Shown below is information regarding the 2023 Medicare Fee Schedule for Wisconsin Providers only provided by NGS Services and also a link to CMS.gov for fee schedules in other states.
Wisconsin Providers: Here is the 2023 Medicare Fee Schedule for your perusal. Please make this accessible to you and your staff.
“Get the fundamentals down and the level of everything you do will rise.”
— Michael Jordan
It’s always the basics. The fundamentals.
This is what all efforts to improve performance – and health — go back to.
All of your efforts in practice management boil down to communication and control.
All the books on procedures, patient management, and practice management can be distilled down to communication and control. Those are the basics you need to get to your goals and those of your patients.
Of course, the inverse of these facts is also true. Whether out of fear, confusion, or fatigue, when these fundamentals are not administered, things don’t go well.
Communication
I was recently helping a doctor and the practice manager improve their patient financial consultations. The manager and doctor had worked out what to say that they liked. They called it a “script.”
A few months passed, and I noticed their patient retention had not improved. Neither had collections or other metrics. When we did some training on how the patient consultations were performed, we found that the staff focused on the memorized script, not the patient. Their communication was robotic, and they never got to know the patient. We replaced the script with a simple outline and let the staff get to know the patients. Visit average and collections improved.
Good communication is alive, interested, and empathetic. It results in understanding.
Control
Another office we worked with complained about low collections. They had plenty of new patients — the veteran doctor got great results. After investigating, we found that the report of findings and treatment plans were rarely completed, and scheduling was hit-and-miss at best.
And that’s not all. The doctor and staff often came to work just a few minutes before patients came in. Sometimes they came in late.
This office was out of control — and so were the patients.
Positive control is moving a project, patient, or condition from one status to a predetermined goal. This is what a procedure does. A well-run business has procedures, protocols, and systems that it adheres to achieve its daily and weekly goals.
Management
Management is implementing effective procedures, with excellent communication, to achieve goals.
In all your practice improvement efforts, check first if the procedures are being done, and then if they need to be improved or removed. Then, look at the quality and quantity of communication used to implement the procedures.
Improve the fundamentals — your patient and team communication and control — and you will have a prosperous and happy 2023.
Seize your future – with a smile!
Ed
Gratitude is not only the greatest of virtues, but the parent of all others.
(Cicero, Prolancio, 100 BC)
As many of us in the U.S. prepare for our annual Thanksgiving events, I wanted to offer a short perspective.
Daily events challenge us, and we struggle to deal with them as best as we can. Events in our offices as well as in our communities, country, and the world can be daunting.
So, it helps to pause, more often than we do, and appreciate the advantages we have from those who have come before us. Likewise, to be grateful for the people we know: our family, friends, and those with whom we work. And, of course, our patients. In small ways and large, we all help each other.
But I also want to mention our future and the opportunity it gives us all.
As we move through the Holidays and winter sets in up here in the Northern Hemisphere, the New Year comes at us again too soon. We live in uncertain times, but as business owners and health mavericks, now is not the time to hunker down as if to hibernate and hope that any storms that occur may pass us by.
They won’t. But we can prepare and seize the opportunities that lie ahead.
Forward-minded entrepreneurs always find a few new approaches to making things better while many business owners remain on the sidelines, wary of jumping into the game and fully committing.
The future offers us the opportunity to play and enjoy the thrill of creatively making a difference, however difficult.
So, enjoy the Holidays, and all those close to you, near and far, in the present and respects to those who have passed. Take time to nourish yourself and those around you. There truly is much to be thankful for!
But while doing so, also appreciate the freedom we all have to make a better practice and a better life in the years to come.
Seize the Day and Seize the Future. (Carpe Diem, Carpe Futurum)
With Gratitude for all you do,
Ed, and all of us at Petty Michel
Imagine this scenario:
Written on a white board near the chiropractic patient adjusting area:
Last to show and the first to go.
Patient: Hey Doc, what does that mean, written on the white board there?
Doctor: Hi Sam, glad you asked. Just a reminder for me to explain that pain usually shows up after a health problem is present for a period of time, and usually goes away or lessens during the early part of our program of care. In other words, the pain can go away but the issue that caused it can still be present.
Patient: Oh, I got you! So, even though I am feeling much better, I better stick with the program, is that it?
Doc. Yep!
===
You know patient education is important. It improves outcomes. It improves retention. It improves referrals.
This is a simple procedure to improve your patient education: Assign a creative staff member the task of writing images or sayings that prompt the patient, or prompt you, to talk about a health subject. That’s it!
It prompts TABLE TALK.
Table talk is the BEST form of patient education and, for that matter, promotion. It comes from you, the doctor, during the most transformative time in your office.
Here are a few sample subjects you could post on a white board near your adjusting table:
Add a drawing now and then:
Just so you don’t get too serious, add a joke now and then:
****They wanted too mulch
****A time traveler walks into a bar.
===
This procedure doesn’t cost you. Like chiropractic (or our consulting!), it pays!
But only do it for two months at a time, otherwise it will lose its novelty for you, the staff, and patients. Run it 2- 3 times each year.
Once a month, meet with your team and come up with some new patient education prompters. This is also another way to educate your team in the process.
Keep the conversation going.
The more they know, the further they’ll go.
