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Tag Archives: chiropractic
Recognizing Greatness in Our Teams
Synergy and the Balanced Business
Linda Skiles,
Wisconsin Chiropractic Assistant of the Year 1990, 2024
We are all busy helping our patients, clients, and customers. That is what we do.
As a doctor and business owner, you have spent years learning your skills and spending fortunes investing in your business. You have sacrificed personal and family time to make a go of it. Your attention is on service, outcomes, and the bottom line. This is understandable and correct.
But sometimes, a key element of the practice gets little attention.
I have seen this in other offices as I have seen it in ours.
A business has 2 major parts. It is like a yin-yang engine. One side of the formula pushes, and the other pulls. One side is production and services, and the other is support and organization, like a car engine with driving pistons and other moving parts supported by the stable engine block.
To the degree each side, each component supports the other, the faster the engine will go.
This is synergy.
The support and organization side of the business engine does not always get the recognition it deserves. Most employees, at some point, have wanted to improve their practices and have been eager to do so.
We live in a mostly thankless world with constant negative reinforcement. We often don’t acknowledge the excellent work of our staff, our patients’ successes, or even our spouses’ contributions.
I feel that all chiropractors and their staff should take time off every month just to celebrate their successes and acknowledge their grit.
LINDA SKILES
This brings me to our Linda Skiles. Linda is our practice manager and is the C.A. to all our offices – doctors and staff. She has worked with us since 2001. She may have worked with you in one manner or another.
This weekend, in front of 400 or so in attendance at the fall convention of the Chiropractic Society of Wisconsin, Linda was acknowledged as Chiropractic Assistant of the Year.
Linda began working for a chiropractor in 1985. After he retired, she worked for another group practice here in Wisconsin. She then began working for Petty, Michel & Associates.
In 1990, Linda was awarded Chiropractic Assistant of the Year by another Wisconsin association, the Wisconsin Chiropractic Association.
In addition, she has volunteered her time to many chiropractic projects and local community activities in her small country town here in Wisconsin. She has received numerous private commendations for her good work over the years and sets an extraordinary example of team member work ethics.
She gets things done!
In 2023, she completed the Practice Manager MBA program and is now in the Practice Manager Internship and Certification Program.
Linda has contributed to the profession for 39 years and is not about to retire.
You can read more about Linda’s career here.
Let’s all take time to recognize the contributions of our support teams, without whom the engines of our businesses would not run.
Keep your motors runnin’,
Ed
Dave Michel, Linda Skiles, Ed Petty
Where Is Your Chiropractic Marketing Department?
Excellent Service in Your Chiropractic Practice is Marketing
Here is a little exercise that can boost your new patients and improve the quality of your patient care. And create a little more excitement in the practice in the bargain.
First, let’s review a couple of wise words about marketing:
1. Jay Levinson, from his book Guerrilla Marketing.
Marketing is everything you do to promote your business, from the moment you conceive of it to the point at which customers buy your product or service and begin to patronize your business on a regular basis. The key words to remember are everything and regular basis.
2. Peter Drucker, Management: Tasks, Responsibilities, Practices (p68)
Marketing is so basic that it cannot be considered a separate function (i.e.,a separate skill or work) within the business, on a par with others such as manufacturing or personnel. Marketing requires separate work, and a distinct group of activities. But it is, first, a central dimension of the entire business. … Concern and responsibility for marketing must, therefore, permeate all areas of the enterprise.
What Levinson says is that marketing is EVERYTHING you do consistently.
Drucker says that while there are specific marketing activities, marketing is too fundamental to have its own department. It is a “central dimension of the entire business.”
Yes, there are specific marketing activities to help your chiropractic and healthcare practice, some of which you delegate to advertisers, such as Internet marketers. Larger offices hire field representatives. I have hired and trained practice marketers who effectively generated new patients from external activities.
However, most of your practice marketing comes from the actions you and each team member take in the office. This is true in ANY business, but especially in chiropractic or smaller independent healthcare offices.
A common misconception is that some vague or distant marketing department or advertising company takes care of marketing and is not a “central dimension” to each person’s job.
Every position in your office has a marketing component. It comes with the role of a team member. Doctor, front desk, billing and patient accounts, therapy, rehab, and anyone who is on the team, is a marketer.
So, where is the marketing department? It’s your entire office! Here are a few marketing activities each team member can do:
- Be genuinely interested in each patient.
- Honestly care for how each patient is doing.
- Do your very best with each patient with Present Time Consciousness.
- When and if appropriate, invite your patient to bring in a family member or friend for a scheduled consultation or event.
- Congratulate patients for any success.
Then, there is a list of specific marketing activities you can do: newsy newsletters, internal and external events to the office. You can find many of these suggestions on our blogs.
HEALTHCARE TEAM MEMBER MARKETING EXERCISE
In your team meeting, have each team member present at least two types of marketing actions they can do from their position every day.
Help them with this. If you have time, have your team practice their marketing procedure with each other.
As an added emphasis, consider that now that we are in the world of AI, real-life human interest and live communication is more valuable than ever. Believe it or not, one of your key marketing “niches” is just your plain ol’ non-hyped interest in the other person. Never fake that. In our ever-increasing sterile and digital world that is becoming more robotic, less human, and less spiritual each day, genuine human communication is more valuable than ever.
Don’t ask for where the marketing department is,
For it resides within thee!
Always selling health,
Ed
P.S. By the way, I left out telling jokes as a marketing action! One office up “nort” here in Wisconsin, I swear, generates new patients with the doctor’s Ole and Lena jokes! This may not be appropriate for your office though! (lol)
OLE AND LENA (A favorite!)
Ole and Lena got married.
After a beautiful ceremony and a fun but modest reception, they got in Ole’s car and headed out on their honeymoon.
When they reached Saint Paul, Ole put his hand on Lena’s knee.
Lena said, “Ole, we’re married now. You can go farder den dat.”
So Ole drove to Duluth.
