The Cobbler’s Children Have No Shoes

shoe cobbler sitting with 4 children telling a story.Are Your Chiropractic Staff on Health Programs?

You may recall the proverb about the cobbler’s children not having shoes, which illustrates how people often neglect their own needs while helping others. This happens in various fields—like a laundromat where the employees wear dirty clothes or a car repair shop with poorly maintained cars.

Recently, many offices we work with have had staff missing work due to illness, which can be costly. As the saying goes, “An ounce of prevention is a pound of cure.” Health should be a core value for your team, something everyone strives for, not just a business mission. It should be like a fun quest—finding ways to get healthier.

Unfortunately, some teams aren’t on health programs or aren’t as informed as they could be. Your staff should be the healthiest and fittest in town, with strong immune systems and natural remedies to boost their health during flu season.

While taking care of patients is a priority, it’s equally important to focus on improving your own team. This includes training your employees to enhance their skills and knowledge of your services. A trained, motivated practice manager can support both your people and your practice.

If you’re interested in having someone trained as your manager, sign up for our waitlist, and I’ll send you details about the upcoming program starting March 31.

In the meantime, encourage your team to start their mornings with planks, Vitamin D, and green drinks—and maybe a little dancing!

Take care of your people, including yourself, and stay goal-driven.

Ed

Read the full article here [LINK]

Sign up for Waitlist

Ask Lisa: Day One and Day Two Best Practice Procedures

Greetings…
You asked for this … we heard you and have got you covered.

Here at PM&A, we consistently recommend the use of checklists, and establishing and documenting your Day 1 and Day 2 procedures is no exception. Keep reading for a comprehensive checklist to make your Day 1 and Day 2 run seamless.

Day One Upon New Patient Arrival

___1. Introduce yourself, what you do, and welcome the Patient.
___2. Provide office tour
___3. Check for questions, problems, and clear up questions as needed.
___4. Doctor Sees patient, does a thorough consultation by the use of objective tools
and history of patient such that the patient feels they were completely
understood, and all relevant facts that might relate to the patient’s current
condition(s) is learned. Adjustment is performed if appropriate and is part of your
typical clinical Day 1 process.
___5. CA does insurance/third-party benefits verification using the insurance verification
form and prepares for the financial consultation on Day 2, using worksheet.

Day Two

___6. Doctor thoroughly reviews the patient’s x-ray/objective findings before the report
of findings
___7. Doctor goes over with the patient the written Report of Findings and the patient
also receives an initial treatment plan with the necessary amount of visits and
treatments (adjustments and therapy) as best suited for the patient’s condition.
___8. Doctor reiterates “Time, Repetition, and Effort” as necessary to patient’s
successful treatment program and provides folder/packet to the patient.

In a private area away from other patients… the CA works with the new patient to:
___9.   Go over schedule of care and completes multiple appointment card.
___10. Stress keeping appointments.
___11. Communicate missed appointment make-up procedure and any fee associated
with no call, no show.
___12. Confirm doctor has discussed health care class, and invite patient and spouse.
___13. Discuss financial arrangements. This is your financial consultation with the
patient. Written financials are completed beforehand and made available to the
patient as part of their packet.
___14. Verify all needed paperwork in the packet.
___15. Stress that the patient review the written ROF from doctor.
___16. Go over check-in / check-out procedures, i.e., does the patient sign in using a
kiosk? Is the kiosk located at the front desk, or in the treatment area? Check-out
would include making sure their next appointment is on the schedule and
collecting any patient payments due.
___17. Validate patient’s desire for care & treating doctor’s skill.
___18. Ask the patient if there is anyone else in their family they would like to schedule
a complimentary consultation and exam, and if so, write down their names, and
follow up
___19. Provide educational pamphlets to give to the patients.

___20. Ask the patient if they thought of any further questions, and wrap-up, reminding the patient of their next scheduled visit.

After the patient has completed their care plan, the doctor recommends wellness care to each patient that achieves maximum chiropractic improvement, and the patient accepts the wellness care program.

Email us at services@pmaworks.com to request scripting examples for financial consultations.

Looking for additional information on how to customize the above checklist to your office? Give us a call – we’re here to help!

Lisa
920-334-4561

How to Avoid the Groundhog Day Syndrome in your Chiropractic Office.

What would you do if you were stuck in one place and everyday was exactly the same, and nothing you did mattered?

Here is a summary of Ed’s weekly Goal Driver Newsletter.  Jump here to read the full article.