And seize the future.
Ed
This promotion has rarely failed. It is simple, fast, and not gimmicky. It is aimed at patients who have not been in for a while.
Patients drift off, and life gets in the way, but your patients still know you, like you, and trust you. And, like all of us, they could now use a nudge to improve their health.
So why not send them a personal letter? In your own words, tell them to get their rear back in here so they can stay in the best of health for the winter months.
Special promotions work best if they are linked to a genuine cause. In this case, the cause is National Chiropractic Month and also the fact that you have a sincere desire to ensure that people you have seen in the past continue to do well.
Special promotions also have an offer. It could be a free service or a discounted service, or the fact that your payment will serve as a donation to a worthy charity. It could also just be special Halloween organic pumpkin cupcakes from your local bakery (give the business a plug for a discount!) when they come in.
Make the offer for the entire month of October, or perhaps just for the last week.
Headline the letter with something like
It’s Chiropractic Checkup Time
October is National Chiropractic Month
You can then, for example, use your own words to say:
Our records indicate that you may not have been in to see us for a while. If that is the case, I’d (for multiple doctors – we’d) love to see you and like to offer you…[your offer.]
Remember, postural and spinal problems are often present long before any pain occurs. Therefore, getting a periodic chiropractic exam is good health insurance to ensure you remain healthy. Chiropractic is great for helping with back pain, headaches, arm and leg pain, and many other problems.
But even if you aren’t experiencing pain now, don’t wait until you have a problem. I sincerely believe the old saying, “An ounce of prevention is worth a pound of cure.”
You can also encourage them to make appointments for their family and friends.
Even if you have all the patients you can handle, this is still a good reminder for those you have seen to stay healthy.
Because that is their goal as well as yours.
Seize the future,
Ed
Are ready for flu season?
Big Pharma is.
If you haven’t seen the ads yet, you will soon. And so will your patients and potential patients.
It’s just business. “The global influenza vaccine market size was valued at USD 7.02 billion in 2021. The market is projected to grow from USD 7.54 billion in 2022 to USD 13.58 billion by 2029.” (Market Research Report, Fortune Business Insights, Sept 2022)
So, what does this have to do with practice and business development?
Your Unique Selling Proposition
In a practical sense, you are the uncola of the cola healthcare world.
You are health doctors – not disease doctors or drug doctors. However you want to frame it, you can define what you do as different than the pharmaceutical alternatives in such a way that you stand out from the crowd.
Remember, it is not necessarily what you do that counts. It’s what you stand for.
You stand for natural health. As Simon Sinek reminds us, “People don’t buy what you do; they buy why you do it. And what you do simply proves what you believe.”
Better Service and Better Health
In my book, the Goal Driven Business, I reference how consumers want more information about their services and products. Especially in this age of abundant and ready information. Patient education is not a chore, it is a service that, if it is well presented, patients appreciate.
But even more, you know about the immune system and what improves it. But natural approaches to boosting the immune system are not emphasized by the medical “information” that is promoted and posted. But you know better: adjustments, exercise, vitamin D, C, and all the rest. Acupuncture too!
It does take a little more time to educate your patients and community. But think of it as a clinical service that makes you unique and special. Think of it also as a marketing expense.
Pride and Purpose
There might be another reason to educate your community on natural approaches to viruses, one that is more personal.
You might feel that your patients and neighbors are being misled and that vital information is being kept from them. You may want to right this wrong!
And lest anyone tries to reframe you as unscientific, the leading cause of death is errors in medicine.(2)
So… the Flu Season is on its way. Go for it!
Enter the race and position yourself and your team as the good guys, the Natural Health Clinic that gets results. And by the way, don’t overlook that you all need to practice what you preach!
There is a very large portion of the population that is seeking a more natural lifestyle. Google search terms show strong interest in natural remedies. You will appeal to them — they are just looking for a health-oriented team to help them maintain and improve their healthy lifestyle.
Seize Your Future,
Ed
Links to the above references and others on the blog, here:
Learn how to create a Goal Driven practice that is more profitable and fun – get The Goal Driven Business
“No company, small or large, can win over the long run without energized employees who believe in the mission and understand how to achieve it.”
Jack Welch, former CEO Boeing
There is a direct relationship between motivation, skill, and the outcomes achieved in your practice.
One doctor we work with told me that, after being in practice for over 30 years, he is now getting better results than ever before. I have watched him continue to train, study, and practice his skills over the years. As a result, he feels he is on a whole new level of expertise. He has discontinued most of his external marketing efforts. He routinely sees 100 visits per day and has brought in another doctor to help.
But you, as the doctor, are only ½ of the equation. The other half is your staff. Even if you are the best in your state, if your team is not equally as skilled and motivated in their areas, the quality and quantity of your services will be impacted.
You want everyone on your team to be professionals on the road to becoming experts.
They may not know that this is what is expected. Perhaps they consider their job is, well, just a job. Some doctors refer to their staff members as secretaries or girls. I know! The early 1960’s still lingers.
Make a shift in how your employees view themselves and how you view them as well.
I have been recommending to doctors that when they interview potential employees, they let them know that in 1 year, they are expected to give part of the lay lecture to patients on health care.
