Tag Archives: chiropractic

Case Management in a Chiropractic Office

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Chiropractic Case Manager Job Description Summary

In many chiropractic offices the majority of the attention on patient care is on the first 5 to 12 visits. In some offices, it is only on the first 5 visits, or less. It can get so bad that the primary concern is only on getting more and more new patient first visits.

An old maxim in dental consulting is that the biggest cost to the dentist is the incomplete dental program. A patient who discontinues care after the first $1,000 of a total program of $10,000 just cost the dental office $9,000. This also applies to the chiropractic office.

Actually, many chiropractors are producing incomplete cases. This is not in the best interest of the patient’s health or in the viability of the office. Imagine a hygienist that only cleaned the upper teeth, or a baker that only baked his bread half way through. Yet, many offices are only getting their patients partially through their treatment programs.

The job of your clinic is to get your patients to complete their entire treatment program and on to a Wellness Program. During the course of a patient’s care, the doctor and staff may concentrate only on their specific duties with the patient, such as scheduling, treating (adjusting), collection, etc.  Usually no one has the job of overseeing the patient’s progress along the entire treatment pathway, through all the adjustments, scheduling, therapy, education, payments, until they finally “graduate” and go on to a Wellness Program.

Yet a full Wellness Program takes some of the pressure off of the need for a constant stream of new patients and makes for a smooth running office.

To help ensure that patients get complete and comprehensive care, the position of Case Manager should be held by someone in the office.

Who should be the case manager: It can be fulfilled by the doctor, or the therapy or back office assistant, or the front desk or even the billing and collections staff member.

Time spent as a case manager: It should take no more than one hour per week.

Mission: The mission of the Case Manager is to ensure that all patients move through the various departments of a health care clinic smoothly and quickly, ensuring that they get excellent service such that they complete their treatment program as quickly as possible.

Duties and Responsibilities

1.  Coordination. Once a week, or daily before treating hours, the case manager should get the doctor and essential staff together for a Case Management Meeting. A great time to do this is 20 minutes before the first patient for the day, or weekly for one hour. During this time, the appointment book or a list of active patients should be reviewed.

    This is the most important tool the case manager (or case coordinator) has. During these meetings, the following points, among others, can be reviewed on each active patient:

    • Patient’s Progress
    • Patient’s Satisfaction
    • Re-exam (last/next)
    • Re-x-ray, or other diagnostics
    • Re-x-ray, or other diagnostics
    • Re-reports (progress report of findings)
    • Supplements
    • Exercises, nutritional or other recommendations
    • Financial conclusion (Initial, subsequent, and transitional to Wellness.)
    • Education programs, such as spinal care class, special lectures, pamphlets, etc.
    • Awards, compliments, thank you for referrals, good attendance, etc.
    • Family and friends referrals
    • Transition or adherence to a Wellness Program.

    2.  Outcome and Statistics. Keep a statistic of “Completed Treatment Programs”. Once a patient reaches a maximum level of improvement they are ready to go on to Wellness Care. One way to keep this statistic is to track the number of patients beginning a wellness care program.

      3.    Patient Progress Card. Make up a general treatment plan for every patient in the form of a simple checklist. This would include all service procedures, therapy, diagnostic, as well as educational actions. The last steps would include transitional consultations onto a wellness care program. This could be called a Patient Progress Card, and placed in the patient’s folder.

      4.    Day 1 & 2 Procedures. Ensure that day one and day two procedures are well documented and kept up to date with current procedures, and a simple flow chart outlined.

      5.    Regular Visit Procedures. Ensure that regular patient procedures are documented, and a simple flow chart outlined.

      6.    Staff Training. Staff walk-throughs for day one and day two procedures, and other flow procedures rehearsed at least on a quarterly basis. The best offices practice monthly.

      7.    Financial Consultations. Financial consultations done on all patients as often as is needed.

      8.    New Patient Orientation. New Patient Orientation done on each patient.

      9.    Patient Satisfaction. Ensured patients are very happy with service.

      10.    Pathways. Pathways for different types of cases documented and reviewed by all.

      11.    Flow Charts. Flow charts for first three day procedures outlined and rehearsed.

      12.    Conversion. All patients completing services are converted to wellness or other programs.

      Outcomes. The major outcome of the position of Case Manager is “Completed Treatment Programs.” That is, patients who have completed any acute or chronic treatment programs prescribed by the doctor and have reached maximum improvement. This definition could be extended to include: a patient who has completed their active care program and is educated so that they will continue onto a wellness program.”