The Groundhog Day Syndrome can feel like doing the same thing over and over, with no progress or change—whether it’s handling repetitive tasks or dealing with the same issues at work. This can lead to burnout and a sense of being stuck, much like the movie Groundhog Day, where the main character endlessly relives the same day.

Life is cyclical, and each cycle offers new opportunities for growth, much like levels in a game. If your team is feeling bored, stressed, or stagnant, it might be time to move to the next level.

Here are two strategies to avoid the Groundhog Day Syndrome:

Create a Fun Theme for the Year: Choose a theme that aligns with your mission, such as encouraging fitness or community service, to motivate your team and patients.
Constant Improvement: Regularly evaluate how you can improve services, outcomes, and overall performance. Treat it like a game—always striving to level up.

Start the new year with fresh goals, and embrace growth! Consider enrolling in our Practice MBA program starting March 31, 2025, for further development.

Let’s break the cycle and keep moving forward!

Ed

MBA Program Information[LINK]

 

Chiropractic and Natural Healthcare Predicted to Grow

People want and need your services

Happy New Year!

Welcome to the First Newsletter of the New Year!

Thank you for being a valued subscriber and for your continued support throughout the past year. We truly enjoy creating these newsletters and hope they provide you with valuable insights to help you achieve your goals.

Our focus remains on practice growth and business development. We aim to assist you in enhancing both the quality and quantity of your services—ultimately boosting your bottom line. Along the way, we want to ensure you and your team enjoy the journey.

Don’t forget, Lisa, our expert in insurance, credentialing, and practice sales, also sends out a newsletter on the first Thursday of each month. Feel free to reach out to her anytime for expert advice. (Details about Lisa can be found below.)

CHIROPRACTIC GROWTH: A POSITIVE OUTLOOK

To kick off the New Year, our message is simple: Stay positive and goal-driven!

There is so much to be optimistic about, and I’ll be sharing solid reasons for this in the upcoming weeks. But let’s begin with one key piece of good news—the growth of chiropractic and natural healthcare.

The chiropractic profession is projected to expand at a compound annual growth rate (CAGR) of 26.3% between 2023 and 2033. This means the industry could grow from a yearly value of $571 million in 2023 to nearly $6 billion by 2033!

chiropractic growth 2023-2033

In comparison, the dental market is expected to grow at a much slower rate of just 4% annually.

While some forecasts for chiropractic growth are more conservative, most predict an increase of at least 10%. The study I reference appears to be well-researched, and you can read more about it on our blog (link below).

IT’S NOT JUST CHIROPRACTIC—NATURAL HEALTHCARE IS BOOMING

The growth isn’t limited to chiropractic care. Naturopathy, for example, is expected to grow by 15-20% over the next decade.

The organic food market has experienced significant growth as well. Sales, which were about $13 billion in 2005, surged to $64 billion in 2023 and are projected to reach $144 billion by 2032.

Similarly, the U.S. supplement market has exploded. In 2000, it was valued at $15 billion; in 2023, it reached $53 billion.

WHAT’S DRIVING THE GROWTH IN NATURAL HEALTHCARE?

The reasons behind this surge in natural healthcare are clear—especially for those of you working directly with patients. Americans are increasingly looking for ways to improve their health, and what’s been promoted to them for decades is no longer cutting it. As a result, they are turning to alternative solutions.

When comparing the health of Americans to other industrialized nations, the U.S. ranks near the bottom. Surveys indicate a significant shift in consumer attitudes towards proactive health management rather than reactive, symptom-focused treatments. There is also a growing preference for non-invasive, drug-free approaches.

In many cases, people are turning back to simpler, more natural remedies—sometimes even relying on what “Grandma knew”—as they seek alternatives to pharmaceuticals due to concerns about side effects and dependency.

Other key factors driving the growth of chiropractic and natural health include:

  • Increasing Awareness and Acceptance: More people are becoming aware of the numerous benefits of chiropractic care.
  • An Aging Population and Active Lifestyles: The incidence of conditions like back pain, arthritis, and sports injuries is on the rise—especially among seniors and those with sedentary lifestyles. Many are looking for non-surgical solutions, and with professional football teams utilizing chiropractors, weekend athletes are following suit.
  • Integration with Traditional Medicine: There’s an increasing trend of collaboration between chiropractors and other healthcare providers. In fact, I personally know chiropractors working in hospital settings.
  • Affordability: Chiropractic care is generally more cost-effective compared to many conventional medical treatments.

Your future looks bright – keep smiling!