========================
If your practice-building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
The Goal Driven Business
By Edward Petty
Use the Learning Pyramid for a Better ROI in Your Chiropractic Healthcare Practice
Don’t complain. Just train
“Over the long run, superior performance depends on superior learning.”
— Peter Senge
As the Clinic Director of your chiropractic and healthcare practice, you instinctively know that if you are not continually improving the service to your patients and potential patients, they will go to practices that are.
In fact, if you do not provide the BEST outcomes and service in your area, patients and potential patients will look for other practices that are the best, or at least better than you.
The BEST health care practice wins in the long run.
So, how do you get to be the best?
By constant improvement!
This was the concept the Japanese pushed in the 1970’s with their cars. They called it Kaizen.
Speaking of Japan, there was a study that showed how many hours employees trained over a 6-month period. Japan spent an average of 364 hours, Europe averaged 178, and the U.S. a paltry 42.* I discuss this more in my book, The Goal Driven Business. (pg 156)
The formula for improvement is simple: study and train.
The purpose and goal of training is improvement. This is why professional athletes and musicians constantly train. They do this for improvement and, ultimately, to bring about a good return on their investment.
Improvement has a definite ROI! A study by the Associate for Talent Development found that companies offering comprehensive training programs have 218% higher income per employee compared to those without formalized training.*
But what are the best methods for training — reading, listening, podcasts, seminars?
USING THE LEARNING PYRAMID TO TRAIN YOUR CHIROPRACTIC TEAM
The Learning Pyramid* illustrates the percentage of knowledge retained through various learning methods. Here are the typical percentages associated with each method:
- Lecture: 5%
- Reading: 10%
- Audio-Visual: 20%
- Demonstration: 30%
- Discussion: 50%
- Practice by Doing: 75%
- Teaching Others: 90%
This model emphasizes active participation in the learning process. Teaching others or practicing by doing, leads to higher knowledge retention rates compared to passive methods like listening to lectures or reading.
If you take your team to a seminar, do it for camaraderie and the sense of being part of something bigger. It can be motivational. But then, ensure that they take notes from one of the presentations and then teach it to the rest of the team at the next staff meeting.
Another angle is to have team members select a chapter from a book you all are reading (from your Lending Library!) and then have them teach it to the rest of the team a month later.
Train on your procedures every month. For example, you could demonstrate how you would like a patient to be positioned on a therapy table. (Get it recorded for future reference!) Then, have a staff member demonstrate the procedure back to you. You can also pair people and role-play the procedure. Do this for any of your office procedures. For those of you in group practices, doctors can practice their procedures.
BALANCING INFORMATION WITH PRACTICAL APPLICATION
The idea is that there are two sides to the learning coin: the information side and the practical application side. You can’t learn how to throw a fastball from reading a book. You must find a baseball and someone brave enough to catch your pitches and practice throwing hundreds of times. However, a book may have useful information on improving your throwing technique from those who have done it more than you.
It is best to go over the idea of training and improvement with your team first so they understand what you are doing and why.
Keep training fun. Your manager should ensure that training occurs every month.
And like Clarence Gonstead said:
“Practice. Practice. Practice. Never stop.”
“Our future will be our results.”
Keep training,
Ed
P.S. Who was Clarence Gonstead, D.C.
References:
ROI on training. An Evidence-Based Look at the ROI of Investing in Training (mentorgroup.us)
Clarence Gonstead https://www.gonstead.com/
The Learning Pyramid the learning pyramid – various percentages of retention. (thepeakperformancecenter.com)
========================
If your practice-building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
The Goal Driven Business
By Edward Petty
Overcoming the Barrier to Improvement
Sharpening Skills Pays Off
There is the old story about the lumberjack who said that if he were given five hours to chop down a tree or lose his life if he failed, he’d spend three of the five hours sharpening his axe.
Stephen Covey talks about “sharpening the saw,” one of his famous 7 Habits of Highly Effective People. (An essential management and leadership book.)
He says: “We must never be too busy to take time to sharpen the saw.” Sharpening the saw is about “renewal. “Renewal is the principle—and the process—that empowers us to move on an upward spiral of growth and change, of continuous improvement.”
With constant use, our bodies, cars, and practices wear out.
We don’t always notice this, but gradually, performance diminishes. This is why you encourage your patients to come in for regular maintenance, supportive, and wellness care. This is why you take your car in for maintenance.
And this is also why you take time to work ON your business.
IMPROVING YOUR TEAM
The fact is, each one of your team members desires to improve their skills and see the business where they work progress. They want to enhance their career and work life. They want to see their business going somewhere and to mean something.
And business CEOs want better performance. This is why companies spent over 100 billion dollars on employee training in 2023. And they do this for 1 reason: it pays.*
A study by Accenture (a multinational management company) found that for every dollar invested in training, companies received $4.53 in return. This equates to a 353% ROI*
There is no doubt that improvement pays dividends. But what gets in the way? Money? Maybe that is a factor, but I don’t believe it is the big one.
WHAT GETS IN THE WAY OF IMPROVEMENT
It is the idea of time. There are a couple of easily overlooked rules about time I talk about in my book, the Goal Driven Business, that if understood and used, can give you the time you need for improvement.
The first rule comes from what is known as the Pareto Principle. It states that just 20% of your work produces 80% of your desired outcomes. Conversely, 80% of your work time produces only 20% of your desired outcomes.
Improvement for your health or your business is the 20% that generates 80% of your positive outcomes. It is the little bit of effort that produces the biggest results.
Isn’t everything you do important? No! There are a few highly vital actions that you must do, and then there are less important actions. As an elementary example, it is important that you wear shoes to work. It is not as important what kind of shoes you wear. So, if you have 10 pairs of shoes, you probably only wear 2 of them 80% of the time. No matter how many shoes you have, the ratio comes out to be about 80/20.
There is another rule I refer to.
It is Parkinson’s Law of Time. It says that work expands to fill the time available.
The essential fact in both laws is that more time is available for improvement than you might think.
Just like your patients take time to come in and see you, you should ensure that you and your team take time to work ON the business and each other’s professional skills.
