coordination Meeting. Meet with the clinic director and go over with him or her: a) what you have discovered about how the past marketing has been working and b) your proposed plan for the future. Incorporate her or his ideas and add to, revise, and or continue scheduled activities on your planner/calendar. This is a brief planning for the next 3-6 months and should last about an hour.

___6. Next Meetings. Reconfirm your next month’s meeting and your 3-month meeting.

___7. Goals. Set monthly goals for total new patients and visits at a staff meeting or with your doctor at this meeting.

___8. Coordination. Spend time to ensure that all projects are coordinated with all areas of the office, and any outside vendors or contacts.

____9. Publish Calendar. Print the calendar and post it on a bulletin board for the rest of the staff to review.

Fast Tips V: The Road To Wellness, Personal Demand, Patient Referrals

Posted on November 17, 2004 by Edward Petty

Getting Patients to Wellness You will get more of your patients on to Wellness Care if you ensure that each step of their treatment program is executed completely. Here is a simple exercise that can help improve the number of patients you have on Wellness Care, increase referrals, and enhance teamwork:Make a list of all the important procedures by you and your staff on key patient visits, such as Day 1, Day 2, Re-Evaluation Visit, Regular Visit, Transition to Wellness Care Visit, Wellness Visit, etc. This would include a thorough report of findings, a financial consultation, patient education during each visit, possibly a 6th visit micro-report, re-eval. after 12th visit, etc. Review and adjust this checklist regularly with doctors and staff against every 10th patient for quality case management.Many of your retention problems can be traced back to shortcutting of your own successful procedures. Making a list of all of your patient procedures from acute care to wellness care, and then ensuring that you and your staff actually DO each procedure, will greatly improve the number of patients you can get to wellness. For more information, click here.

Demand. A vital element to practice success is the use of “demand.” This is such an obvious ingredient that it is easily overlooked.What is demand? Webster defines it as: “to ask or call for with authority:…or insistently”. Having a dream, a goal, or a promotional plan is useless without the self-discipline to activate it. You have to demand action – from yourself, your staff, and your patients. And it has to be positive. Set short term and realistic goals and practical plans. Then, be unrelenting and insistent, accepting no excuse until you achieve your objectives.Interestingly enough, done correctly, your staff and patients will respect you more for it.

Don’t Ask Your Patients For Referrals. Don’t ask your patients for referrals. Tell them. Don’t beat around the bush and ask for permission. You don’t need approval to do this, or a license: you already have one. You are the doctor, and you have a responsibility and a mission. Most people just don’t know about chiropractic, or your specialized services.Timing, however, is important. Ensure the patient is appreciative of your care. Ideally, the she or he has mentioned something about a relative or friend, but this is not necessarily. Example: “Mrs. Jones, I would like you to bring your husband in so I could check his back.” Be direct and friendly. Done correctly, patients interpret your directness as honesty and genuine care, and often comply.

On the Road to Wellness. Retaining Patients by Using a Patient Progress Sheet

Posted on October 13, 2004 by Edward Petty

On the Road to Wellness.

Patient Retention: How to use the Patient Progress Sheet

The patient progress sheet is a checklist of basic administrative and clinical actions that need to occur for every patient to ensure that each patient receives complete care. On occasion, unimportant activities can be dropped out which can negatively effect the total quality of patient care, resulting in patients dropping out of care. By following this patient progress sheet, the doctor can ensure that all of the necessary actions on each patient occur.

The patient progress sheet should be kept in the patient folder, either as a full sheet of paper, or as sticky pad attached on the inside front cover. Each doctor’s office can determine what is most appropriate for his or her particular situation. A staff member can be assigned this duty to make sure that each Patient Progress sheet gets completed.

Example

Date Initial Procedure

__________ ____ Initial Paperwork
__________ ____ Pre-Consultation Video
__________ ____ Pre-Consultation
__________ ____ Consultation
__________ ____ Initial Exam
__________ ____ First Financial Consultation
__________ ____ X-Ray
__________ ____ Other Diagnostic Tests
__________ ____ Initial Payment
__________ ____ Scheduled for Second Visit

__________ ____ Pre-Report Video
__________ ____ Second Visit Report of Findings
__________ ____ Written Report of Findings
__________ ____ Second Financial Consultation
__________ ____ New Patient Orientation/Spinal Care Class
__________ ____ Multiple Appointment Plan Scheduled in Appointment Book
__________ ____ Scheduled for New Patient Workshop
__________ ____ Attended New Patient Workshop