      Performance Monitors

      • Number of Completed Treatment Programs
      • Number of Patients Beginning Wellness Care Programs
      • Number of Wellness Program Visits

      It is easy to drop out important but not urgent actions with patients during their care. Ultimately, this leads to poor quality and a deterioration of results. With a Patient Progress Card, and the Case Manager System in place, quality and patient results will improve, and your volume will increase. Often it is not what we see that hurts us, but what we don’t see. It is the gradual omissions that eventually add up to an empty office. Ensure each patient completes all of the steps of their treatment programs.

      For better patient retention, increased referrals, improved treatment compliance, and more revenue, implement the Case Management System!

      Chiropractic Newsletters

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      Newsletters to Your Patients

      Pity the poor practice newsletter!

      So misunderstood. Forgotten, neglected, and ridiculed.

      Scorned as too expensive, dismissed for eating up too much staff time, and disregarded because they just don’t “work.”

      But is any of this true…?

      Not necessarily.

      Too expensive? They can be. Fancy paper, color photos, six pages,  and sent first class can cost thousands.

      Take too much time? Oh boy, how true this can be!  Who is going to get the information and write it, format the newsletter, get the mailing list, organize the mailing, do the printing, add the postage, and take it to the post office?  That is a LOT of work, and costly staff hours.

      Do they work? After spending so much time and money on any other promotion, you would expect the new patients to come in for a good return on your investment. Often, this does not occur.

      BUT WAIT… it doesn’t have to be like this. IN FACT:

      Patient newsletters can cost as little .50 cents per newsletter. That includes, postage, paper, printing, and taking them to the post office.  The offices where we see them used regularly have shown an increase in patient referrals and in reactivated patients.

      Before we outline how to do it, here is why you should.

      Why You Should Do A Newsletter
      When a patient starts care with you, you and that one person, old, young, male, female, it doesn’t matter, that ONE person and you – have started a conversation. They confided in you about some things about which, outside of close family friends, no one knows. It is personal. Professional, yes, but the fact is, you and your patient have started a dialogue.

      It is your job to continue it. It is not their job to do so – it is yours.

      You are the doctor and they came to you. They reached out for help. All you have to do is to keep the conversation going. It may be one sided for a while, but they are listening.

      We are all spammed to death. It has been estimated that each one of us receives up to 3,000 to 5,000 separate advertising impressions each day in the U. S. People are numb to advertising. It is no wonder that your ads in the local paper just don’t have the pull they used to.

      Patients who have once been to you already know who you are. When they receive a letter from you, it is from someone who knows them.  You are communicating to someone who already knows you and knows that you know them.

      Statistics tell us that it is much more profitable to invest in keeping the patients you have, and marketing to them, than trying to procure new patients that do not know you.

      Patients stop seeing you because sometimes, Life gets in the way. Finances, personal problems, work, and after a while, they kind of just loose touch.  But you are mistaken if you think that your relationship with them is over.  Once someone tells you intimate details about their personal condition, a relationship has started. Think about who you have confided in personally. You feel a special connection to them, right?

      So, a conversation has started and by simply maintaining it, you will find that the patients stay with you longer, come back to care more frequently, and refer more of their family and acquaintances.

      How To Do A Newsletter
      For those of you who have the Marketing Manager System (sm)  computer program, there are a number of sample templates and examples that can be easily reformatted for your office.

      Newsletters are thrown away, of course,  but they are reminders and brief advertisements about your services. They should not look like another pamphlet – homemade newsletters work very well. Too fancy is too expensive and look like the regurgitated pulp that gets thrown in most health articles and brochures.

      Add a column just from you. We have a sample doctor’s column which you can use. On our members site for our clients, we have others.  Add some news, maybe one of Margie’s favorite non fattening brownie recipes, a snapshot, a testimonial, and a list of upcoming events. That’s about it.

      Put it on one piece of paper that gets folded over twice and become self mailer. Bid it out to local mailers and you will find that the printing, paper, postage, and mailing all comes out to about fifty cents each.  If you have 1000 patients to whom you are mailing, that comes out to $500. If you do the mailing every 4 months, it averages to be $125 per month.

      Make sure that one person is delegated to oversee the newsletter. It should not take but a few hours to do.

      Email newsletters are nearly free, of course, and can be effective.  You can capture the email addresses from your patients and send out personal newsletters using services such as constantcontact.com, aweber.com, or a new one icontact.com. There are many others that have simple templates where you can simple type in the information and send out.

      Homemade Newsletters versus Preprinted Newsletters

      There are a number of companies that will print and mail newsletters out to your patients for you.  There are also a number of chiropractic commercial websites that will send out prefabricated electronic email newsletters to the email addresses you supply them.  The advantages are obvious – someone else does all the work and patients receive a professional good looking copy in their mail box, or their email in box.