I also recommend that staff study and report what they learned at staff meetings. This lets them know that they ARE professionals, should be knowledgeable and need to take responsibility for what they know.
Also, teaching is another approach to learning, as in the adage: “To teach is to learn twice.”
To stress the importance of training, I sometimes ask a staff member to answer some basic questions about chiropractic when I am at a team meeting. For example, I might ask them to define “subluxation,” or “what are the effects of a subluxation,” or what does “pain is the last to show and the first to go” mean? Often, the staff member stumbles or can’t answer. After a tense moment, I lower my head and look at the doctor. Then, I help the staff member with the answer so they don’t feel bad.
I teach a specialized exercise program part-time. Have for years. I have learned that the student’s performance is directly linked to how well I have taught them.
Your employees are your students. This is often overlooked by clinic owners and here is why: they are focused on just 2 roles — doctor and owner/entrepreneur.
However, there is a 3rd role most doctors are reluctant to fulfill, which is the manager or CEO.
As CEO, you are responsible for the training and coaching of your team and hence, their performance. This is a style of management sometimes called Servant Leadership or Servant Management.
You want and really need an expert support team. A team of experts support the doctors will greatly improve the quality and quantity of services and make your life much easier. To achieve this, you’ll need to take on the CEO role. At first, this may seem to add extra work to your already busy week. But in time, things improve.
Done right, you will have a Goal Driven Practice driven by a Goal Driven Team. Still, there are real barriers to becoming a Practice CEO and creating a support team of Goal Driven experts.
Look for our new program in 2023 where I will teach the Fast Flow CEO System as part of several Goal Driven trainings for next year.
And if you haven’t purchased The Goal Driven Business yet, do so. Required reading!
Seize your Future,
Ed
If you are interested in being part of a limited number of offices trained in Goal Driven Management and the Fast Flow CEO System, click here for updates in the months to come.[ special email category]
Where everybody knows everybody else’s name
Do your patients consider your practice so cool that they want to hang out with you more?
Do they come in early just to soak in the vibes and chat with other patients?
Do you have a practice club?
There are sizable benefits to creating and sustaining your own practice community. The fact is you probably loosely have one already. It is a rich resource that, if better organized and cultivated, can improve patient retention and referrals.
People want to be part of something larger than themselves. This includes belonging to a group whose values they share. Edward Deci, Ph.D., says it is an intrinsic, innate motivation we all have.
A practice club, or organized community relations program, strengthens your connection with each patient. But in addition, it builds relationships between your patients and even non-patients who are supportive of your practice.
I grew up in a small farm town. We had a very busy barbershop. It was always full of men, smoking cigarettes and talking to the barbers – and each other – about the comings and goings of our small town. I think my dad dropped in at least every other day. The barbershop had created its own interactive and slightly exclusive club.
As a more organized example, the motorcycle company Harley-Davidson established the Harley Owners Group, nicknamed HOG. You must own a Harley motorcycle to belong, and then you are eligible to attend many events the company sponsors and receive discounts on all its products. I know a few HOG members, and they are loyal to the brand and share a bond with each other. And they are active, servicing their bikes and using Harley products.
You can sponsor your own “rallies” and probably have. Patients attend, see you and your staff outside the office, and get a chance to talk. But even more, they can connect with other patients. This is how your practice network strengthens.
You can better organize your community by delegating someone to be your Community Services Coordinator for a few hours every month. They would plan and implement various events, with everyone on staff would participating.
In addition, they could start an online club, such as a private Facebook Group. Your patients would be invited to join, as well as local businesses who share your values.
In my experience, most community-building efforts rarely amount to much because there is no one in charge to keep the group energized. Events are “one and done,” with little follow-up. This contributes to the Practice Roller Coaster effect. They do work at generating referrals and improving retention, for a while, but the energy created ebbs away.
Authentic newsletters, events, phone calls, a social media group, success stories, and special bonuses help keep the community humming along.
Network Effects is an economic term. It simply means that the more people use a company’s product or service, the more valuable it becomes. The larger your network becomes, the better the service improves. And the better your services improve, the larger your network becomes.
It is momentum related. Think of a flywheel or pushing a car with a dead battery. (ugh). Once you get it going, the going gets easier.
From my favorite HOG advertisement:
“It’s a free country. Live like it.
Screw it, let’s ride.”
And also,
Seize your future,
Ed
Want to improve your community building? Schedule a call and we can look at options. To schedule, go here.
In the Sierra’s
Using your brand to generate more patients, increase retention, and recruit top talent!
Promoting your brand has not been an important or even viable method of marketing for most chiropractors.
But that is no longer true.
Brand marketing needs to be part of your marketing mix. I will tell you why, but first, let’s define our terms:
Brand marketing is different from direct response marketing. Brand marketing focuses on generating awareness of your office, while direct response aims to generate new customers.
A smaller business with limited resources must focus on direct marketing rather than brand marketing. This is especially important when you begin.
Once your practice is maturing, your patients know you. You are the brand. You probably don’t plan on growing the business any further so there doesn’t seem to be any real need to promote your brand in the community.
But now there is.
Franchise health companies are stepping up their activities. For example, the Joint Chiropractic, which filed with the SEC for around $35 million 10 years ago, and is a public traded company, acquired an additional 7.5 million in funding just two years ago. Their website says they have more than 600 locations, and I have seen their marketing activities in Wisconsin.