__________ ____ Received Pamphlets During Care on visits:
__________ ____ 4. __________ ____ 8. __________ ____ 14.
__________ ____ 16. __________ ____ 20. __________ ____ 24.
__________ ____ Was Educated by Doctor
__________ ____ First Re-Exam
__________ ____ First Re-Report
__________ ____ Follow Up Financial Consultation
__________ ____ Second Re-Exam
__________ ____ Second Re-Report
__________ ____ Second FC-3
__________ ____ Third Re-Exam
__________ ____ Third Re-Report
__________ ____ Third FC-3
__________ ____ Fourth Re-Exam
__________ ____ Fourth Re-Report
__________ ____ Fourth FC-3
__________ ____ Re-Exam
__________ ____ Transitional Report of Findings
__________ ____ Transitional Financial Consultation
__________ ____ Released from Active Care
__________ ____ Started Wellness Program

Patient Birthday Cards

Posted on June 23, 2004 by Edward Petty

Sending birthday cards to your patients is a nice thing to do. You probably like to receive them on your birthday day.

But besides being a nice thing to do, the birthday card helps maintain the relationship with your patient. It can also be used to reactivate inactive patients, as well as help generate referrals.

Procedure

Order the birthday cards. These can be postcards, or, preferably, real birthday cards from the store or from a chiropractic supplier. See if you can get your office name embossed on the card. Post cards do not have the same impact as a real card, but are less expensive, fast, and nearly as effective.
The List. On the 15th of each month, generate a list of all upcoming birthdays for the following month.
Review. Review this list and delete any names that you do not want to send a card to.
Address. Have one of your staff address all the envelopes and place them in your room with the cards included.
Sign Each Card. Sign each card personally in blue ink, and add a note where appropriate.
Optional Certificate: Add a coupon for a free adjustment, or a discount on a service or product, but only if they come in during the next two weeks. If you offer a free adjustment, you may want to mention that they may need an updated exam and x-ray that is not part of the offer. However, you can also make it part of the offer if you want. You can also include a “Guest Pass” a friend or relative.
You may want to mention that this offer is good for all patients and their friends, but due to Medicare restrictions, Medicare patients may only receive the free massage.
Offers. Here are some examples of offers:
Free adjustment
Free adjustment and 10 minute massage
15 minute massage and examination (for guest or patient)
When the Patient Comes In. When the patient comes in for their service, you should do an initial consultation to ensure that they have not had any new injuries, etc.
After the Service. After the patient receives the service, provide them with a mini-report of findings and give them your recommendation for continued care.
Delegate. Delegate this program to one staff member. She should keep monthly stats and report these to you, including:
# BD cards sent
# Patients in off of BD cards
# Patients reactivating from BD visits
# Patient referrals from BD “Guess Passes”

The Front Desk Revisited

Posted on June 23, 2004 by Edward Petty

The Front Desk Revisited

It is a curious thing, the front desk.

Is it a receptionist job? Is it an insurance job? Is it a “do-everything-all-the-time-now” job? In most offices, it is one of these.

But what is it really? What should it be?

Ultimately, the answer is: what is going to produce the greatest ROI (return on investment)?

Over the last 15 years, in office after office, we have found that the front desk position can be a tremendous source of income that is overlooked. “How’s that?”, you say. Should they be selling more vitamins and pillows? Collecting more deductibles and co-pays? Of course they should, but that is not the point.

Think about if for a minute. What is the real function of the front desk?

There you are, the doctor. You are all ready to get to work. You go into your adjusting room and there is a patient waiting for you. Or, there isn’t a patient waiting for you and there hasn’t been for the last 45 minutes. That is the job of the front desk. Put simply, the front desk’s job is:

To keep the treatment/adjusting rooms always full, moving patients in and out according to their schedule.

Now, you can add on other tasks to the position, but very carefully so as not to distract from the primary purpose. If what you really want is a secretary or an insurance clerk, then get one.

Your ideal is someone who energetically AND cheerfully interacts with all your patients in such a way as to keep them all coming in as needed.

Your front desk assistant should be someone who is friendly. She should really like people. She should want to get your patients in to see you on a regular basis. She should be controlling too. Not mean, just not shy about insisting that Betty come in at 2:33, three times next week, and also bring her husband Fred in on Wednesday for a complimentary screening.

Give your front desk a grade and work to improve on it each month. A 1-10 scale can be used. “One” would be staff that are apathetic, who have tired forced smiles and a “whatever” attitude. “Ten” would be an energetic, friendly, and aggressive staff, like an Olympic volleyball team during a game.