      We have seen these work, however we prefer the home made newsletter.  The reason is that professionally done newsletters are a bit like pamphlets – they look nice, but they are generic and soulless.  This can be particularly true of email newsletters. Some prefabricated newsletters make room for your customized inserts.  In this case, these might work well.

      The primary problem with the preprinted newsletter, whether “hard copy” or electronic, is that it can take you out of the loop. You cannot really delegate all of your patient communication.  You can delegate some of your communication, but the point is, you want to maintain a personal relationship with your patients.

      There is more to it than this, but don’t worry about getting it too prefect or too fancy. Funky, friendly, and funny is good.  Just do it and keep the conversation going. You will see your old patients returning, referrals increasing, and established patients coming in to thank you for that the recipe you put in your last newsletter.

      #  #  #

      [Petty, Michel & Associates offers special practice development programs designed to help you achieve your goals.  For more information on our 3 Goals Seminars, coaching programs, and products: Services Products]

      What the Moon Has to Do With You Success

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      The moon is back to normal again.

      Just a few hours ago, though, standing in the middle of a snow-covered playground near Lake Michigan, in the night sky at about 3 degrees above zero, it looked like a smudge. A grey brown spot that was almost black, like someone had tried to erase it with an old eraser, but part of its image still remained.

      For a few hours, the earth blocked out the sunlight to the moon, at least from our perspective. These unimaginably huge spheres of matter, nearly perfectly in balance, were gracefully moving like billiard balls in a ballet.  Compared to this, all else really seems insignificant.

      Before street lamps, car lights, TVs and late night computers, the night sky entertained us. Everyone could recognize the constellations, and an interplanetary event such as an eclipse was a very big deal. All our ancestors were stargazers – the night sky gave them the comfort of familiar signs, as well as wonder and awe. And mystery.

      Besides the city lights to distract us, we have our daily duties and deadlines that rivet our attention to the near. Your patients, your notes, your computer, staff members, phones; most things are just a yard stick away.  Like a ping-pong game, your focus has to be complete, quick, and close, or, you lose.

      When your attention drifts, patients think you don’t care, staff thinks you take them for granted or are displeased, and insurance companies can’t read your notes.   Success in practice requires keen attentiveness.

      You can’t survive asleep at the wheel, dreaming or daydreaming. To be a winner you have to be alert and actively attentive to your job each minute you are at the office.

      And if that is all you do, you soon will burn out.

      Studies have shown that you have to, now and then, disengage. Take a break. Learn Japanese. Play with your kids. Help the poor.  Pray. In their best selling book, The Power of Full Engagement, the authors offer studies and examples on why it is important to become involved in disrelated activities to balance our hectic if productive lives.

      All this goes back to the moon and the sky.  I don’t think we look up enough. The sky, the stars, and the whole natural God given world are about us, mysterious and awe inspiring.

      In business, we have to focus on the short term and build for the middle term. But it is the far away that calls us, if we can stop to listen.  What makes you curious, fills you with awe, love, and seems a mystery? What does your future whisper back to you, as if you could hear your eulogy years from now? What are your greater purposes?

      Balancing these three is the key to a successful practice, business, and life.  Your first goal is to play each day fast, full out, like a basket ball game you have to win. Your second goal is to gradually build a strong organization with the right teammates and the best plays that have proven to work for you. But your third goal, and there may be many, are why you work at all.

      If your business has plateaued and stopped growing, it is because one or more of these goals is not being worked on correctly.

      We have developed a general pathway and framework for doctors to move upward so that they can correctly work on and achieve all three goals. It doesn’t matter what technique you use, therapies, providers, or offices.

      We are excited and pleased about the development of this new approach to practice management and marketing and how it impacts our consulting and the results our clients can see, as well as our own business and personal lives.

      We will be publishing and just talking more about these three goals, but we encourage you to come to our seminars.   You can learn more about them by clicking here. 3-Goals Seminars

      And, in the meantime, as my old pal, Jack Horkhiemer the stargazer always says:  “Keep Looking Up.”

      photos from Microsoft and NASA

      Billing Audits and “Red Flags”

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      Angie’s Angles
      From a Chiropractic Billing Consultant

      For your protection, you should be aware of the Top 10 Red Flags for a billing audit in a chiropractic office. Here they are.

      Since this is the beginning of a new year, I will start with the Top 10 Red Flags for a billing audit (in no particular order):

      1.  “Phantom Billing”—Billing for services not rendered.

      2. “Double Billing”—charging more than once for the same service, e.g., using an individual code again as part of an automated or bundled set of tests.