Training and improvement, like chiropractic, doesn’t cost. It pays.
Keep improving,
Ed
*references
https://www.mentimeter.com/blog/training/employee-training-statistics
https://www.myhrfuture.com/blog/measuring-the-roi-of-employee-training-and-development
========================
If your practice-building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
The Goal Driven Business
By Edward Petty
Managing Your Coordination of Benefits
YOUR GUIDE TO COORDINATION OF BENEFITS AND WHO PAYS FIRST
Having issues with getting reimbursed due to reimbursement disputes between payer groups? Wondering who to bill first?
This question comes up a lot in the field, which tells me, dear reader, that you may be experiencing frequent circumstances in which your Medicare beneficiary patients fall into one or more of these categories:
- The patient is not working and is 65 and older and carries retirement insurance
- The patient has been in an accident resulting in personal injury
- The patient carries a straight Medicare policy with a secondary insurance policy
- The patient carries a straight Medicare policy with a supplemental insurance policy
- The patient has been injured at work
- The patient or patient’s spouse is working and carries group health insurance
In each of the above situations, Coordination of Benefits kicks in, which is the theme of our September article.
According to eHealth, Coordination of Benefits by definition is: “When a person is covered by two health plans, coordination of benefits is the process the insurance companies [payers] use to decide which plan will pay first for covered medical services and what the second plan will pay after the first plan has paid. Coordination of Benefits prevents duplicate payments for the same service on the same date of service, and helps keeps the cost to the patient affordable.”
Let’s look at each of the above circumstances, with resolution for proper claims processing and reimbursement according to the Centers for Medicare and Medicaid Services:
1.) The patient is not working and is 65 and older:
Medicare Pays First if the patient has Retiree health coverage and is not
working
2.) The patient has been in an accident resulting in personal injury
The patient’s no-fault insurance or liability insurance pays first and Medicare
pays second for services related to the accident or injury. *
3.)The patient carries a straight Medicare policy with a secondary insurance policy
Medicare is billed first and will forward their remittance to the secondary payer if the services are billed with AT (Active Treatment) modifier.
They may or maynot forward to the secondary if the services are billed with a GA modifier (indicating service was a maintenance adjustment), and will not forward if a GZ modifier is billed (indicating a maintenance adjustment but no signed
Advanced Beneficiary Notice (ABN) is on file), since you cannot bill the patient
for a maintenance adjustment without an ABN.
You may need to file the secondary claim for adjudication on the GA adjustment directly to the secondary payer.
==============================================
Do you have questions or need help with:
insurance audits
credentialing new providers
debugging complex insurance issues
customizing billing systems to improve collections,
practice appraisals, and more.
Ask Lisa
Call Lisa: (920) 334-4561 (mobile)
https://pmaworks.com/lisa-barnett/
============================================
4) The patient carries a straight Medicare policy with a supplemental insurance policy
The same applies as with a secondary policy: Medicare is billed first and will
forward their remittance to the secondary payer if the services are billed with
AT (Active Treatment) modifier.
They may or may not forward to the secondary if the services are billed with a GA modifier (indicating service was a maintenance adjustment), and will not forward if a GZ modifier is billed (indicating a maintenance adjustment but no signed Advanced Beneficiary Notice (ABN) is on file), since you cannot bill the patient for a maintenance adjustment without an ABN.
You may need to file the secondary claim for adjudication on the GA adjustment directly to the secondary payer.
5) The patient has been injured at work
Workers’ compensation pays first for items or services related to the workers’
compensation claim. However, Medicare may make a conditional payment if the
workers’ compensation insurance company denies reimbursement. In this case
the patient is financially responsible but Medicare may pay pending the
insurance company’s review of your claim.
6) The patient and/or patient’s spouse is working and carries group health insurance
-
- Medicare pays first in both circumstances if the Employer has fewer than 20 Employees.
- The group health carrier pays first in both circumstances if the Employer has greater than 20 Employees
- If the patient has a disability and that patient or spouse is currently employed at an Employer with 100 or more employees, the group health plan pays first
- If the patient has a disability and that patient or spouse is currently employed at an Employer with less than 100 employees, Medicare pays first
What about in non-Medicare situations where there is a minor child listed as a dependent on dual-spouse or parent policies?
The “birthday rule” is commonly applied for children covered by two employer group health plans. In this situation, the plan covering the parent whose birthday falls first in the year will pay primary on the children; the other parent’s plan becomes the secondary payer.
I hope that this gives you guidance as you navigate through the payer world of coordination of benefits. Have further questions? We can help. Reach out:
lisa@pmaworks.com
920-334-4561
For more info on insurance:
- Ask Lisa: Payer Notes Request, Now What Do I Do?
- Ask Lisa:Revenue Cycle Management (RCM)
- Ask Lisa:What is the Most Important Component of Your Chiropractic Practice
- More Ask Lisa
*The exception would be if the case is being handled by attorney representation and a settlement is forthcoming. You may bill the liability carrier and seek renumeration, in which case the patient is responsible for repaying the carrier (or Medicare) for services rendered at your office, after receiving settlement. You may bill the patient for their care up front, in which case they would need to wait for their settlement monies.
References:
1) https://www.medicare.gov/health-drug-plans/coordination/who-pays-first
2) https://www.medicare.gov/publications/11546-Medicare-Coordination-of-Benefits-Getting-Started.pdf
3) https://www.ehealthinsurance.com/resources/individual-and-family/coordination-of-benefits
Raising the Vibe Level in Your Chiropractic Office
We ordinarily send our Goal Driver newsletter out to chiropractors and other healthcare business owners and support staff on Tuesday at 11 Central Time.
Today is different. This newsletter is going out early.
Today is the first working day of this week (in the U.S.) after a refreshing extra-long Labor Day weekend. It is the first day of September, and summer vacation is behind us. And it is just 4 powerful months (120 days) to 2025!
I wanted to send this to you before your day begins to help you get your motor running.
So here is some music.
You can listen to some tunes while you take your morning jog and cold plunge (!), get your kids ready and drop them at school, and drive into the office.