Physical therapy franchises are spreading, such as FYZICAL. According to its website, it has grown to more than 448 locations in 7 years as of 2021. In addition, acupuncture franchises, massage franchises, and dental franchises are on the rise.
You can also see increased competition if you have been recruiting doctors, providers, or support personnel lately. Job seekers can acquire a startling amount of information about you and what it is like for employees to work with you. They are interested in your culture, benefits, and values – which are all part of your brand.
It could be said that your brand is: what makes you stand apart — and better – from all the comparable alternatives.
It is your Unique Selling Proposition.
A well-defined and promoted brand will help you:
Once again, it all goes back to goals. (Doesn’t everything?)
What is the mission of your office? What are its values? What are its valuable outcomes?
This Is a Distillation Of Your Story: why you are a doctor, why you are in business, and what brings you joy daily?
Answer this for yourself, and then ask your staff:
What makes us special?
Survey a few of your patients: what makes us special from other providers? Why did you choose us?
Your brand showcases all this into an identity that people can know, like, and trust.
It can be somewhat symbolized with a logo and tag line, like the Nike “shoosh,” and the tag line: “Just Do It.” It can be represented in your newsletters, your office decor and cleanliness, the appearance of you and your team, and in all aspects of your promotions on social media.
But primarily, it must be demonstrated each day by you and your team living up to your values, your commitment to your mission, and providing world-class service and outcomes.
The world is moving faster, and we all have to work to stay ahead. And if we do it right, not only will it be rewarding but also fun.
Carpe Posterum (Seize the Future)
Ed
Need help with your branding strategy? Schedule a call and let’s have look at the best strategic options
SCHEDULE NOW
This past weekend, outside our local grocery store, the Village (what they call a suburban town out here) closed off the main street and had an art fair. So I took a few minutes to look around before I headed home with my organic veggies!
There were maybe 30-40 10×10 tents with various artists displaying their works. The day was hot, and I was in a hurry. Suddenly, I stopped when I saw an old familiar sight, one that I hadn’t seen for a few years. There it was-a chiropractic health screening booth.
That’s right… s c r e e n I n g s!
The signs said, “Spinal Health Screening” with the name of the corporate chiropractic company which now has offices in a few states in the Midwest and in WA, according to their website.
Now, for the most part, I like screenings and, if done right, recommend them. I would not be overstating the fact that we have personally participated in hundreds of screenings in hundreds of venues over the years. (I still have a couple of PVC Posture Analyzers in my garage.) We have personally trained well over 50 “Screening Technicians” and hundreds more in seminars and via our marketing manuals. We used screenings when we opened up our 24 offices here in Wisconsin.
Now that people are less in fear of being murdered by one another for carrying the COVID, outdoor events are resurfacing.
Here is a short list of benefits of screenings:
Here are 5 essential ingredients to help you achieve these benefits:
Get out there with your people… they need you!
Ed
PS BY the way, just curious… please reply if you would like a short webinar on what we have seen works best for screenings.
Here in the United States, July 4th is a date we celebrate each year, commemorating the independence as colonies from Great Britain.
And I can’t help but see a parallel between those hardy souls in the American colonies that wanted their freedom and, well, you! Chiropractors and their teams.
To colonize means to “take control of a people or area, especially as an extension of state power… to take or make use of (something) without authority or right.” (Merriam-Webster)
It could be said that the profession of medicine has been colonized by a few corporate interests. Same has been happening with other professions and industries. A few large corporations own and control more and more businesses that were once independent.
But for the most part, chiropractic as a profession has remained independent.
It hasn’t been easy, what with the AMA and Pharma coming after you, as was disclosed in the Wilk’s trail. (That was just a speed bump for them!) But Team Chiropractic has won its independence and freedom due to the courage of those who have come before you.
And it also comes from your continuing courage today.
So, this Fourth is also about your independence and your continued efforts to do the BEST for your patients and your communities.
Celebrate this!
Yes, it is just another day at the office. But this weekend, have an extra cool drink and recognize your leadership and courage in standing up for the true health of your patients and your community.
Stay free, and help others do the same.
Ed
It’s Monday morning. The staff is getting the office ready for the new day. And while doing so, they are wondering… “How is the boss’s mood going to be today?”
They are taking their cues on how the day will transpire based upon, at least in part, your emotional state.
Your team, as well, will often be tempted to manage their roles in the office emotionally, based on the circumstances in their personal lives.
There is nothing wrong with positive emotion. Emotion is a feeling “a mental reaction subjectively experienced” (Merriam-Webster). Some are more positive than others, such as joy, delight, cheerfulness, and others are more negative, such as anger, grief, and fear.
But emotion is reactive. Setting your sights and working for goals is proactive.
Your Scoreboard
Your practice numbers show you if you are headed towards your goals or away from them.
They can predict what needs to be done to improve your business and achieve your goals. They also keep everyone on your team informed on the status of the practice and included in its management.
There is a right and wrong way to use your numbers to help you achieve your goals.
There is, in fact, an entire methodology on how to use statistics to improve business performance.
Large companies use analytics to manage and improve their production in formal processes such as Kaizen, Six Sigma, and Total Quality Management.