      3. “Clustering”—Using only a few codes on the theory that it will average out.

      4. “Upcoding”—Using a higher reimbursement code than the code reflecting the service rendered; e.g., billing for complex services when only simple services were performed, billing for brand named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.

      5. “Unbundling”—Using two or more billing codes instead of one inclusive code where
      regulations require “bundling” of such claims. Submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.

      6. “Code Jamming”—Inserting or “jamming” fake diagnosis codes to get insurance coverage.

      7. Billing for non-covered services

      8. Billing for services that are not reasonable and necessary.

      9. Inappropriate balance billing—billing Medicare beneficiaries for the difference between the total provider charges and the Medicare Part B allowable amount.

      10. Routine waiver of co-payments and billing third-party insurance only.

      The complexity of managing a practice is not a walk in the park. As a Billing Consultant with PM&A, my job is to free doctors from the worries that can accompany running the financial end of a medical practice.  I can review and streamline your billing department, train staff, and credential doctors with insurance companies, among other services.

      Questions on how any of these might apply to your office? Contact me and I will let you know.
      Next month – look for tips on nailing your Financial Consultations!!

      How Gratitude Can Improve Chiropractic Clinic Performance

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      “Gratitude is not only the greatest of virtues, but the parent of all others.”
       Cicero (106-43 B.C.)

      Those Greeks were pretty smart, and Cicero’s statement is just one example.

      According to an article in Psychology Today, gratitude is a sentiment we’d all do well to cultivate.  “Feeling thankful and expressing that thanks makes you happier and heartier–not hokier.”

      But more than that, when gratitude is expressed to others, many benefits occur.  A simple “thank you” goes a long way in improving the morale and ultimate performance of others. Of course, it has to be genuine. Counterfeit praise is easily seen through and can do more harm than good.

      According to Tom Rath, co-author of How Full Is Your Bucket, “Gallup polling has revealed that 99 out of 100 people say they want a more positive environment at work, and 9 out of 10 say they’re more productive when they’re around positive people.”

      He points to research that shows when a work team has more than three positive interactions with managers for every one negative interaction, it is significantly more likely to be productive.  The point is not to keep managers from correcting or reprimanding, but just to express more praise.

      To improve your gratitude attitude, consider the following actions:

      1. In your personal life, you can list the kindnesses of someone you’ve never fully thanked.  According to Lauren Aaronson in Psychology Today, if you read this letter aloud to the person you’re thanking, you’ll see measurable improvements in your mood. She refers to studies show that for a month after a “gratitude visit” (in which a person makes an appointment to read the letter to the recipient), happiness levels tend to go up. In fact, according to her references, the gratitude visit is more effective than any other exercise in positive psychology.

      2. In your practice life, list the positive contributions of each team member.  Once each day, take just a moment to recognize your team member’s action and express it to them. Your communication does not have to be lavish, just a short 3 second notice of something good followed by a “thanks for the report, Dr. Smith” is all it takes.

      One chiropractor I worked with years ago seemed to always be in a bad mood. He was quiet and basically ignored his staff. His opinion was that he paid them to work, they should work hard, and that was it.  But, his office wasn’t doing well so he called me in.  I made several visits to his office, each time simply improving the communications between he and his team. I coached him on listening to each staff member and to simply acknowledge them for their contributions.

      A few month’s later, we saw his practice grow.  I remember this because he was always complaining to me that I was not doing anything for his office! (Sheesh!) His constant complaining and lack of appreciation was the real problem yet he just didn’t see it.

      This concept is not new, of course, but it is worth remembering now and then. More studies that validate the practical aspects of this as a management tool are covered in the above referenced book.  But beyond management, like Cicero says, it is just an all round good virtue to cultivate.

      For a motivational tent poster with the above quote, click here.

      And … thank you for taking the time to read this!

      Note: If you feel you need some instant appreciation yourself, try this. (Will need speakers or earphones.)

      The Four-Handed Chiropractic Office

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      We once knew of a dentist that was able to see hundreds of patients each week. Just himself.

      How?

      He had four hands. Actually, he had about 40 hands.

      Four-handed dentistry became popular in the 1960’s and is a procedure that utilizes a dental assistant at the chair side of the patient with the dentist.

      The two extra hands of the assistant allows the doctor to do the essential work on more patients. It is actually more than just adding two more hands. It includes all aspects of cooperation and coordination, allowing for maximum production through improved efficiency.

      But his success was due to not just having extra “chairsides.” He had everything delegated, had separate departments in his office systematized, and had manuals for each department from which he constantly trained his staff. And, he had a fast and efficient management system to keep it all going. This permitted him to work with patients and develop the personal rapport that helped to keep them coming back to complete their treatment programs and refer their family and friends.