You can play it at the office with your team. And patients.
Pick your vibe below, or any music, turn up your speakers, and get your motor running!
Have a great day,
And seize the rest of 2024!
Ed
Steppenwolf – Born To Be Wild https://www.youtube.com/watch?v=egMWlD3fLJ8
“Unstoppable” (The Score ft. Fleurie) https://www.youtube.com/watch?v=_PBlykN4KIY
“Eye of the Tiger” (Survivor) https://www.youtube.com/watch?v=ob8TNqQw2hY
Chariots Of Fire Theme Song https://www.youtube.com/watch?v=8a-HfNE3EIo
“Lose Yourself” (Eminem) https://www.youtube.com/watch?v=xFYQQPAOz7Y
“Gonna Fly Now” (Bill Conti) (Theme from Rocky) https://www.youtube.com/watch?v=ioE_O7Lm0I4
“Brave” (Sara Bareilles) https://www.youtube.com/watch?v=4Ny_LX3byp8
Beastie Boys No Sleep Till Brooklyn https://www.youtube.com/watch?v=IDVq9s6HCB4
“Enter Sandman” (Metallica) https://www.youtube.com/watch?v=9Q8SxnbL1ms
Dream On (Aerosmith) https://www.youtube.com/watch?v=iJDtukGW79Y
“It’s a Great Day to Be Alive” (Travis Tritt) https://www.youtube.com/watch?v=d4tSE2w53ts
“This One’s For the Girls” (Martina McBride) https://www.youtube.com/watch?v=4fvKzTC3-BA
“I Hope You Dance” (Lee Ann Womack) https://www.youtube.com/watch?v=F44nrK0MxEQ
Somewhere over the Rainbow – Israel “IZ” Kamakawiwoʻole https://www.youtube.com/watch?v=V1bFr2SWP1I
Stand By Me | Playing For Change | Song Around The World https://www.youtube.com/watch?v=Us-TVg40ExM
Bobby McFerrin – Don’t Worry Be Happy https://www.youtube.com/watch?v=d-diB65scQU
I Dreamed A Dream. Susan Boyle (part of Britain’s Got Talent) https://www.youtube.com/watch?v=mS5Om47vsaA
========================
If your practice-building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
The Goal Driven Business
How to Win as a Chiropractic and Healthcare Practice Athlete
Like the Olympic athletes, as a chiropractor or practice owner, you have begun a venture few dare. Where you go, there is no hiding or coasting. You are immediately rewarded or penalized based on your and the entire team’s performance. There is no guaranteed tenure in your job or assurance that you’ll have business next month. It is all up to you and each member of the team.
Read Ed’s weekly newsletter to find out how to:
- DEVELOP A CHAMPION’S MINDSET.
- BUILD YOUR SUPPORT TEAM.
- CONTINUOUSLY IMPROVE.
- CELEBRATE THE WINS!
Read More[LINK]
The Time I Asked a Doctor The “Who” Question?
What is the who question?
It was at a large seminar. Maybe Parker, maybe a state convention, I don’t recall for sure. I was talking with some doctors I knew in the hallway when one of the sessions ended. The doors opened, and the doctors who attended the presentation began pouring out of the conference room. One of them joined us.
He eagerly discussed some new promotional projects he heard about in the session. He also said that he learned some new approaches to scheduling and billing. I was interested, so I asked him some questions. Once hearing about the ideas, I said that they sounded good.
But then I asked the WHO question: “Who is going to implement these new projects?”
He looked at me, suddenly changing his demeanor as if I had insulted him by asking him such an obvious and stupid question, and he walked away.
True story. But hey, that’s what we do at PM&A: ask the tough but obvious questions.
Time and time again, we have seen doctors and staff come back from seminars with useful information that never gets applied. And there is a reason for this.
THE MISSING “WHO”
The missing WHO is your manager.
Many practices do not have a functioning manager. And for those offices that do, their manager is usually not operating as fully as they could.
Every practice, whether large or small, has a set of departments or roles. Minimally, these include:
- front desk
- billing and collections (patient accounts)
- and the clinical services of the doctor or provider.
Beyond these, there is a boatload of other tasks that fall outside of the front desk, billing, and doctoring. Who does these? Who organizes these? Usually, the business owner, who is also the doctor, does.
Dealing with these tasks can take up valuable time and energy. And this is expensive. It costs more than most business owners realize. What is a clinical hour worth? $500, $1,000, $2,000. Having the doctor spend time on non-clinical or non-growth-oriented leadership projects is expensive!
There are so many benefits for a practice to have a manager that I have long considered why doctors and business owners don’t create and invest in this position. Even on a part-time basis, it makes practical sense.
I think these are some of the reasons:
- Reluctance to delegate: Starting a practice as an entrepreneur, many practice owners are accustomed to handling all aspects of their business themselves and may find it difficult to relinquish control over certain tasks and responsibilities.
- Lack of awareness: Some practice owners may not fully appreciate the potential benefits and return on investment that a skilled manager can bring to their practice.
- Misconceptions and uncertainties about the role: Is the manager our billing assistant, our accountant, or a glorified assistant? Can my spouse or daughter be the manager? What are their job duties?
- Overestimation of current efficiency: Business owners might believe their current operations are running smoothly enough without a trained manager.
- Concerns about team dynamics: when someone takes on the role of manager improperly, they can disrupt the team’s harmony.
And especially,
- Where can I train my staff member to be a skilled manager?
Because of these reasons, and a few more, we have launched our manager training program. I encourage all practice owners to create the manager position in their practice and then support it. If you are ready, I encourage you to consider our manager training program.
Our program starts the week after Labor Day and is filling up. Let us know if you are interested, and let’s talk soon.
Ed
“Based on our largest global study of the future of work, Gallup finds that the quality of managers and team leaders is the single biggest factor in your organization’s long-term success.”
It’s the Manager, by Jim Clifton and Jim Harter
What Makes You and Your Chiropractic Healthcare Practice Special?
Celebrating Health and Business Freedom
JULY 2nd
1776, Philadelphia.