Warning: even if you have the right staff, you and the systems in your office may hobble them and keep them from performing to their highest capability. Eventually, conflict will occur and they will leave. So having the right systems in place is as important as hiring the right people.
OK, let’s approach this from another angle. What is the MOST expensive bill you have to pay each month? Rent? Nope. Staff payroll? Uh-uh. Consultants fees? Hardly! The most expensive bill you pay every month is the lost revenue of uncompleted treatment plans. You can do the math, but let’s face it: most of your patients do not complete their treatment plans (assuming you gave them one!), let alone adhere to any kind of a maintenance program.

Let’s be honest. How many times have YOU started an exercise program and sort of had it drift away from you? Why are people hiring personal coaches or personalized diet programs? THEY WANT REGULAR COACHING AND SUPPORT because it WORKS. We ALL need some cheerleading and friendly nudging in this world of disappointments and inertia. People drop out from your program because the pain went away, because the pain did not go away, because of money reasons, or logistical reasons such as time and travel. We have all heard these analysis’s before. But, the reasons also include the fact that they just drifted away. All of these barriers, with the right amount of support from you, can be overcome. The front desk’s job is to get the patient in so that the clinical and financial aspects of the patient’s care can be tended to correctly.

Think about what kind of front desk YOU might need to keep YOU on your health program or New Year’s type resolutions?

With this in mind, look at the volume in your office and if it is not where it should be, review all the systems of the front desk first, including your personal influence. Then, review the personnel. Make the changes as needed. With the best systems and the right people, your front desk can ensure you are seeing as many patients as possible.

Patient Education Quiz and Drawing

Posted on June 14, 2004 by Edward Petty

Patient Education Quiz and Drawing

Patient education can become boring. The same old words, definitions, and scripts can lose their excitement after a while. During a report of findings you can get the feeling that even though your patients keep nodding their heads, like those of little dash board animals, they just don’t seem to get it.

One of the biggest problems in education is trying to keep things interesting. To help with this, you might try the following program. It quizzes the patients on their understanding about chiropractic and rewards them for their correct answers. It can be done once or twice a year to better educate your patients and add some extra energy into your office. As an added bonus, it will also better educate your staff.

Procedure

25 questions. If you are going to run the program for a month, you need to come up with about 25 health related questions. These can be defining chiropractic terms, such as “subluxation” or “vertebra”. You can also add questions that often come up in your adjusting room. For example, “What makes the pop sound when I get adjusted?” To involve the staff, set time aside at a staff meeting and work out some of the questions. For each question, come up with a simple and obvious answer. Then, come up with two “decoy” type of answers. Don’t be too much of a perfectionist here. Again, keep it simple.

White Board. Each adjusting room and reception room should have a white erasable writing board, or a chalk board. Each morning, a designated C.A. should write down the question in each room with the three answers. Slips of paper should be nearby with a pencil for the patient to write down their answer. Large printed posters can be used if there are no white boards available.

Answer Box. A box should be placed on the front desk with a small sign saying: “Chiropractic Quiz Answers Here.”

Drawing. At the end of the week, all the correct answers are placed in a pile. From this pile, a slip is randomly selected. The patient is informed the next week that they won the drawing.

Prizes. Prizes can be nutritional supplements, pillows, free massage, or anything of a reasonable amount (less than $40.) They also could be modest gifts from local businesses that are also your patients.

Duration. The program can last one week, or an entire month. The drawings should be held weekly. December is a good time for this internal program as external promotions are less effective.

Promotion. You should promote this drawing with a poster and by word of mouth. You could call this “Chiropractic” or “Health Education Month.”

Fast Tips I

Posted on June 14, 2004 by Linda

Chiropractic Quiz. Once per quarter, promote an internal drawing for modest prizes based upon a drawing of patient quizzes. Make up a list of eight to ten easy questions asking for the definition of “subluxation”, some questions about the office (how long has the our office been here?), history about chiropractic, and maybe referral question like “At what age should kids get a chiropractic check-up?” All the answers should be available in pamphlets, wall posters, or even from the staff. The staff then grade each quiz and all that are 100% go into the drawing for prizes donated or bought from local vendors (who are ideally also your patients). This could be a part of a special “Chiropractic Education Week.”

Card Quota. An “old school” program that works because it forces you to communicate, promote and network. Set a modest goal each morning of how many cards you are going to hand out, come rain or shine. Don’t be too ambitious, because you can’t go home until you have reached your goal. This is a disciplined program. This is a little bit like doing push-ups – It can seem tedious, but if you make a habit out of it, you will have a stronger practice.