      All of this leads to a key concept: capacity. Capacity is the ability and “room” to produce. Four-handed dentistry increases the capacity for the dentist to serve more people.

      The reason why many offices stop growing is that, simply, they run out of room. It could be that there is not enough physical space or not enough effective staff. It could be poor patient, staff, and paperwork systems that clog up the flow so badly that even a can of Drano or a visit by the Rotor-router man couldn’t fix.

      And, sometimes, even our mental capacity can get “filled-up.”

      A well-organized office allows you to leverage your abilities and create more production. It also opens up the room to produce.

      Imagine trying to play a football game on a 10 yard by 10 yard field. This is what many of us are trying to do, yet we just don’t know it. If you are having a hard time growing your office, you may have unseen capacity constraints holding you back.

      A four-handed chiropractic office would be an office where there were many “hands” efficiently doing all the work, allowing the doctor(s) to focus only on those key actions necessary to treat patients and run the office.

      Give this some thought and we will SOON show you some specific examples and what to do about capacity restraints in your office. Stay tuned…

      P.S. If you know any doctors or marketers who would enjoy this article, just send them an email with this link: http://www.pmaworks.com/main/Four-Handed_Chiropractic_Office.shtml
      P.P.S. E-mail addresses are never shared.

      You are free to use the material from these articles in whole or in part on your web site or eZine (email newsletter) as long as you include the attribution below and also let me know where the article will appear.

      “This article is by Ed Petty of Petty, Michel & Associates. Petty, Michel & Associates web site is a comprehensive resource on practice development for chiropractors. For free marketing resources and valuable development tools visit http://www.pmaworks.com”

      Randy Pausch

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      Randy Pausch
      Last Lecture

      Carnegie Mellon Professor Randy Pausch, who is dying from pancreatic cancer, gave his last lecture at the university Sept. 18, 2007, before … a packed McConomy Auditorium. In his moving talk, “Really Achieving Your Childhood Dreams,” Pausch talked about his lessons learned and gave advice to students on how to achieve their own career and personal goals.

      Summary of lecture from the Wall Street Journal.   Viewing time  4 minutes 39 seconds.

      Link, or watch below:

      Full Lecture 1 hour 39 minutes

      Fall Chiropractic Marketing

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      Here are some quick ideas for you to consider for your fall marketing of your chiropractic services.

      There are different approaches to these themes and projects. Please give us a call anytime for advice on how to implement them. You can also find them on your MMS computer program. For those of you on the MMS Coaching program, you can also find information on your Member’s site, which is updated often.

      Internal/External

      • September – Kid’s Day
        i.    Spinal Care Class (New patients and their guests friends.)
        ii.   Care To Share Program (Referral drawing)
      • October – “Pinched Nerve Awareness Week” (October is national Spinal Health Month.)
        i.    Reactivation Program
      • November – “Headache Awareness Week”
      • December – Donation Drive
      • January – Weight loss and Fitness Programs

      Community Services
      Now is an excellent time to work on setting up your external community events. Schedule workshops and screenings in business, clubs, and organizations over the next 5 months – through January.

      An important key to setting up these events is knowing what it is you are going to provide. For example: a workshop on headaches, or fitness, or a screening, or something else entirely.

      We have found that there is a direct ratio between having a clear idea of what service you are going to provide and the success in scheduling the event. Here are some ideas, but again, there are many more on your MMS computer program and please call if you have any questions.

      1. “8 Healthy Home Remedies for Relieving Headaches”
      2. “How to Stay Fit When You Sit”
      3.   Company Health Fair
      4.   Employee Appreciation Luncheon

      Lastly, and as always, keep yourself inspired.  One way to do this is to keep learning and working on improving your procedures.   Fall is not just a time when children get to learn. We always have the opportunity to improve if we just study.  We can analyze our new patient intake procedures, our patient education programs, our clinical protocols for different cases, etc.

      If you are feeling like your practice is getting boring, just study it. Learn how it could be improved.  A professional is constantly improving.

      Till next time,

      Ed

      Chiropractor: Are You a D.C. or a D. S.?

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      Whether you are a D.C. or a D.S. makes a big difference in your patient retention and patient referrals.

      Many years ago we were working with a chiropractor who, while he had a great practice, couldn’t manage it worth a damn.  Even so, because his patient retention and patient referrals were exceptional, he had a high volume practice.

      As we worked with him to improve and expand his business structure, his volume continued to increase. This was a while back; when note taking was very simple, but I think he got up to seeing around 500 visits a week, with peak weeks over 600. We helped with marketing and associate doctors, and he continued to grow. He had all kinds of marketing programs, plenty of associates, and made a great name for chiropractic.  But at the heart of his growth was a special secret he often related.