The weather was cooler than usual, with intermittent rain showers. Some 50 members of the 2nd Continental Congress met at Independence Hall and finally agreed, after months of discussion,
“That these United Colonies are, and of right ought to be, free and independent States…”
We celebrate this declaration on July 4th in the USA as our Independence Day.
Aside from the summer cookouts, barbecues, parades, and festivities, we celebrate freedom – freedom from tyranny and freedom to pursue “Happiness.”
= = =
It could be said that multinational investment corporations, along with Bill Gates — whom Google Search offers up as the most powerful doctor in the U.S.*, have colonized the healthcare system in the U.S.
You and your team are independent chiropractic and healthcare businesses. You are not a colony of Big Pharma, Medicine, or Food. They have fought and marginalized you, but you have won and remain free. (**)
And it is not too big of a leap to point out that this is what you do for others: you help your patients and clients to become freer from pain, discomfort, and dysfunction. You help them become more independent from drugs and the toxic influences of our world.
As the July 4th celebration is for American Independence, I invite you to see this time as also a celebration for independent businesses and health care providers — like you.
= = =
Freedom is never free, and each of us at Petty, Michel & Associates appreciates your efforts to maintain and grow your business and help your patients and clients seek happiness.
So, THANK YOU!
Thank you for staying free and helping others do the same.
Ed and Dave, and all of us at Petty, Michel, & Associates
References:
* Screen capture of Google: “First search result when asked: “Who is the most powerful doctor in the U.S.”
** Contain and Eliminate, Howard Holinsky
=============================
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
Revenue Cycle Management (RCM)
Revenue Cycle Management (RCM)
Two weeks ago we hosted a webinar, How to make insurance work for your office using six components. Since then, there has been interest in learning more about revenue cycle management or RCM. You asked, and here it is delivered.
According to TechTarget*, revenue cycle management is the financial process facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. The below diagram will give you a visual. The diagram consists of eight elements, listed here:
- Prospective patient calls inquiring about services, and making appointment. This is where your revenue cycle begins. Proper intake sets the stage for future revenues.
- Insurance eligibility and benefits verification, is critical for you and the patient to determine best estimates.
- Clinicals (doctor treatment(s); diagnoses; and entering charges which can be done by doctor or staff, depending on your office procedures.
- Clean Claims submission: Mistakes can happen here, but once you are aware of what needs to be done to create a clean claim, you’ll know what to watch for when you review your claims batches prior to sending.
- Payment Receipt or denial from remittances, & Payment Posting
- Insurance follow-ups on denials/records requests
- A/R Follow Ups
- Statistical Reporting (we recommend running: Daily Collections; and then monthly/quarterly/annually running stats on New Patients, Patient Visits, Services-Charges, and Collections.
Revenue Cycle Management (RCM) Diagram
The important thing here is to be consistent, meaning every step and each element of the flow must align with the goals and mission of the clinic. For example, a pediatric/wellness practice will have different polices each step of the way for RCM than a sports medicine clinic would. If you are having issues, you need to examine which step in your RCM is bottlenecked, or which step is not in alignment.
Ed’s book, The Goal Driven Business, will help you ground your practice goals and develop and maintain the consistency needed to keep your goals in alignment with the cycle.
Oh, and if you are leaning towards planning for less insurance participation, watch for details on our next upcoming class, Converting to a Patient Self-Pay Model — Preparing for Your Future Practice.
Happy Fourth of July!
Lisa
PS: Download the RCM Diagram
References:
*https://www.techtarget.com/searchhealthit/definition/revenue-cycle-management-RCM
Why You Should Have a Turnkey Chiropractic and Healthcare Practice
The Practice Development Scale
If you were going to buy a practice, wouldn’t you prefer it to be “turnkey?”
If you were to work as a chiropractic doctor or provider in another clinic, you’d want it to be “turnkey,” right?
Or, as a support professional and assistant, I bet working in a turnkey office would be your preference.
WHAT IS A TURNKEY PRACTICE?
The term “turnkey” implies that the necessary operational elements of a practice are in place so that all the owner or practitioner has to do is “turn the key,” and the practice just goes!
A turnkey practice is so well organized that the stress level is low, the revenue is high, and the service outcomes are excellent.
Consider a scale of 1-5, where 5 is a turnkey practice, and 0 is an insolvent practice.
SCALE OF PRACTICE DEVELOPMENT
___5: Turnkey Practice
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The practice is fully equipped and operates at close to full capacity. It is ready to be sold, to bring on additional providers, or just happily and profitably cruise.
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There is a strong, established patient base ensuring regular revenue.
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Administrative, billing, scheduling, and management systems are highly efficient.
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The practice is financially robust, accumulating income over expenses each month.
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The practice has a trained and established manager who ensures the seamless operation and continuity of all systems and procedures.
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Staff are highly skilled, well-trained, and capable of independently managing the practice. Morale is high.
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The business owner spends just a few hours each month on administration.
___4: Well-Established Practice
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The practice is well-established and runs well.
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There is a large, loyal client or patient base.
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Administrative systems are efficient.
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The practice is financially stable.
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Staff members are trained and experienced.
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The owner spends a few hours each week on administration.
__3: Growing practice
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The practice is showing signs of growth.
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The client or patient base is stable and increasing.
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Administrative systems are more organized.
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Financial health is improving.
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Staffing is more stable, with ongoing training.
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Owner works hard each week
___2: Basic Operational Practice
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The practice has the basic elements required for operation.
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There is a modest, gradually growing client or patient base.
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Basic administrative systems are in place but may be inefficient.
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Financial stability is tenuous but improving.
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Staff are present but may lack competence or numbers.
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Daily admin operations are dependent on the owner
___1: Struggling practice
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The practice is operational but faces significant challenges.
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There is a small, inconsistent client or patient base.
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Administrative systems are inefficient or nonexistent.
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Financial difficulties are prevalent, with cash flow issues and potential debt.
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Staff may be minimal, overworked, or inadequately trained.