Special Promotions Scheduled. Schedule at least two special types of promotions over the next six months, such as a special appreciation day for your local firemen, seniors, or some other group, or schedule a “Chiropractic Education Week.” And remember, October is just around the corner, and it is as “National Spinal Health Month”.

Outside Sign. If you can get a marquee installed next to your outside sign, do so. Promote your upcoming events on it. Work out a monthly schedule of announcements mixed in with motivational quotes. Keep changing the marquee.

Fast Tips II -14 Fast Tips That Work

Posted on June 14, 2004 by Edward Petty

14 Fast Tips That Work

Planner. A marketing planner or calendar is to marketing what your appointment book is to the front desk. Until a marketing project is scheduled, it is just a wish. Give all marketing projects a date, even the ones planned six months from now.
Marketing Coordinator. Assign a staff member the role of “Marketing Coordinator” for the office. It is a part-time role that makes sure that all marketing plans are coordinated and get done. You already have someone to coordinate your front desk and your billing and collections, why not your marketing too? Should take less than two hours per week.
Delegate. All marketing projects should be delegated to the marketing coordinator and/or other staff and doctors. Avoid projects that become orphaned: make sure they are assigned.
Past Successful Activities. If it worked once, it will probably work again. Have a staff meeting and review your best months. Make a list of what you were doing when you had your “best-evers.” Schedule them again, or establish them as recurring procedures.
Staff Education. Do a quick reality check: Survey your staff individually for the definition of “V.S.C.” or just “subluxation.” Ask them to explain the consequences of a subluxation. You may be surprised to find that they knew less than you assumed. At least twice per month, during staff meetings, teach your staff not only the basics of chiropractic, but its history as well. Too many doctors take for granted that their staff understands the powerful dynamics at stake with a subluxation. A better-educated staff is more motivated, more capable, and more active in patient education.
Office Mission. Work out a simple statement of the mission of your office, and ensure that it is oriented both around quality care and quantity of care. Once every other month, quiz your staff on this mission, and review it yourself. Alter it, as needed, every six months so that it reflects the purpose of the office.
Morning Rally and “Pre-view”. Doctor and staff can start each day by getting to the office at least ten minutes before the first patient and “preview” the day: plan out promotional, patient educational, and service actions for that day, and end on a motivational theme.
Change the Office. Every 3-6 months, make minor rearrangements in the office. It is easy for those patient educational posters to become invisible in a few months after you have looked at them for 700 times. Rearrange the paintings and posters, paint a wall, or put in a new carpet. Keep your office fresh and new.
Patient Successes. Too often, doctors and staff take the miracles of chiropractic for granted. For a quick shot of motivation, collect patient successes and at least once per month review at least five of them together.
Compliments. Doctors are trained to find what is wrong, and fix it. Too often, what is right goes un-acknowledged. Since you want more and more “right” things to occur, acknowledge them now and then with the patients and with the staff, especially for excellent job performances.
“What’s New in Chiropractic”. To help prompt doctors to “Inform While they Perform,” and to encourage patients to ask questions, post news articles about chiropractic or issues relating to health and chiropractic on a bulletin board in the reception room, adjusting rooms, or other locations where patients will take notice.
Waiting Room. Get rid of your “waiting” room. Always call it your “reception room” and make sure that patients are well “received”.
Unclog Your Front Desk. Many front desks have a tendency to gradually become “clogged” with extra paperwork. Slowly, processing paper or entering data into a computer can become more important than working with patients. Get rid of extra work on the front desk, and allow the front desk staff to spend more time working with patients and generating referrals.
Front Desk Purpose. Here is a secret: a primary purpose of the front desk is to get and keep the appointment book full. Go over this with your staff, and trim away extraneous work that is not related to this job, get your front desk staff focused on this

Fast Tips – III: Summer Time Tips

Posted on June 14, 2004 by Edward Petty

Fast Tips: III SUMMER MARKETING IDEAS

Summer is a great time to promote your services. Actually, it is always a great time to promote your services, but the summer months provide unique opportunities that are relatively easy and inexpensive. Here are some ideas:

Screenings. They still work! The problem with screenings over the years is that the old posture analysis machines, whether made out of PVC tubing or flashy chrome, have been used by two or three chiropractors at every outdoor summer event since the mid 80’s. This has a tendency to get boring if not annoying to potential screenees. Additionally, with closed panel insurance plans, the office that screens a potential patient is often not a provider for the insurance plan of the person whom they are screening. So, it can be tougher than it once was. Despite this, we have offices that still produce new patients from screenings.
The most important ingredient to any successful screening is the attitude of those doing the screening. Are they upbeat, forward, friendly and talkative, motivated by a strong sense that people need to be free of the stresses that your office can remedy? The second most important ingredient is a thorough objective and/or subjective screening done with excellent communication. And of course, third, where appropriate, the scheduling of the appointment.