As you can see, the future for chiropractic and natural healthcare is incredibly promising. Keep moving forward with optimism and a focus on your goals.

Let’s work together to make America healthier, one patient at a time!

For auld lang syne, my friend,

Ed

References on blog [LINK]

Delivering Kindness in Your Chiropractic Healthcare Practice

young lady with older lady showing kindness and caring

The article emphasizes the importance of kindness in chiropractic healthcare practices, suggesting that kindness is the core “business” chiropractors are truly in, rather than just focusing on adjustments, marketing, or insurance. Kindness, defined as acting with concern for others without expecting reward, enhances relationships with patients and within the team. This, in turn, leads to improved patient referrals, retention, and overall satisfaction.

Kindness also has personal benefits, improving the well-being and mood of both healthcare providers and patients, while creating a positive ripple effect in the community. The article concludes with a poem, Let Us Be Kind by W. Lomax Childress, reinforcing the idea that kindness is a priceless and transformative force in life and business. The message encourages practitioners to stay driven by kindness, especially during challenging times.

The Silent Recession and What to Do About it in your Chiropractic Healthcare Practice

farmer in a field of obstacles

The article addresses challenges faced by chiropractic practices in 2024, attributing some of the struggles to broader economic factors like a “Silent Recession.” Small businesses, including clinics, saw a 30-40% revenue decline, with inflation and rising operational costs outpacing Medicare and Medicaid reimbursements. Insurers’ tactics, such as requiring prior authorizations, denying claims, and delaying reimbursement, have also complicated financial operations. Additionally, many patients face financial strain due to inflation, high interest rates, and rising living costs, further affecting clinic revenues.

To counter these challenges, the article offers solutions focused on improving clinical and administrative practices. Clinicians are encouraged to focus on the fundamentals of their care, adopt a purposeful approach to healing, and invest in ongoing training to enhance patient outcomes. Administrative support is emphasized, suggesting that a strong organizational structure and team training are critical for long-term success. The article also highlights the importance of staying independent, noting a trend of independent medical practices being squeezed out by governmental policies and rising inflation.

The author encourages chiropractors to remain resilient and continue fighting for their independence in the face of these challenges, implying that larger industries may have a vested interest in eliminating smaller practices. The message ends with a call to action for chiropractors to stay strong and prepared for 2025.

Read the Full Article Here:  https://www.goaldriven.com/post/the-silent-recession-and-what-to-do-about-it-in-your-chiropractic-healthcare-practice

Employee Satisfaction Scale and Chiropractic Practice Performance

professional working mom with baby on her lap during a business meeting

Ed shares the connection between employee satisfaction and the performance of a chiropractic practice, drawing parallels to how companies are rated on platforms like Glassdoor. The Glassdoor ratings range from 1 to 5 stars, based on employee satisfaction, with higher ratings indicating a more positive work environment, better leadership, and improved profitability. Studies have shown that companies with higher employee satisfaction ratings tend to be more productive and profitable.

The article lists five key factors that influence employee satisfaction, which are crucial for improving productivity and profitability in a chiropractic practice:

  1. Workplace Culture: A positive work environment, shared values, and team dynamics play a major role in employee satisfaction.
  2. Management Quality: Effective leadership and management style are key factors, with poor management being a common cause of dissatisfaction.
  3. Compensation and Benefits: Fair and competitive salaries and benefits packages are essential for employee satisfaction.
  4. Work-Life Balance: Employees value companies that support a balance between work and personal life.
  5. Career Opportunities: Opportunities for growth and advancement within the organization are important to retain motivated employees.

We can’t emphasize enough that administration and management play a significant role in creating a positive workplace, which in turn supports quality clinical care. While the focus of a chiropractic practice is on providing excellent service and outcomes, having a well-managed, supportive, and motivated team is essential for achieving success. The author concludes by encouraging chiropractic practice owners to continue improving their business management, suggesting that better administration is the key to improving both employee satisfaction and practice performance.

What Gets Measured — Gets Managed in Your Chiropractic and Service Business

bus driver with the dashboard in front of him guiding him where to go.

ED shares how chiropractic business owners can effectively manage their practice as it grows by using key performance statistics. Initially, managing both patient care and business operations is feasible when a practice is at 50-60% capacity. However, as the practice grows, the increasing demand for management and staff coordination can lead to stress and “growing pains.” To overcome this, the article introduces the Fast Flow CEO system, which helps doctors manage their businesses effectively by dedicating just a few hours a month to business operations.