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Owner stressed by dealing with administrative tasks
___0: No Practice / Insolvent
SELL, CLONE, OR CRUISE
Once you have achieved turnkey practice, you can sell it for the highest price.
Or, you now have the option to add another provider profitably. There is no limit – if you develop each provider to a turnkey level before adding more.
But the third option is just to cruise and have fun seeing patients with a great team supporting you and the practice. This option allows you to continue helping your patients while integrating your personal life with your practice life.
In a subsequent article, I will list the key roadblocks, some of them hidden, that can get in your way from creating a turnkey practice. I will also show you how to get to a turnkey practice faster.
But just knowing this scale will give you a map to better chart your course to success.
Keeping the end in mind,
Ed
=============================
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
How to Make Better Use of Patient Reviews
In Chiropractic and Healthcare Clinics, Patient Reviews Are More Than Marketing
One of our chiropractic clients just sent me a patient review.
It expressed a profound improvement in the patient’s life. It was moving!
I am sure you have similar reviews.
Patient testimonials are useful in marketing and demonstrating your credibility. There is software that captures and encourages positive reviews, and you can just ask patients to write something about their wins. You can also record the patient talking about their health success in a short video. These can be included on your website, social media, and in your newsletter.
MORE THAN MARKETING
But testimonials and reviews are more than marketing.
FIRST, they are a personal statement sincerely expressed by your patient. Your patients courageously express their wins so other people can learn about them. They are standing up for themselves and the doctors and staff that helped them.
This is not a small thing — you should personally acknowledge any review you receive.
SECOND, you and your team may not always see or appreciate the outcomes of your combined work. Aside from providing clinical services, there is also scheduling, payments, note-taking, patient communication, and marketing. Plus, everyone shares a hundred other administrative tasks. All of this eventually results in a great result for your patient.
In college, one summer, I worked in a cannery. I was a “tray boy,” I put trays of empty cans on a stand and then took them off once the cans were filled with fruit (pineapple) from a conveyor belt that never stopped. That’s all I did. I never saw the completed canned products, their labeling, or even enjoyed eating them. I was basically a robot, a cog on an endless conveyor belt.
Similarly, team members can focus on their specialties and not always see the transformative results they are helping to create with patients. Work can become routine, just an assembly line that never ends.
LASTLY, the testimonial describes your WHY.
The idea of “Why” was popularized by Simon Sinek and his Ted Talk and posted on YouTube in 2009. He uses a 3 ringed circle to illustrate this idea.
The outside circle describes WHAT the business does. The next inner circle describes HOW the business does what it does. And the innermost circle describes WHY the business does what it does.
“Every single person, every single organization on the planet knows what they do, 100 percent.
“Some know how they do it … But very, very few people or organizations know why they do what they do. And by “why” I don’t mean “to make a profit.” That’s a result. It’s always a result.
“By “why,” I mean: What’s your purpose? What’s your cause? What’s your belief? Why does your organization exist? Why do you get out of bed in the morning? And why should anyone care? … the inspired leaders and the inspired organizations — regardless of their size, regardless of their industry — all think, act and communicate from the inside out.” *
Everyone in your office, patients, staff, and perhaps people in your community, know WHAT you do. You provide health care. Some of your team members might know HOW you do it – what procedures you use and how they work for patients.
But to have a fully engaged and motivated team, and even a patient community, you need to keep connecting them to WHY the offices does what it does. And not just the office “mission statement,” but WHY this is your mission.
IN YOUR OFFICE
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Thank each patient for their review.
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Connect team members and their work with the clinic outcomes and patient successes.
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Connect everyone, including yourself, with the WHY of your services.
Ed
P.S. IN OUR OFFICE:
When the doctor sent me their patient’s review, I realized that, for all of us at Petty Michel & Associates and our Goal Driven Training, this was our WHY as well.
—————————————————-
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
A Health Challenge for Your Chiropractic and Healthcare Office
A month promotion where everyone wins
A local hot yoga studio where I live usually sees their numbers drop in the summer. So, a few years ago, they instituted a solution to lowered attendance: The Yoga Challenge. Attend 30 times over the summer and be eligible for a trip with your guest to a week of Yoga at a retreat in Costa Rica.
I know the owners, and the program has been overwhelmingly successful.
Why is this?
Well, obviously, a week paid for in Costa Rica can be a wonderful experience and so is an appealing goal. But much more than that, there are the intrinsic rewards of personal achievement and playing for a bigger goal. 30 visits of hot Yoga over three months is an accomplishment – you couldn’t help but get in better shape — if you didn’t become dehydrated and wrinkled like a dried prune.
COULD THIS TYPE OF PROMOTION BE USED IN YOUR CHIROPRACTIC OR HEALTHCARE CLINIC?
The short answer is … YES!
We have worked with clinics that have had success with versions of this program.
Essentially, a Challenge is a game and we all like games!
Whether it’s puppies, babies, or the Olympics, the gaming spirit is part of our makeup. Can we win? Can we achieve it? Let’s go for it.
Computer games include the concept of gamification. (Fun Fact: The computer game industry is expected to hit $282 billion in 2024)* That does not even include revenue from professional sports or racing.
I cover all this subject in my book, the Goal Driven Business , and how to apply it to everyday practice.
AN EXAMPLE – ONE-MONTH CHALLENGE IN YOUR OFFICE
You could meet with your team and discuss different versions of a “Care to Share Better Health Challenge.”
The goal would be to have fun getting healthier, helping others get healthier, and maybe win a few gifts!
“By accepting this Challenge, you will get healthier, help others get healthier, and maybe even win gifts!
To participate, patients receive tickets for completing health-oriented accomplishments.
Here are some examples of health-oriented activities:
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Attend one of our Wellness Classes. (2 tickets)
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Bring a guest.(2 tickets)
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Post a review of our services.(2 tickets)
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Keep all of your appointments. (3 tickets)
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Refer a friend to a no-charge consultation with one of our doctors. (2 tickets.)
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Exercise at least 3 hours per week (12 for the month). (3 tickets)
Tickets are entered into a drawing for several possible prizes at the end of the month.