To update your screenings, and make them more productive, you can bring in other testing tools, such as SEMG, Metracom, etc. You can also offer different and more services. Consider “flexibility testing,” computerized range of motion or “joint mobility testing,” back and neck analysis, etc. You can also offer a free “pressure point” check, a five-minute massage for all local community members who get a posture analysis, a drawing for a free ice pack for anyone who receives a complimentary spinal screening, etc. You should also try to do cooperative screenings with other chiropractors if you can find out ahead of time who is planning to participate in the event. You can also set up alliances with other chiropractors, or other doctors such as podiatrists, dentists, etc., while at the event. These alliances can also serve you long after the screening event is over.

But most importantly, invest in the people doing the screenings. Their skill and commitment is more important than testing machines. Limit screenings to 4-5 hours maximum per staff, if possible. Keep it fun. Make sure there are enough people to help, and set up a training or rehearsal time beforehand to go over and practice, if necessary, the screening procedure. (We can help with the training.)

One other note: Screenings are both direct and indirect marketing. That is, although you should work to get appointments made for a complimentary consultation and exam at your office, you should also use this time simply to network and hand out cards. Nothing works better than face-to-face marketing in our media saturated environment. Even if the person does not come in immediately, if they had a good experience with a friendly person, they will be more likely to see you in the future. We have seen people make appointments months later from screenings, or from other sources such as patient referrals, that said they had also talked to the doctor or staff at a screening event. 6 If your screenings are not up to par, or if you are not sure screenings are for you, give us a call.

If you don’t want to do screenings, (and even if you do) there are plenty of other activities in which to become involved.
Networking. There are so many outdoor events, from pancake feeds to runs, special picnics to fishing competitions, that you can’t help but bump into half of your community just by walking around. You can attend for just an hour, buy some food, talk to an old acquaintance, meet new people, find some way to interact, and of course, hand out volumes of cards.
Donations. Many activities will accept a donation from your office, which helps to support their event or cause. In exchange, they promote you and your services. Since these are usually local and informal events, the promotion acts as an endorsement from the local event leaders in your neighborhood.
Participation. Many events, such as a run or a community barbeque, simply require your participation. Get out there and help flip hamburgers while wearing your office T-shirts and get active with those who are also active. Find a list of upcoming events in your local newspaper, on the Web, or from your Chamber of Commerce and schedule you, your family, and your staff to attend this season’s summer activities, playing in community near to you…

Fast Tips – IV: Extraordinary Service

Posted on June 14, 2004 by Edward Petty

Fast Tips IV: EXTRAORDINARY SERVICE TIPS

Regular service is not enough. Your service must be extraordinary. Actually, that is not really hard to do today. The care that is provided by many service companies, including health care clinics, is very poor, and by some estimates, getting worse. With a lack of quality employees, high turnover, the stresses of insurance cutbacks, and higher overhead, staff services are less than what they once were. Yet, more than ever in this e-world of internet transactions, the companies that provide the best personalized service are the ones that will not only retain their patients and customers, but will be the ones that generate the most word of mouth referrals. Here are some tips to improve service:

1. No Waiting. This is a consistent complaint from patients in our office surveys. If a patient has to wait more than 15 minutes, give them the service for free. That is a penalty for you and the staff, and an incentive to remedy one of the most common patient complaints. Also, give patients something to do if they have to wait, such as a survey, a success story form, an interesting chat with a staff member, an upbeat magazine that they are interested in, etc.

2. Personalize. Learn something new about each patient each day. This could be where they grew up, if they have ever ridden a horse, whether or not they hunt or knit, or what is their favorite type of pie. Ask the staff to do the same. This will force you to be interested in each patient as a unique person, and not just the 342nd office visit for the week.

3. Sweet Day. Have a desert day! Make it at the end of the month and provide deserts for everyone who has kept their schedule (more or less — don’t be too strict!) for the entire month. Survey your patients during the month for their favorite deserts, and give them multiple choices, as simple as possible. Remove all guilt by promising that there will be no sugar or fat added, and that they all deserve the deserts anyway. You will get no arguments, and you will be very popular.

4. First Visit Calls. This is an old standby. The doctor should call the new patient after the first adjustment. Call the patient from your car on the way home, from a restaurant, or while you are skydiving after work. Make it short and sweet, and your patients will be very impressed by this demonstration of your personalized care.

