Tag Archives: michel

The Hidden Power of Patient Testimonials in Chiropractic and Healthcare that Go Beyond Marketing

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women healthier and pain free after chiropracticIn this newsletter I was going to show you some neat tricks to improve team accountability. Accountability is a powerful and positive trigger that drives excellent practice performance.

But something happened just before I started the article.

I received a patient success review from a doctor we work with.

It read it and…WOW! What a success! What a Win! (It is below!)

And I thought – boy, this is really good for marketing. But reviews like this also have other practical uses in your practice that may be overlooked.

Mostly, these are marketing tools—patients give reviews to let the community know what you do. They’re legit and one of the absolute best methods to sell your services. I’m sure when you buy products on Amazon, you look at the reviews. Right?

But patient reviews have 2 other very powerful benefits that may be overlooked.

Two Hidden Benefits of Reviews in Your Chiropractic Practice

First, they reinforce wins for your patients. A patient comes in barely able to move. You adjust them. They get better. And then—they start to forget how bad it was. It’s human nature. We adapt to our new normal fast. Or their wins come on so gradually they don’t even notice the change.

When patients write their reviews, they reconnect with where they were and recognize where they are now. That testimonial becomes their documented “why” — why they’re investing in care and why they’ll stick with their treatment plan.

Second, patient reviews keep the WHY in mind for you and your team.

The daily demands and deadlines that are required working in a practice, for the chiropractor and staff, can bury the reason you work in this profession: to help people heal.

Reading chiropractic patient testimonials reconnects you and your fellow team members to your purpose and the purpose of the office. When Mrs. Johnson writes about finally holding her grandson without pain, or the athlete describes returning to their sport—that’s not marketing copy. That’s meaning. That’s impact.

That is the essence of health care.

The Joy of Practice

If you can stay connected to the wins of your patients, I think you’ll find that practice stressors, or “onset burnout,” will start to melt away.

So,

Keep generating patient reviews. And if you aren’t, do so.

Get them posted so your community can see what you do: website, social media, Google Business profile, and your newsletters.

Read them. At weekly team meetings, staff and doctors can take turns reading one or two patient successes. I have seen patients how up at team meetings and at spinal care classes to talk about their wins!

Patient testimonials aren’t just marketing assets. They’re memory landmarks for patients who might take their wins for granted.

They’re purpose statements that remind the entire team what you all are really doing there. They’re the antidote to the sometimes-dreary aspects of practice management.

So yes, get the reviews for marketing. But also share them with each other. Let them be the thing that brings everyone back to why you all do this work.

And stay driven to enjoy the wins,

Ed

The public patient review I just read.:

Doctor Max is an absolute miracle worker. He is the best. I went to him a month ago basically as a last resort. I had tried everything else, and I mean everything. When I went to see him, I could barely walk. I had to use a cane. Getting in and out of vehicles was soooo very painful. I had sciatic pain, lower back and hip pain and could not bend my knee at all. Regular doctors told I would need a knee replacement. Nope..,not doing that. Doctor Max took X-rays of back, neck, hip and knee. Immediately he had a course of treatment. Now, after 1 month of treatments, 3 times a week, the change is a true miracle. I feel like a new woman (and that is tough to do at 80 years old LOL). I’m still going in for treatments to continue healing to make sure my body stays in great condition. I am convinced, if I had not found Doctor Max I would be in terrible shape and facing a knee replacement I did not need to have. Not only is Doctor Max great, but his staff is wonderful.” Cindy B

Kickstarting Your Patient’s Health and Their Referrals In Chiropractic and Healthcare Practices

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chiropractic healthy start coupon

A healthy start for 2026 in your chiropractic practice

Now is a perfect time to connect with all your active and inactive patients.

If you haven’t yet, compliment them for working on improving their health last year. Express your gratitude for trusting you with their health.

Then, as their Health and Wellness Coach, encourage them to set some health goals for the first quarter of the year.

You can be a little forward about it…you want them to win! Patients appreciate chiropractors and other doctors who genuinely care about their results.

You can also encourage them to invite their family and friends in to see you if they’re dealing with back pain, headaches, or other conditions you can help with.