Key to this system is the use of performance statistics, which help track progress and identify areas for improvement. The article outlines essential components for tracking performance, including:

  • Key statistics: New patients, paid visits, charges, and collections.
  • Time period comparisons: Weekly, monthly, and yearly comparisons.
  • Same-month comparisons: Analyzing ratios like Visits/New Patients or Charges/Collections.
  • New patient tracking: Monitoring where new patients come from, especially for practices investing in marketing.
  • Marketing expenses: Tracking cost per new patient to optimize marketing spending.
  • Visual tools: Graphs and charts to help visualize trends and results.

The article emphasizes that these numbers represent outcomes, not just data. The goal is to improve patient care and practice efficiency, not simply to increase the numbers. Displaying these metrics in team meetings and using them as a “dashboard” helps everyone stay aligned with the practice’s goals.

The overall message is that managing a growing chiropractic practice requires smart use of data to drive decisions, improve outcomes, and continue progressing toward long-term goals.

 

Chiropractic End of Year Marketing and Business Checklist

goal driven  checklist to prepare for the New Year

This article provides a comprehensive checklist for chiropractors to prepare their practices for the end of the year and the upcoming new year. With 2025 just around the corner, the focus is on winding down advertising and shifting toward internal marketing strategies during November and December. Key ideas include:

  1. Holiday Promotions: Offer Thanksgiving turkey giveaways, special promotions for veterans, donation drives, and patient appreciation events like gift exchanges or holiday parties.
  2. Referral Programs: Encourage patient referrals with giveaways such as poinsettias and gift certificates, and express gratitude to external referral partners with thank-you gifts.
  3. Newsletters & Reminders: Send personalized practice updates and reminders to schedule appointments through the holidays.

Planning for the Future:

  • Spend time with your team reflecting on 2024’s achievements and brainstorming goals for 2025. Consider creating a unifying theme or project for the year ahead.

Business Essentials:

  • Financial Review: Meet with your accountant to assess finances and tax strategies.
  • Employee Benefits & Contracts: Review employee benefits, consider bonuses, and evaluate insurance contracts for profitability.
  • Compliance & Licensing: Ensure adherence to HIPAA and other regulations, and confirm that all licenses and malpractice insurance are in place for the coming year.
  • Budget Planning: Set a budget aligned with your practice goals.

Start with a clear vision and remain focused on both immediate tasks and long-term objectives for continued success in the new year.

Recognizing Greatness in Our Teams

Synergy and the Balanced Business

smiling happy womanLinda 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

 

two men and a woman receiving an awared

Dave Michel, Linda Skiles, Ed Petty

Where Is Your Chiropractic Marketing Department?

two business women discussing marketing

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

The Goal Driven Business
By Edward Petty

order now button

Use the Learning Pyramid for a Better ROI in Your Chiropractic Healthcare Practice

three generations of women cooking in a white kitchen

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:

  1. Lecture: 5%
  2. Reading: 10%
  3. Audio-Visual: 20%
  4. Demonstration: 30%
  5. Discussion: 50%
  6. Practice by Doing: 75%
  7. 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

The Goal Driven Business
By Edward Petty

order now button

Overcoming the Barrier to Improvement

lumberjack with ax and pile of logsSharpening 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

The Goal Driven Business
By Edward Petty

goal driven business buy now button

Managing Your Coordination of Benefits

insurance 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.

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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/

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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:

*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

lady walking on the beach listening to music

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

 

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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.

 
goal driven business www.goaldriven.com

The Goal Driven Business

goal driven business buy now button

How to Win as a Chiropractic and Healthcare Practice Athlete

balance beam 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:

  1. DEVELOP A CHAMPION’S MINDSET.
  2. BUILD YOUR SUPPORT TEAM.
  3. CONTINUOUSLY IMPROVE.
  4. CELEBRATE THE WINS!

Read More[LINK]

The Time I Asked a Doctor The “Who” Question?

woman multitasking in a chiropractic office

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:

  1. 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.
  2. 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.
  3. 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?
  4. Overestimation of current efficiency: Business owners might believe their current operations are running smoothly enough without a trained manager.
  5. Concerns about team dynamics: when someone takes on the role of manager improperly, they can disrupt the team’s harmony.

And especially,

  1. 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?

statue of liberty in a display of fireworks, life, liberty and happiness, petty, michel, goal driven

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

Most powerful doctor according to Google.

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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.

goal driven business www.goaldriven.com
The Goal Driven Business
By Edward Petty
goal driven business buy now button