In the Goal Driven System, we use a simplified version called GAP, the Goals Achievement Process, which works just fine.
At the beginning of each month:
Remember that numbers by themselves are nothing. They are symptoms or representations of the quality and quantity of your outcomes. Don’t get so caught up with the “stats” that you lose sight of what the numbers represent. Expecting the numbers to improve without confronting and enhancing the factors causing the numbers is at best ineffective and, at worst, can be abusive.
But numbers can assist you and each team member to stay focused on the goals: your office mission, its values, and its outcomes.
In a Goal Driven office, your team takes its cues from the office scoreboard.
There is an art and a method to capture, display, read your statistics and apply what they tell you. This is not adequately taught to most doctors in business – or to employees. Yet managing by numbers is a fast and very effective method to keep your business improving.
We are creating a short training course to remedy this called Goal Driven Analytics for the Chiropractic Practice. Subscribers to this newsletter (you!) will be the first to hear about it.
In the meantime, stay true to your goals, and use your scoreboard to help you do so.
Seize the Future
Ed
We just awarded a two-doctor chiropractic office employee the SPARKLE award for outstanding service to patients and team members for 21 years of service.
Why a SPARKLE award? Well, that was the term most frequently used to describe this team member.
The clinic owner said: “She has dedicated almost 21 years (7,440 days!) of her professional (& personal, let’s be honest) life to our practice & the pulse of our family and pediatric practice. Over those years we have walked many of life’s journeys together, and she has formed meaningful connections with our patients. We have shared laughter (SO MUCH laughter!), tears and everything in between. She has changed many lives in her nearly 21 years.”
While she indeed does “sparkle,” so does the entire practice. And the sparkle of this office is a byproduct of its synergy.
I even feature their practice as a positive example in my book, the Goal Driven Business.
The owner, the doctors, and the staff are all committed to the goal of providing the best service possible to each patient. But their goals also include supporting each other.
According to Merriam Webster: ” ‘The whole is greater than the sum of its parts,’ expresses the basic meaning of synergy.”
In his 7 Habits of Highly Effective People, Steven Covey refers to synergy as Habit #6.
“Synergize is the habit of creative cooperation. It is teamwork, open-mindedness, and the adventure of finding new solutions to old problems. But it doesn’t just happen on its own. It’s a process…”
Much of the Goal Driven Business draws upon Covey’s work as I have seen his concepts help create a business that runs at full capacity smoothly.
His preceding two habits particularly apply:
This chiropractic practice has formal communication systems, but they also communicate abundantly informally. And each team member has the goal of helping each other and the patients “win.”
In the end, it all goes back to goals. It always does. The owner keeps the goals, including the mission and core values, at the forefront of the team each week. Further, she sets an example by living these goals professionally and personally.
And as a result, staff are happy, patients are happy, and the office runs at full capacity, profitably and smoothly.
You can generate synergy in your office by improving communication and focus on win-win goals for the patient and for each other.
And make your practice SPARKLE!
Ed
PS. For help in creating a synergistic and sparkling practice, contact us!
“Call your mom!”
When we dropped off our son at college as a freshman that late summer day years ago, I told him: “Call your mom!”
And he did, but not often enough.
The fact that moms are extraordinary is an understatement. They are not ordinary people.
Motherhood just isn’t giving birth or the nine months before — if that wasn’t miraculous enough. It isn’t just the diaper months, the nursing, the crying, or the “terrible twos.” It goes on through all the stages of their child’s life – preteen angst at discovering their identity, infatuation break-ups, finding their social tribe, and all the challenges growing up leads us through.
Mother is always there.
And motherhood never ends. As long as she lives, our mothers are there throughout our lives.
Motherhood is a magical cape that certain women wear, your mom, for instance, that at one time protected you and at another helped you fly. Often without your gratitude.
Yea, dads are around too, often in the background. But moms are the first line of comfort and care, someone who loves you more than themselves.
And if moms are so vital in our lives, they are too in our practices.
Always show special gratitude to the mothers in your office.
This Sunday, May 8, is Mother’s Day. Do something special for all the mothers in your practice. Not as a gimmick but as a sincere act of gratitude and respect. Some offices give a flower to every mother that comes in on Friday or the days before. You can always provide some organic chocolates, a scented soap, or tea.
Yes, there is a marketing aspect to this, but excellent customer service is marketing. In most cases, women see doctors more than men, and mothers are often more dominant in determining and advocating for better health in families. (1,2) They are probably your better patients, and your better referral sources as well.
What if you don’t know if they have children? Well, first of all, you should. You are creating relationships with your patients. But if you don’t know, you can always politely ask them – and you will get to know them even better and strengthen your relationship.
For those who are not mothers, give them a flower to give to their mother. Then, have them post the photo on social media, and you can reward them with something.
So, Call Your Mother, and do something special for all the mothers in your life.
Ed
1. https://www.cdc.gov/mmwr/volumes/66/wr/mm6602a12.htm
2. https://www.huffpost.com/entry/why-men-dont-go-to-the-doctor_n_5759c267e4b00f97fba7aa3e
A chiropractor that stood up for chiropractic.
THIS IS A SPECIAL NOTE OF THANKS and a tribute to Chester Wilk, D.C., who passed away just a few days ago.