5. Golden Rule. Treat each other, staff and doctors, in a way that provides the most service to each other. How can I make your job better? What can I do from my job that will help you do yours? These questions can be asked amongst staff members and doctors. By giving extraordinary service to each other, you will set an example and create a climate for extraordinary service to the patients of your clinic.

Components of Patient Retention

Posted on June 10, 2004 by Edward Petty

There are three keys to retention, in this order of importance:

Rapport. A bond of friendship, a relationship based upon the patient’s sense of being understood and cared for, and cared about, by the doctor. Be genuinely interested.
Control. The doctor knows best. That is why the patient is seeing you and paying you. The patient will feel more secure and confident if they feel that their doctor is in precise control of their specific treatment program. They can gain this experience from you by your friendly assertions to comply with what you recommend for them. Be the boss.
Education. You can talk and you can tell, and you can have posters and videos and give lectures, and even these may not help get the patient to appreciate the need for continued care. However, you should do these and more. You are competing against not only an entrenched bias towards an “outside-in” approach, but a cultural tendency for the “quick fix”. Additionally, you are up against a continuous bombardment by industries with a vested interest to sell their pharmaceutical and medical products and services. Never give up on patient education, however. Use examples of any fitness program. It takes time, it takes repetitive work, and it takes effort. You can write that down. (I knew a chiropractor who wrote this done on the patient’s x-rays while giving a report of findings!)

TIME
REPETITION
EFFORT

Freedom from pain comes ultimately from being healthy, which has to be maintained more than obtained.

Education as a whole can be very difficult. It is a skill you have to develop. It is best done in person. You are a doctor, a teacher. The education has to be simple: you have to relate it to real conditions of the patient and people they know, you have to be interested in the subject, and the education has to be just a bit entertaining.

Special Event: Health Care for Kids

Posted on January 28, 2004 by Edward Petty

Kid’s Health Care Event

Once or twice each year, you can hold a special event in your office called “Kid’s Day”. This is a special day that draws attention to the effectiveness of chiropractic care, as well as its importance in the total health care of children. Its objective is to generate goodwill in the community and in your office, better educate your patients who have children on natural health care, and to definitely generate new patients. The following outline lists out some of the specific action steps which will help you to make your “Kid’s Day” a success.

Objectives for Kid’s Day

The first objective for Kid’s Day is to better educate parents on the importance of regular chiropractic checkups and the tremendous benefits of chiropractic care for children. This would include mostly your patients, but you should also get other parents in as referrals from your existing patients.
We want to create goodwill with your patients, as well as members of your community who are not your patients. You can do this by providing complimentary services and add “extra value” in your current services on Kid’s Day.
We want to generate new patients from the parent’s referring in their kids of all ages. This can be grandparents referring in teen-aged children, as well as middle aged children bringing in their younger children.

Action Steps

Duration of Promotion. “Kid’s Day” can also be promoted as “Kid’s Week” or “Kid’s Health Awareness Week”, “Back to School Health Check-up Week”, “Back Pack Safety Day”, or any other term that seems appropriate for your community. Read through the following action steps, and then decide if you want to have your promotion cover one day or an entire week.
Date of Promotion. Kid’s Day or Kid’s Week is usually held in the Spring or Fall. In Spring, it is usually held in April or May, as spring sports and summer activities begin. Spring vacation is also a good time.It can also be held as a “back to school” promotion. Some offices prefer to have their back to school promotion during the last week or two of vacation, in preparation for school, and some offices prefer to have it after school has begun. Usually, we have found that Kid’s Day works best once the children are in school and back from their vacations. You can call your local school(s) and ask them when they are recessed for either a holiday or a school administrative day where the children will not be in school. If you can set up your Kid’s Day in conjunction with a non-school day, this will make it easier for the parents to bring their children.
Saturdays are a great day to have a Kid’s Day, with Saturday morning cartoons, etc. Thursday also works well, however be prepared for a very busy evening, as kids will be coming in after school if you have it once school has begun. You want to schedule your Kid’s Day during a time when it will not be disruptive with the regular flow of patients.
What is Being Offered. Make a list of all the things that you will be offering to your existing patients who have children, former patients who have children, to your existing patients who are children, and to your community who have children. These can be complimentary scoliosis checks, complimentary exams and x-rays, and a complimentary lecture for patients and their friends and family, and back pack posture checks. For existing kids, free adjustments, crayons and coloring books, prizes and contests, etc.
Special Class Just for Parents. About two weeks prior to your Kid’s Day, you can schedule a special lecture on “Natural Health Care Methods for Children”. Schedule your existing patients to come to it and send out a mailer and flyer to your patient base promoting this special lecture. This is a very important function for the front desk. The FDCA needs to keep a list of who will be attending the lecture and schedule them, as well as friends and family of those patients that she is scheduling who will also be attending. For example:”Mrs. Jones, may I schedule you for our special workshop on Natural Health Care Methods for Children next Thursday, at 6:30 p.m.?”
“Yes, Sally, I would love to go.”