CHALLENGE FOR YOUR CHIROPRACTIC AND HEALTHCARE TEAM
What makes a program like this work is that it is also a game for your staff. If specific goals are met, then they, too, receive awards!
Everyone is in the game!
A Challenge will need planning and lots of cheer leading! As with any internal type of promotion, it depends on the level of synergy in the office.
Talk it over with your team and customize it. Make up your own Challenge. Set goals for visits, class attendances, introductory consultations, and/or new patients.
And, let the games begin.
Ed
*Reference: Gamification Fun Fact – https://www.statista.com/outlook/dmo/digital-media/video-games/worldwide
UPCOMING EVENTS
We have two upcoming events for you.
Improving Your Collections. On Tuesday, June 25 at 12 (noon) Central Time, Dave Michel and Lisa Barnett will present a free webinar to subscribers to this newsletter and our clients: The 6 Critical Components to Improving Your Collections. Click below to sign up.
Practice MBA for your manager (and you!). Our 2nd Practice MBA session for your manager and you as a clinic director is getting set to start later this summer. The results from our last one continue to be inspiring. One mature clinic I just checked in on yesterday has its revenue up 21% this year. If you are interested and not yet on the waiting list, please click below to find more info and reserve your space.
—————————————————-
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
What is Health Literacy in Chiropractic and Natural Heath Care?
The more people know about health, the more they will help others be healthier.
I just ran across a “study” entitled “The Relationship Between Health Literacy and Medical Costs. *”
Their findings:
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Patients with lower health literacy had higher hospitalization rates compared to those with higher health literacy.
What does this mean? Let’s look at how Health Literacy is defined:
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“Health literacy is the ability to obtain, process, and understand basic health information and services to make appropriate health decisions.” (U.S. Department of Health and Human Services) (HHS)
So, how is this working out for us in the U.S.?
-
The U.S. ranks last in a comparison of 11 high-income countries in terms of general health. This is despite the U.S. spending the most on healthcare compared to these nations.*
So, it can be reasoned that Americans aren’t getting much information on health care. Our people are fatter, sicker, and more depressed. Our kid’s health is getting worse.*
IMPROVING HEALTH LITERACY IN CHIROPRACTIC AND NATURAL HEALTH CLINICS
However, as the above study illustrates, there is a direct connection between educated patients and better health.
We already know this from experience in practice. I just thought it was interesting that there was a study showing this fact: better educated patients are healthier. They also refer more people for care.
Here are 3 approaches to improved patient education, though there are many others:
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Inform while you perform. Educate your patients each day about some aspect of health care. This is also called Table Talk.
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Care Class. It used to be common procedure in practice building to have regular new classes for patients. Not only were they educational, but entertaining. They built community. They also increased patient referrals, patient retention, and improved the motivation of those giving the talks. They cost next to nothing, except for the doctor’s and staff member’s time. In some offices, refreshments were added. In one chiropractic clinic I worked with would award attendees with clinic t-shirts and provide great pizza and had a full class!
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Newsletter with a case study. When your patients are not in the office, send them a short note. Maybe add a video. Doesn’t have to be professional, just authentic and describe a successful case or some health tip that they can use.
I think that because we work and live in a health profession that we take health knowledge for granted. And it can be easy to assume people know what you know.
They don’t.
There is a chasm between what you know about health and what your patients know.
How full would your schedule be if your patients, and their family and friends, knew what you knew about how to stay healthier?
Health literacy is a term from the medical world that has obviously failed to bring about health literacy.
No surprise there.
But in your corner of the world, you can change this and increase true health literacy with all your patients. And help more people.
Seize the future,
Ed
References:
* American Journal of Public Health, 1998. Baker, D.W., Parker, R.M., Williams, M.V., Clark, W.S.,
* U. S. Ranks last. https://www.commonwealthfund.org/press-release/2021/new-international-study-us-health-system-ranks-last-among-11-countries-many
* Kids getting sicker. https://childrenshealthdefense.org/follow-the-science/54-of-us-youth-are-chronically-ill/?itm_term=home
—————————————————-
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
Summer Chiropractic and Healthcare Marketing. Get Outside!
Eighty percent of success is showing up
Summer is a great time to promote your chiropractic and healthcare services. Winter hibernation is over, as is the enforced isolation from COVID, and people are out and about.
Communities are coming alive with farmer’s markets, bicycle riding clubs, coffee shop meetups, parades, art shows, and fairs of all kinds. You got yer Lions Club pancake breakfasts, church barbeques, donation drives, and 5-Ks.
Online social networking is fine, but it is extra powerful if backed up or done in conjunction with people and events locally in your community. In Real Life!
You can just show up and meet people. Let them meet you like an elected official when they run for office. (It is an election year!) You can also get a picture taken of the event and then use this in your internal promotions. That’s me in the photo above a few years back when I jumped into our local 4th of July parade and had my picture taken with our state representative, Sheldon Wasserman, M.D. (He told me his mom sees a chiropractor, and I didn’t care about what political party he was part of.)
You can get a list of upcoming community events from the Chamber of Commerce and schedule a screening, talk, or information booth, or volunteer your help in a charity drive. You can also just show up. Be neighborly.
There is often a run or walk as part of a donation program during the summer months where you and your staff can participate. We have seen offices proudly wear their office t-shirts and recruit many patients to do the same. Encourage and support your team members to participate on their own.
I’d assign a staff member or two to find events and opportunities to join. Make it a team activity.
You can power up all your activities by partnering with other local businesses.
And take your cards. As the old timers told me, the old school technique of practice building was “WOC – Whip out Card!” It’s physics: you put out energy and communication, and it will return to you.
When you are networking, you get to know people. Be interested in them and their interests. Then you can hand out your cards. You can also hand out coupons for a screening or workshop at your office.
As Woody Allen is to have said:
Eighty percent of success is showing up.
You can’t lose. It’s Summer. Get Outside. Enjoy the freedom!
And seize the day!