Dr. Wilk was the Wilk in Wilk versus AMA, the case where a federal judge ruled in 1987, based upon evidence, that the American Medical Association had been attempting to “contain and eliminate” the chiropractic profession.
Dr. Wilk and four other chiropractors first filed the suit in 1976. Doggedly pushing it along, Dr. Wilk, colleagues, and attorneys had to keep fighting even after the ruling against the AMA. From Wolinsky’s book, Contain and Eliminate:
“Wilk had earned a reputation as a street fighter. In 1974, he’d written a book of his own, Chiropractic Speaks Out: A Reply to Medical Propaganda, Bigotry, and Ignorance. In it, Wilk made a case for the validity of chiropractic based on scientific research, and he attacked the AMA for trying to stop chiropractic education and block insurance and Medicare reimbursement for chiropractic services. “Chiropractic is not a cure-all, but neither is medicine,” Wilk said.”
“The case was finally settled in January 1992. The amount of the settlement is under court seal. The settlement went toward attorney fees for Wilk et al., plus additional funds went to support a center for disabled children run by a chiropractor in Kentucky and the chiropractic schools with a request from the National Chiropractic Antitrust Committee led by Dr. Chester Wilk, which raised funds for the suit, that the colleges earmark the windfall for research. Not all did.” (Wolinsky)
I had the honor of having lunch with Dr. Wilk and his wife many years ago in Chicago. Later, in 1996, we both presented at a seminar hosted by Petty, Michel, and Associates to doctors and staff here in Milwaukee.
He was not flamboyant and seemed unassuming, but to me, he had a steely commitment to chiropractic, and I could see that he was not someone to be bullied.
Were it not for Dr. Wilk, and many others that worked with him to defend the profession of chiropractic from the illegal acts of the American Medical Association, you might not be where you are now.
The story about the Wilk’s case is a lesson for us all and an example well set.
And whether you are a chiropractor, work in the chiropractic field, work in any health field, or pursue healthy solutions for yourself and your family, no one or no organization has any right to suppress health information from you.
Dr. Wilk was not to be bullied or silenced, and neither should any of us. He stuck to his goals through thick and thin.
Please take a moment to pay your respects to this humble man and how we can continue his work.
Seize the Future!
Ed
PS links:
Dr. Chester Wilks Book: Medicine, Monopolies, and Malice
https://www.amazon.com/Medicine-Monopolies-Malice-Chester-Wilk/dp/0895296470
Wolinsky book: Contain and Eliminate
https://www.dynamicchiropractic.com/mpacms/dc/o2.php?f_id=34
More info about Dr. Chester Wilk https://chiro.org/Wilk/
 Dr. Chester Wilk at Petty, Michel and Associates seminar discussing the Wilks vs AMA trail in 1996 |
 Mr. Ed Petty at Petty, Michel, and Associates seminar discussing practice development. |
Again, its all about the goals.
On occasion, you may need to hire a new team member. We always help our clients with hiring and “onboarding” new employees on our major consulting programs.
I don’t buy it. We have been hiring great employees.
You must understand and appreciate the seismic changes that have been occurring in society. The workplace is not what it used to be.
The Assembly Line
I discuss this a great deal in my book, The Goal Driven Business.
The Industrial Age needed an industrial mindset for a workforce. As a worker, you were a cog on the assembly line. You checked out of your life when you punched in and checked back in when you punched out. Not much was required from you…except your brawn and obedience. It was a machine world and required mechanist minds and behavior. The employee worked just as hard so they wouldn’t get fired, and the employer would pay just as little so that the employee wouldn’t quit.
We have long since passed the Industrial Age, but our work culture hasn’t changed that much. The worker at the sandwich shop asks you what you want on your lunch sandwich, the cashier totals your groceries, and the therapy tech at the hospital follows their checklist.
But a reckoning has been on its way for some time.
And that time is now.
Many factors have culminated in today’s “hiring crisis.” It is a perfect wave, of sorts.
But let’s first dismiss the judgments from the “OK Boomers.”(“OK boomer” is a catchphrase and Internet meme often used by Gen Z to dismiss or mock attitudes typically associated with baby boomers.” Wiki.)
Older generations have always viewed younger generations as flighty, fickle, and poorly motivated workers. I am one of the hardest workers I know, but my dad didn’t think so when I was stumbling around after college trying to find something to sink my teeth in.
While the youthful uncertainties of work may not have changed, there has still been a dramatic shift in our culture.
Millennials are in debt the way no other generation ever considered. Today’s average college tuition is 31x more than it was in 1969. (1. Yahoo) Total student loan debt is 1.75 trillion. (For comparison, the U.S. Budget in 2020 was 6.6 trillion) with the average borrower owing $29,000.
We have been in an inflationary spiral, with housing leading the way. Generally, the cost of living is rising. The increase in the Consumer Price Index for March is equivalent to an annualized rate of 15.4%, the largest 12-month increase in 40 years. (2)
So, finance is a factor—a big one.
In 2015 Gallup, surveyed over 80,000 working adults. The majority (51 percent) of employees were unengaged at work, while another 17 percent were actively disengaged, for a total of 68 percent not engaged. That means that nearly 2/3rds of the workforce were dissatisfied with their jobs and ready to make a change.(3)
COVID 19 sent a shockwave throughout the work-a-day world. It jarred employees out of their jobs and they were now free to pursue something more in line with their new values and purposes.