      What was his secret?

      Well, one of them was the way he started each case.  On his initial consultation with each patient he would say:

      “Before I tell you what chiropractic does, let me tell you what it doesn’t do. As doctors of chiropractic, we do not prescribe drugs.  (Pause.) We also do not perform surgery. (Pause.) Lastly, we do not treat symptoms.” (Long pause.)

      He would let that sink in for a few moments. He would then briefly explain what chiropractors were really after.  Namely, subluxations. And while there may be other terms for this condition, from a marketing point of view, this has worked. It fixes in the mind of the patient that there is an underlying cause or a basic contributing factor that resulted in, or at least affected their current complaint(s).

      Over the years of consulting, we routinely see doctors “going shallow”, treating only the superficial symptoms that patients come in with. “Hey doc., I must got a crick in my back. Can you just give me a crack here (points) and fix it?”  Horror of horrors!

      It is easy to focus only on the symptoms.  First, it is the reason why the majority of your patients come to see you.  They have pain, stiffness, or discomfort and want it fixed.  Second, it is what your insurance company requires in your documentation.  Third, it is the path of least resistance. Give the patient some relief and then move on.  Fourth, chiropractic is usually SO effective with symptoms relatively quickly, that we often are just happy with that.

      I am certainly not advocating any particularly type of treatment guideline.  I am just pointing out that many successful chiropractors look for earlier traumas in their consultation and history and maybe spend just a bit more time on the general diagnostic process, if only a minute more.

      This is from a marketing point of view, not from a clinical perspective. In these times of higher deductibles, you have to put the value into your service.  If a patient comes to you for a pain in the “keister”, and you only address that, not only is the patient being the doctor, but also you are relegated to “therapist.”

      Another doctor David and I worked with had a practice “melt down” one winter day. (By the way, we see these “melt-downs” every now and then! Too much insurance B.S., mid-life burnout, staff problems, etc. Please call us if you feel one coming on!)  He was mostly a “straight” doctor, but had purchased a very inexpensive, used EMS (muscle stim.) unit for patients.  One day, one of his patients came for his adjustment. He told the doctor that he didn’t want adjustments anymore, just wanted some of that electronic muscle stimulation.   Our doctor blew a fuse. “Fine”, he said. “Here, take the dang machine and go home. You can have it.” And he actually gave it to him.

      A bit extreme, but it was probably good to get it out of his system. The doctor was feeling that he had become only a band-aid therapist for his patients because of the therapy unit. It took a while, but we got him to see that it was not the patient’s fault. The patient simply did not understand the purpose of the doctor’s treatment program.

      D.C. could be called Doctor of “Chronicity.” I was reminded of this recently by one of our clients.  D.S. could be “Doctor of Symptoms.”

      We suggest the following:

      1.    Be a D.C. Doctors who emphasize the chronic nature of the patient’s symptoms seem to have busier practices.  We suggest that you should do both:  definitely help patients get what they want – pain relief.  But, as appropriate, work with them to get what they really need.

      As a side note, some doctors can become so philosophical that they loose touch with the fact that “the Customer is King.” (In Japan, I have read they say that the “Customer is God.”) Philosophy, principles, and emphasizing the chronic nature, as indicated, is fine.  So is “Wellness.” Just remember that you have to also give the patients what they want and keep them happy.

      2.    Integrity. Needless to say, in all things you have to call it like you see it and maintain your integrity. If there are no chronic conditions, then so be it. But at least, take the time to look.  Be curious, investigate, and don’t let the insurance company or the patient’s desire for fast results compromise your clinical integrity.

      3.    Interest. Traumas may have occurred many years earlier, or accumulated over the years.  Be genuinely interested and focused on their case. Even intense about what you discover in their exam and x-ray and how you explain it. “Would you look at this, Mrs. Jones”, pointing to a spot on the x-ray as if this was the first x-ray you had seen of this kind before. (And it is.)  This will increase the patient’s confidence in you and acceptance of your treatment plan.

      4.    Time, Repetition, Effort. It may take time to correct the condition. It may take repetitive visits (like an orthodontist), and it will take effort on the patient’s part as well as yours.

      Go over the factors of time, repetition, and effort with the patient. You can also ask the patient how long do they think it will take to correct the condition.   If you have educated them on the true nature of the condition, you might be surprised to hear that they often offer a longer period of time than you were ready to present to them in your treatment program. (A very successful doctor recently reminded me of this.)