“Great, Mrs. Jones, I have you scheduled for our workshop. It starts at 6:30. Now, Mrs. Jones, do you know any other parents that might benefit from learning more about natural health care methods in raising their children?”

“Hmmmm, why, yes, Sally, I do! My next door neighbor, Mrs. Smith, is always taking her children to medical doctors and I think that she would like to know about other alternatives.”

“That’s great, Mrs. Jones. May I schedule her with you as well?”

“Yes, for the time being. I don’t know yet, but I will talk to her about it.”

“That’s okay, Mrs. Jones. I will put her down as a tentative attendee, and tomorrow, when you come in, we can confirm it. Here is some information about the workshop and a pamphlet on health care methods for children that you can give to your neighbor.”

“This is great, Sally. Thank you so much. I am sure that she will want to come. I will call her tonight and I will confirm it with you tomorrow when I come in for my next adjustment.”

The workshop should cover topics that are of concern to parents, which might include: colic, earaches, scoliosis, diet and exercise, Attention Deficit Disorder, bedwetting, and any other problems that your patients may have expressed concern about.
Extra Services to Children Who are Not Yet Patients. During Kid’s Day/Week itself, all children who are not active patients may receive complimentary consultations, scoliosis examinations, ear examinations (optional), and x-rays (optional).
Current patients who are children. All current patients who are children may receive one free adjustment or therapy, on Kid’s Day or during Kid’s Week.
Other Offers for Children. On Kid’s Day/Week, there should be special videos for children to watch, such as cartoons, movies, etc., that are popular and that they would enjoy. There can also be special gifts, such as erasers with your clinic’s name on them, pencils, rulers, balloons, stickers, crayons, and even chiropractic coloring books. You may even want to throw in treats, such as a few pieces of candy, popcorn, a granola bar, etc. These can be put into little plastic bags with your clinic’s name on them, and handed out. You can also make up and give them and their parents a special certificate offering them a free adjustment or examination on their birthday, as well as a special treat if they come in on their birthday appointment. This treat could be an inexpensive toy, as well as perhaps a birthday cupcake. Also, it would be nice if a costumed character from a popular kid’s television program (Sesame Street, Power Ranger, etc.) was at your clinic during Kid’s Day. Make sure that this is promoted in all advertisements, fliers and newsletters.
Kid’s Contest as an Additional Offer. You can hold a drawing or coloring contest/essay contest for children. You can divide this into two to three age groups, have them draw/write about something depicting “how chiropractic has helped you” or “how chiropractic helps people”, etc. Then judge which one is the best, and give the winner in each age group a $50 treasury bond (cost to you is $25), a gift certificate to a local video store, record store, or Chuck E. Cheese, etc.
Additional offer for parents. Besides the special lecture on “Natural Health Care Methods For Children”, you can put together a special informational pack for parents regarding their child’s health care. Also, any parent who has kids under chiropractic care, or any parent who brings their kids in during the Kid’s Day/Week, you can give them a special gift just for them as parents. This could be anything from a book or booklet on health care for children, a humorous book or booklet about the travails of parenthood, or some other gift, such as flowers for the mothers.

Promoting Kid’s Day or Week

There are many different ways to promote this special events, these include newsletters mailed to existing patients (active and inactive), posters put around the office, press releases put in your local newspapers, newspaper ads in local news-papers, public service announcements for the radios, radio advertisements, and most importantly, doctor and CA promotions in the office to existing patients and the scheduling of them for their attendance.

Newsletter. Send the newsletter out so that it hits the patient’s homes ten to fourteen days before Kid’s Day and one to two weeks before your workshop on kid’s health care for the parents. Include in the newsletter promotional announcements about Kid’s Day or Week as well as the lecture. Also include some informational articles about kid’s health care and maybe a recipe for kids to use, etc.
Personalized letter. If your computer has the capability to do a mail merge, the doctor can also write a personalized letter to just those patients who are also parents.
Posters. Posters can be placed around the reception room and the treatment rooms promoting the offers for Kid’s Day or Week as well as the special lecture on kid’s health care. It should be on brightly colored paper. They can also be placed on bulletin boards around town, such as grocery stores, libraries, YMCA’s, pre-schools and day cares centers.
Answering Machine. As an extra promotional action, you can change the message on your answering machine to something as follows:(Recorded by a 10-11 year old girl)
“Hi, you have reached _______________ chiropractic office. Our office hours are _________________. If this is an emergency, please call ______________. Remember, Chiropractic is for Kids, Too!