One office we work with recently hired a C.N.A. who had quit their prior employment because they did not want to get the COVID jab. They felt that the medical approach they were forced to follow was not aligned with their own values and goals. As a result, they took a new position at a chiropractic office we work with and now happily feel part of their new family.
Indeed, a hiring company, states:
“A work environment that possesses organizational culture is driven by purpose and clear expectations. This motivates and inspires employees to be more engaged in their work duties and interactions with others.”
One of the major processes we work with the business owners is helping them and their teams delineate their own values that they aspire to each day. Positive team culture can be better created and maintained by regularly reviewing these values.
One very competent employee we recently helped hire for an office was so impressed with the Core Values on the office website that she knew this was her place. She has since joined the team and is a high producer.
Employees want security. They are not necessarily looking to become wealthy, at least in the short term. You may need to review your pay scale for your team and make gradual adjustments in these inflationary times.
But we all have intrinsic goals, which include our values, and these take precedence. Work these out for your business and nurture them often. Stay true to them. In promoting for new staff, communicate your values and just how rewarding it is to work with your practice.
I anticipate more “reckonings” and seismic shifts in the not-too-distant future that your business will have to weather and overcome. The world is changing quickly. The stronger you are, the better your chances of surviving and thriving.
Wisconsin Worker’s Compensation Treatment Guidelines DWD CH 81.04
https://docs.legis.wisconsin.gov/code/admin_code/dwd/080_081/81
General. Except as set forth in par. (b) and s. DWD 81.04 (5), a health care provider may not direct the use of passive treatment modalities in a clinical setting as set forth in pars. (c) to (i) beyond 12 calendar weeks after any of the passive modalities in pars. (c) to (i) are initiated. There are no limitations on the use of passive treatment modalities by the patient at home. DWD 81.06(3)(a)
Wisconsin Worker’s Compensation Tx Guidelines Departure from Guidelines / Exceptions
DWD 81.04(5) (5) Departure from guidelines. A health care provider’s departure from a guideline that limits the duration or type of treatment in this chapter may be appropriate in any of the following circumstances:
Wisconsin Unfair Claims Settlement Practices
Ins 6.11 Insurance claim settlement practices.https://docs.legis.wisconsin.gov/code/admin_code/ins/6/11/3
Wisconsin Medicaid CMS1500 Claim Instructions
https://www.dhs.wisconsin.gov/forms/f0/f01234a.pdf
https://www.forwardhealth.wi.gov/kw/pdf/2008-89.pdf
Wisconsin Medicaid – New Requirements and Clarification of Chiropractic Services
https://www.forwardhealth.wi.gov/kw/pdf/2016-35.pdf
Documentation, SOI, 20 visit limit, exam clarification.
State of Wisconsin Insurance Equality
632.87(3) Wisconsin Insurance Equality Chiropractic
Medicare Supplement Mandated Benefits Wisconsin
https://oci.wi.gov/Documents/Consumers/PI-002.pdf
Medicare Supplement and Medicare SELECT policies cover the usual and customary expense for services provided by a chiropractor under the scope of the chiropractor’s license. This benefit is available even if Medicare does not cover the claim. The care must also meet the insurance company’s standards as medically necessary.
Wisconsin Provider Manual Anthem BCBS
https://www.anthem.com/docs/public/inline/PM_WI_00006.pdf
Wisconsin Anthem BCBS Commercial Reimbursement Policy
https://www.anthem.com/docs/public/inline/C-08010.pdf
Wisconsin Anthem BCBS Commercial Modifier Rules
https://www.anthem.com/docs/public/inline/Modifier_Rules_2021.pdf
You are in the relationship business.
People see you for a result – but they stay with you because of the relationship.
There are many different definitions of relationship marketing – marketing isn’t codified like CPT®! (That is maybe a good thing!)
Last week I talked about direct response marketing and indirect or brand marketing. Relationship marketing stems from direct response. It emphasizes retention and patient and customer satisfaction.
Relationship marketing works. It helps with patient retention and patient referrals. It also helps generate referrals from external sources.
But what is it, and how do you improve it?
What is a Relationship?
A relationship is a connection that you have with another person. It is based, ultimately, on communication. Therefore, the quality of that communication determines the quality of the relationship.
Good communication, one that creates a good relationship, centers around understanding. As Stephen Covey advises, Seek first to understand, and then to get understood. Understanding is fundamental for good communication.
The relationship between you and your patient depends on results, of course. But to get results requires understanding the patient. Seeking to understand the patient – showing them a genuine interest in their condition and life – is not only needed from a clinical point of view, but it is vital for good communication and developing the relationship.
How to Improve Patient Communication
Patient Care can be an overused, even over-advertised term. But care is founded first on interest in and concern about the other person.
This means not just going through your script (yuck!) or your checklist with the patient, which may help keep you on track. It means do you understand them, or how and why they came to you? Are you interested?
But how do you do this after the 10,000th patient comes in to the office?
By being a real person who is interested. For example, a patient comes in and wears a green hat. You wonder about the green hat, so you ask them about it. “Hi. I can’t help but notice that you are wearing a green hat. It looks…stunning! Any special occasion?”