      5.    You Are, And Have Been, A Leader. And finally, don’t sell yourself short. As a chiropractor, you are an active member in a profession that, no doubt, has led the way in real health care over the last 100 years.  Certainly, it will continue to do so in the future, provided that you stick to your guns, while always adapting to the ever-changing market.

      By looking for and working to correct the long term causes of spinal related symptoms, you will inspire trust and confidence in your patients as their doctor of chiropractic, coach, and friend. As such, your patients will be loyal and refer their friends because of your care. And, as such, you will be a D.C.

      Ed Petty

      Chiropractic Staff ROI and Motivation

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      Staff Management: An Essential Component To Practice Success

      A big reason for your chiropractic practice is doing well is because of your staff.  And,  a big reason your chiropractic practice is not doing well is because of your staff.  Either way, your staff plays a major role in the success of your business.

      How much can a good staff member contribute to the office? What is the Return On Investment for staff expenses?  There does not seem to be any good research on this for chiropractic offices. (If you know of any, we would appreciate the references.) We have seen some studies and based upon these and our experience it would be safe to say that a staff member should contribute at least double what you pay them.

      This means that if you pay a Chiropractic Assistant, for example, $2,500 (including taxes, FICA , etc.) a month, you should at least be able to generate $5,000 because of her.  On the other hand, when a staff member is not performing well, their contributions can go to zero, or even lower.  If they are alienated from the doctor and the practice, they can actually become a liability.  An unhappy or defiant staff can turn away patient referrals, discourage patient phone appointments, create disharmony with other staff, and many other costly problems.

      Staff Turnover
      The cost of staff turnover can be very high, as much as three times their monthly pay.  This would include recruiting cost, training cost, extra time on your part, lost patient and lost new patients. For example, if your senior front desk C.A. leaves and she is paid $2,500 per month, it could take a couple of months before you find another CA that has the qualifications you need, and at least a couple of more months before they are trained.

      By the way, this is why it is so important to have your practice systematized with all of your procedures written up for fast training and evaluation. (This is what our PM&A Practice Development Programs help you with!)

      Conversely, as mentioned above, you can save money by letting an under performer go.
      Staff Motivation
      Once you have personnel, you have to keep them motivated. Frankly, this can be a problem for many doctors. There is a basic reason for this which I will explain later on. First, let’s look at some interesting information on employee motivation.

      A recent article from the Harvard Business School reports on a study that showed that most employees start out relatively motivated, but things change after about 6 months.

      “The great majority of employees are quite enthusiastic when they start a new job. But in about 85 percent of companies, our research finds, employees’ morale sharply declines after their first six months—and continues to deteriorate for years afterward.”

      One of the biggest causes for this goes straight to the relationship they have with their managers.

      “Many companies treat employees as disposable. At the first sign of business difficulty, employees—who are usually routinely referred to as “our greatest asset”—become expendable.

      “Employees generally receive inadequate recognition and reward: About half of the workers in our surveys report receiving little or no credit, and almost two-thirds say management is much more likely to criticize them for poor performance than praise them for good work.

      “Management inadvertently makes it difficult for employees to do their jobs. Excessive levels of required approvals, endless paperwork, insufficient training, failure to communicate, infrequent delegation of authority, and a lack of a credible vision contribute to employees’ frustration.” (You can read the entire article here.)

      We have seen versions of these problems in every office. Even our own!! It happens. One of the most common habits of doctors that can impede staff performance and motivation is micro managing.  For example, fretting over the office volume, doctors can hover around the front desk causing the staff to be more concerned about the doctor’s constant evaluation than engaging with the patients.

      To solve these de-motivation factors,  the authors suggest the following:

      1. Instill an inspiring purpose.
      2. Provide recognition.
      3. Be an expediter for your employees.
      4. Coach your employees for improvement.
      5. Communicate fully.
      6. Face up to poor performance.
      7. Promote teamwork.
      8. Listen and involve.

      We would add two more factors. First:

      9. Clear policies and procedures consistently applied. You need to coach your team on the same procedures today that you applied yesterday, and will use tomorrow. These procedures should be written down in some form for easy reference. This gives an objective reference for staff coaching (#4) and regular staff evaluations (#6).

      And the most important, and most overlooked in a doctor’ office:

      10. Separate your roles of doctor and clinic director so that you can be a part time manager.

      The Most Common De-motivator
      Most chiropractors are either too busy and/or too focused on doctoring to have much attention left for caring for staff.  After all, the staff is there for the doctor and to help him or her with the patients. The doctor is not there for the staff. And, the staff is paid to do their job.

      So, what’s the problem?

      The problem is that employees are people and not machines.  And, like all living things, they need a certain amount of nurturing. Growing a business is like growing an orchard. It needs tending. Doctors do not feel they should have to do this, and as doctors, they shouldn’t.