Ed
—————————————————-
If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.
Find out what they are and how to sail to your next level by getting and implementing my book, The Goal Driven Business.
UPDATE: Change Healthcare Cyber Attack
Lisa recently had a phone conversation with United Healthcare for an update on the Change Healthcare Cyber Attack Update Regarding United Healthcare Payments & Remittances. UHC advises that they are close to a resolution on getting all of the clinic remittances available on the provider clearinghouses, and troubleshooting improper denials.
For general inquires regarding payments and posting, clinics can email client_assistance@optum.com
Be the Ripple in your Chiropractic and Healthcare Clinic
One of the best chiropractic offices we have had the pleasure of working with has the subject of this email as its theme: “Be the ripple.”
Today’s newsletter comes out early so you can listen to music while you go to work, while you are at work, and after work.
Music is therapeutic and fun.
“Music has real health benefits. It boosts dopamine, lowers cortisol and it makes us feel great. Your brain is better on music. (Alex Doman. TEDx talk, CEO Advanced Brain Technologies)
The tune linked to below has artists from around the world playing together, from Playing for Change: Ripple.
LISTEN
“We never know how far-reaching something we may think, say, or do today will affect the lives of millions tomorrow.” (B.J. Palmer. Developer of Chiropractic)
Be the change, create the ripple, and seize the future!
An Inexpensive Method to Improve Chiropractic and Healthcare Patient Engagement
How to Keep Table Talk Going
The new staff member said she could help with marketing by posting photos on Instagram and Facebook. The doctor said great!
I noticed a photo of a patient or the doctor with a short comment for a few weeks.
I usually had to search for the image. It often had a few likes or hearts. Maybe 5 at most. Then it stopped. The staff member had taken on other duties.
I had been asking the doctor to send regular email newsletters to his patients. He didn’t seem that interested, but we said we would help him put them together which would cost less than $100 per month.
He got us the content, and we put the newsletter together and sent it out. On the 1st day, over 500 people opened and looked at his newsletter. These weren’t strangers. These were patients who knew him, liked him, and trusted him. Most of them just hadn’t been in to see him for a while.
Linda, our manager and service coordinator, just conducted a quick survey with some of our clients. She found that the offices that consistently send out personal email newsletters have all had a positive impact on their practices. They have improved patient referrals, reactivations, and patient engagement.
Some of the responses included: “Increases volume.” “Patients refer.” “They love the recipes.” “[Patients] come into the office and comment that they saw a particular condition talked about in the newsletter that the office was not aware the doctor could help them with.” “Great response when promoting [a new service].”
Social media platforms are entertaining. They have to be because they are in the advertising business.
But unless you pay them for ads, your posts are shown at the whim of the platform. You have no control. Your readers are entertainment seekers and, even if they see your post, are often distracted by other posts and ads.
I have seen ad agencies use social media effectively to generate leads that become new patients. It can be pricey but worth it if done correctly. Done now and then, expert advertising on social media for a special offer for a limited time can work.
But if you do not regularly send personal newsletters to your patient base, you are wasting some of the goodwill you have generated over the years.
A CHIROPRACTIC AND HEALTHCARE PRACTICE IS A NETWORK OF RELATIONSHIPS
A practice is grown and sustained through communication and service to your network. The quality and quantity of your network, and how engaged it is with you, is your practice goodwill.
We are now in the age of Artificial Intelligence. Communications are manufactured. In other words, more and more communication is just plain fake.
But you are not fake, and neither is the easy dialogue you have with your patients. More than ever, people want authentic communication and relationships. Social media posts and ads just can’t compete with your short personal newsletters.
Here’s some tips on how to get your personal newsletter done fast:
SETUP
- Email Coordinator. Assign a team member to help you with the newsletter. Give them 1 hour per week to do so.
- Email service. Use an email service like Mail Chimp, Constant Contact, or others. They will assist with the setup. Have the assistant complete the setup and update it monthly.
CONTENT
- Table talk. Think of a patient that you often see in your office. Imagine talking to them about a subject that you are currently thinking about. It could be headaches, low back pain, nutrition, posture, or really anything you’re feeling passionate about.
Now, write about 2-3 paragraphs as if you were writing a letter to them about your thoughts. (Link below.)
- Recipe. People love these. Always introduce a recipe and personalize it. “This was my grandmother’s favorite rabbit stew.”
- Success story. Introduce it: “Mildred did great.”
- Promotion. Every few months include a special promotion.
You can certainly add other elements. But the most essential component is your original message. It is YOUR VOICE that keeps the conversation going.
Effective newsletters will improve patient retention and patient referrals and reactivate inactive patients.
Nurture and sustain the relationships in your practice.
And seize your future!
=====
Sample message from the doctor for the newsletter
“You know, when I was driving to work this morning I saw this fellow bent over with a walker walking down the sidewalk. I bet if I had seen him 10 to 20 years ago, he wouldn’t be in that condition.
It’s the whole idea of a hinge. If it isn’t used much, it will rust and get stuck. Your vertebrae are like hinges. You gotta keep them moving otherwise they will get stuck.
Exercise helps. So does stretching.
But now and then your hinges (vertebrae) can get stuck, and that’s when you wanna come on and see us.
Keep moving and stay unstuck, and have a great June.
Dr. Bob Marley”
Related articles for chiropractors and independent healthcare practices:
https://www.goaldriven.com/post/sample-patient-group-activities
https://www.goaldriven.com/post/part-2-of-the-best-known-marketing-secret
Call Your Mom
Women, in general, see healthcare providers including chiropractors, more than men do. (The ratio is about 60% women and 40% men.)*
This week, hand each person in your office a flower and ask them to give it to their mom, or a mom. And if they are a mother, give them two. You could make a deal with your local florist and in return, post a sign on the flower vase stating where the flowers came from. Always try to create alliances with local businesses!
And, call your mom. I know, not all of us can. So, thank the moms you do know.
They take care of us and our future.
Here’s to moms!
Ed
*https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name
Another post on moms! https://www.goaldriven.com/post/call-your-mom