A checklist can help you communicate important information, but it can’t take the place of a real live person. It can’t make a relationship. You are not a robot, and neither is your patient.
Be appropriate and respectful, but mostly, be authentic.
This creates trust because your customer sees that you are interested in them as a unique person, not the 10,000th customer. And they see you as a real person, not just a busy professional trying to be interested but really faking it.
I am sure that you have experienced employees in other businesses trying to be interested in you but merely following a script. A bank teller asks me: “Have plans for the weekend?” I am nice back, but I know that she is just doing what her MBA executives in some office far away think she should say.
So, honest and interested communication, added with services and results, will create a strong relationship between you and your patient.
Outside of Your Practice
But relationship marketing goes beyond just your office.
Your patients know people. They can help you get to know their family, friends, and business associates.
You can create relationships with other professional practices, businesses, and organizations. I have seen many examples where a relationship was created between the doctor and an outside entity that resulted in many new patients.
Some examples:
And this is vital: the relationship must be between you and another person associated with the outside entity. You are always dealing, first, with one person.
I have used this definition for years, and it still holds true:
A practice is a network of relationships
that is created and maintained through service and communication.
There are specific barriers to implementing relationship marketing, and you will run into them. I want to keep this article short, so I will refer you to my book below, which addresses the barriers and how to avoid them or bust through them.
But regardless, just communicating more with more interest will bring in more new patients and keep the ones you have longer.
Communicate more and with interest.
And…
Seize the Future (That is where your goals are!)
Ed
Link to the Goal Driven Business Book
Link to the Video Supplement to Relationship Marketing
No matter how many goals you say you have or how you write them out, unless you have the motivation to achieve them – you won’t.
“Motivation is the driving force behind the energy required to complete a task… a person’s willingness to exert physical or mental effort in order to complete a goal or set aim. (Psychology Dictionary.org)
This is a key element in a Goal Driven Business.
You first need to define your goals – and they must be practical as well as meaningful. But you also need the drive to achieve them. Without the drive, the motivation to get to where you want to go, you are just a poser in the business world.
(Case #345) The doctor and I had discussed a plan to motivate his team and increase production. This was many years ago. Over lunch, we had a team meeting to announce the plan to his other two doctors and about 10 support staff. He announced that if certain goals were met over the next 7 months, everyone could get a trip to Hawaii.
Everyone was shocked. Including me! The doctor and I had discussed a two-month plan for rewards based upon a modest performance improvement – but not Hawaii and not the increase in production he wanted. He came up with this on the spot during our meeting.
But that afternoon, amazingly, the phones lit up. People were calling in for appointments. (Never mind that this was an example of Innate or Quantum Entanglement!) As I recall, they had their best month ever. But unfortunately, they soon realized that the goals were unrealistic, they had little support to achieve them, and the doctor saw that he couldn’t afford it even if they did reach their goals. The practice subsequently went into a long-term slump.
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What is the lesson? Well, there are a few of them, but I want to focus on motivation.
While it may seem like people become motivated because of the “carrot,” or the reward, there are deeper reasons – or principles.
Edward Deci, along with others, put forth a new framework for motivation called Self-Determination Theory. Essentially, it states that we are all driven by intrinsic goals as part of our fundamental nature. Our reward comes from the satisfaction we feel from the achievement more than from any external prize.
These are the three intrinsic goals we all share:
AUTONOMY. We all want to play in our own sandbox! We need to feel in control of our own corner of the world. Just like we don’t like insurance companies intruding into our clinical decisions, staff does not like being micromanaged.
COMPETENCE. We all want to be superheroes! Deep down, the prospect of becoming more skilled, more masterful, and better able to be in control of our environment is a drive we all have.
CONNECTION. We all want to be part of something bigger than ourselves. This manifests in two ways: a) being part of and working with a supportive group or team, and b) working to help bring about something more significant than our paycheck or the accomplishment of our everyday tasks.
The office staff was excited to go to Hawaii, but this was not necessarily because they could lie in the sun. It was because it was a huge goal that gave them a very large sandbox to play in – together – to work for a very large result.
Self-Determination Theory is why games work. In Kevin Werbach book, For the Win, he discusses the subject of Gamification.
“For thousands of years, we’ve created things called games that tap the tremendous psychic power of fun. A well-designed game is a guided missile to the motivational heart of the human psyche. …monetary rewards aren’t even necessary because the game itself is the reward.”
Whether it is a sporting event, video game, or Sheepshead (a popular game of old-time Wisconsinites, so I’ve heard), we love our games. And I think we need them.
But it all goes back to the principles of Self-Determination Theory.
Remember when you started your business? The challenge that lay ahead? The new business card that identified you as the hero to conquer new plateaus?
Those drives are still there and can be rekindled, regardless of prior disappointments.
As Soon as You Make a Goal—You Have Created the Potential for a Game.
Win or lose, IF the principles of Self-Determination Theory are in place, you will be motivated and so will those with whom you work.
Apply these principles to yourself and your team – for the game, for the fun, and for the win!
Seize the Future,
Ed
For more information on how to apply self-Determination Theory, games, and motivating yourself and your team, please purchase the book,
The Goal Driven Business. [Link to sell page]