You could ask a patient’s child to record the message and this gets more people participating in the program.
Office decorations. You can get some balloons and put them around the office and hand them out to the kids. Small helium tanks (portable) can be rented for a very nominal fee. Special toys can be brought in and placed around the office and Barney and Walt Disney videos can be playing on an extra TV set. If you are having a coloring contest, put up on the walls all the posters from the kids that have entered the contest so far.
Patient Statements. You can also include the newsletter or letter-size poster promoting Kid’s Day in the patient statements. And/or you may be able to have it printed right on your patient’s statement by your computer. Make sure that the statement is sent out well ahead of Kid’s Day.

Literature for Patients. Collect information on chiropractic and health care for kids. Assemble a pack for each patient that includes pediatric information from magazines and journals that you want to have your patients read. Also in your newsletter and in handouts, collect one or two nice success stories from patients talking about how chiropractic has helped their children.

Office Policy: Family Check-Ups

Posted on January 28, 2004 by Edward Petty

This is an example of an office policy regarding patients and their families’ health care. This can be edited for your office as appropriate, and implemented as a routine procedure.

[OFFICE LETTERHEAD]

TO: ALL STAFF/DOCTORS

Our office has a policy that all family members are encouraged to come in for a no charge “Checkup”. The checkup is a brief consultation and screening.

There are a number of reasons for this.

1. Spinal abnormalities can be generic, and though the family member may not be experiencing any symptoms, it can never hurt to get the spine checked.

2. Additionally, part of our mission is to reduce the incidence of back problems occurring due to long time untreated and unknown spinal misalignments. It is much easier to align the back before major problems occur. Many spinal problems start without any sign or symptom and it is easier to correct them if we can detect them before they become chronic or the patient gets older.

We unfortunately see many people only after a major injury or problem occurs, and then it takes a great deal of work to correct the problem.

Compare this to dentistry. Often, a dental problem can exist long before any pain or symptoms show up. With just a little work, the dentist can correct the problem and prevent a more serious condition in the future.

3. We firmly believe that an ounce of prevention is worth a pound of cure.

4. Lastly, this is courtesy we provide to all of our patients.

This can be explained nicely during the financial consultation/post report of findings. It can also be explained to the patient during the 6^th visit, or re-evaluation visit.

For example: “Mrs. Jones, I am not sure if Dr. Smith explained to you our “Family Check Up” policy. Because we want to make sure your entire family is healthy, Dr. Smith recommends that all the family members of each patient get scheduled sometime for a complimentary spinal screening. There is no charge for this and it only takes a few minutes. Sometimes, children can have similar problems with their spine as their parents.

You can bring your family in at the same time as you come in for one of your appointments. Just let us know beforehand, and we will schedule an extra few minutes for the screening. We would like to do the screening of your children and (husband/wife) with you present so you know what is going on with them. We can make a schedule for you today, or you can call and let us know at your earliest convenience.”

Obviously, try to schedule them that day, but if they do not schedule, schedule a follow up consultation after the fifth visit or twelfth visit in order to implement the “Family Checkup Policy”.

Observations

observations from our travels in the world of chiropractic

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Get Outside to Promote in the Summer

Overcoming The Challenges of Chiropractic Patient Education in the Pharmaceutical Environment

Form For Collecting “Med Pay” From Auto Insurance Carrier For Chiropractic Services

Patient Retention: Form for Determining Percent of New Patients Still Active After 3 Months

Percent of NP’s Still Active After 3 Months

Percent of NPs Still Active After 3 Months

The Future of Chiropractic and What You Should You Do About It

Spring Flower Seed Promotion

Monthly Marketing Managment Duties

Fast Tips V: The Road To Wellness, Personal Demand, Patient Referrals

On the Road to Wellness. Retaining Patients by Using a Patient Progress Sheet

Patient Birthday Cards

The Front Desk Revisited

Patient Education Quiz and Drawing

Patient Education Quiz and Drawing

Fast Tips I

Fast Tips II -14 Fast Tips That Work

Fast Tips – III: Summer Time Tips

Fast Tips – IV: Extraordinary Service

Components of Patient Retention

Special Event: Health Care for Kids

Office Policy: Family Check-Ups