      However, as the C.E.O. their business, they have too. Larger offices have office managers or practice administrators that can help do much of the staff management. We usually recommend that the doctor assign a staff member to take the role, if only for a few hours per week, of senior C.A., office coordinator, or office manager.

      Most doctors can be managers and coach their staff, but don’t. The reason, and the solution are relatively simple: just separate the roles of doctor and clinic director. As the doctor, everyone works for you and the patient. As clinic director and a part of management, you work for everyone else.

      With good business systems in place, a well organized office should require little time of the doctor to be a clinic director.  And in the role of business owner and investor, the doctor should see a very good return on his efforts if his staff is motivated.

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      Chiropractic Practice Bottlenecks: How to Increase Capacity by Removing Hidden Barriers

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      The theory of capacity management, as developed by Eli Goldratt and explained in his books, including the best selling The Goal, discusses the theory of constraints as applied to a manufacturing environment.

      The same principle applies to chiropractor’s business. According to Goldratt, “Capacity is the available time for production.” A bottleneck is: “what happens if capacity is less than demand placed on resource.”

      Bottlenecks can be hide anywhere in an office.  For example:

      1.     Peak Periods. Between the 4-6 pm slot, where there is extra traffic, extra staff or increased capacity is not provided.
      2.     Paperwork. Old forms that are redundant.
      3.     Poor scheduling of patients: (not cluster booked, not booking for NP paperwork)
      4.     Doctors waiting for therapy patients. (No CT or therapy after adjustment)
      5.     Front Desk doing insurance and scheduling at each visit (no MAP and PIA)
      6.     Not enough exam rooms
      7.     Clutter in front desk/insurance area
      8.     Quitting time. After a long day, all staff and doctors are looking forward to leaving and really don’t want extra patients to call or come in. Patients are inadvertently discouraged to come in extra, bring in friends or family , or call in during the last hour.
      9.     Backlogs. Undone reports from the two summers ago, partially completed projects, cluttered desks or office space, all discourage more an increase in production. You only have so much mental capacity, and if it gets frittered away on projects that are not completed, you will have “too many irons in the fire” to add any more. Finish what you started, and make room for more.
      10.     “Difficult people“. Some staff, or patients, will seem to drain you of your energy, or consume too much of your time trying to keep them happy.

      Warning: Too much capacity can also be a barrier.

      A) Personnel. A staff that has to make up work can retard production. Happy staff are productive staff, and the opposite is also true. Unhappy staff will not make for happy patients. This will also suck up the doctors time to try to remedy his “staff problems.”

      B) Space. Too large of a space can disconnect the staff from each other and the patients and minimize the synergy.

       

      Exercise – Getting Rid of Capacity Restraints and Bottlenecks.

      Make a list of any bottlenecks in your office. Start by considering the flow of patients, of paper, and anything that slows it down or gets in its way. Consider patients waiting, paperwork waiting, any times of the day or days during the week where there is a slow down or back log. You can organize it into four categories:

      Physical space
      Personnel
      Procedures
      Difficult people
      Incomplete projects

      Once you have listed these, give yourself 30 days to fix all these capacity restraints.

      NOTE: Bottlenecks can sometimes be difficult to locate, and even more difficult to remove.  Need help: Give us a call. (414) 332-4511

      Procedure on No-Charge Family Check-Ups

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      Office Policy for No-Charge Family “Check-Ups”

      This is an example of an office procedure written for all staff. It encourages patients to bring in their family for a simple spinal screening. Review this and adapt it for your particular office, and go over it at a staff meeting so that all staff understand its purpose and can apply it.

      [OFFICE LETTERHEAD]

      TO: ALL STAFF/DOCTORS

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

      There are a number of reasons for this.
      1. Spinal abnormalities can be generic, and though the family member may not be experiencing any symptoms, it can never hurt to get the spine checked.
      2. Additionally, part of our mission is to reduce the incidence of back problems occurring due to long time untreated and unknown spinal misalignments. It is much easier to align the back before major problems occur.  Many spinal problems start without any sign or symptom and it is easier to correct them if we can detect them before they become chronic or the patient gets older.
      We unfortunately see many people only after a major injury or problem occurs, and then it takes a great deal of work to correct the problem.
      Compare this to dentistry. Often, a dental problem can exist long before any pain or symptoms show up. With just a little work, the dentist can correct the problem and prevent a more serious condition in the future.
      3. We firmly believe that an ounce of prevention is worth a pound of cure.
      4.  Lastly, this is courtesy we provide to all of our patients.

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

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

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

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