Below is a sample coupon you can personalize then use or modify to suit your situation.

Wishing you, too, a healthy start to your New Year — in business and in life!

Ed

== ==

2026 “HEALTHY START” COUPON

We want to help you start your year off as healthy as possible. Use this coupon:

  1. If you are active on your chiropractic program, bring this coupon in to enter a drawing for a [healthy gift, which could be a gift certificate to a local health food store, restaurant, yoga studio, sky-diving, etc.]

  2. If you haven’t been in for a while, bring this in for a free update exam and x-ray if needed.

  3. If you know someone who might benefit from chiropractic care, give them this coupon for a consultation, exam, x-ray if needed, and report of findings for $25 as your guest.

Leaders Like You – in Chiropractic and Healthcare Practices

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Doctors and team members of Excel Chiropractic, Lake Geneva, WI

Empowering Others in Chiropractic Healthcare Practice

You are a leader.

You may not consider yourself a leader. But you are. So is everyone on your team.

Not only by the service you provide, but by the example you set.

What is leadership? Let’s take a look to see if you fit:

  • “Leadership is not about who you are or where you sit. It’s about what you do to make a difference in the lives of others.” — Jim Kouzes & Barry Posner, The Leadership Challenge
  • “Leadership is not about being in charge. It is about taking care of those in your charge.” — Simon Sinek
  • “Leaders become great, not because of their power, but because of their ability to empower others.” — John C. Maxwell

I think you’ll have to agree, both you and your team are leaders. Servant leaders in chiropractic and your healthcare practice.

But, as you know, leadership is tough. It isn’t easy.

But you did it in 2025.

You helped others in big ways and small, regardless of your role.

It is possible, quite likely in fact, that you may not have acknowledged the vital role you and your teammates played in the wellbeing of others last year.

Why not? Well (lol) … because of all the #@#% that occurs when trying to get things done. The list can go on and on… there is so much noise and changes that occur in practice that sometimes it is difficult to see the road we are on.

But, you made it through another year. And in your wake, people are better.

All of us at Petty, Michel and Associates are proud to work with you. We appreciate your struggles and celebrate your wins as independent health care leaders!

In this New Year, stay true to you purpose and your role as the servant leader that you are – and your path to your goals in 2026 will be straighter and more certain.

“We never know how far reaching something we may think,
say or do today will affect the lives of millions tomorrow.”
B.J. Palmer’s 1949 book The Bigness of the Fellow Within

Ed Petty

2025- Health Never Takes a Holiday – Complimentary Posters

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health never takes a holiday signature promotion for december in chiropractic offices

Health Never Takes a Holiday is our signature holiday post for many years.  It has proven to be very helpful for many offices to keep their patients on schedule during the holiday hustle and bustle.

For this program we offer free downloads of posters and tent posters you can use in the office to remind patients that we believe “Health Never Takes a Holiday” and it’s important to keep their schedule of care to stay well.

Please visit https://www.goaldriven.com/post/health-never-takes-a-holiday-in-chiropractic for this year’s complimentary posters.

How the Gratitude Attitude Helps Healing in Your Chiropractic and Healthcare Practice

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Previously published on Goal Driven

gratitude with attitude thanksgiving message from pmaworks

The Gratitude Attitude: Proven to Speed Healing and Grow Chiropractic and Healthcare Practices

I don’t know about you, but I just like saying…” Gratitude…Attitude.”

There are plenty of studies on this subject – how just being grateful can improve health outcomes.

Here are just a few highlights:

  • Fewer aches and overall better health – Grateful people report less pain and are more likely to take care of themselves (exercise, regular checkups, etc.) (Emmons & McCullough, 2003 – UC Davis. My old alma mater!)
  • Heart failure patients who kept a gratitude journal for 8 weeks showed reduced inflammation, better heart-rate variability, and improved sleep (UC San Diego, 2015)
  • Lower blood pressure in grateful individuals (Teixeira et al., 2024)
  • Reduced depression and anxiety (Seligman et al., 2005)
  • Better sleep quality (Wood et al., 2009)
  • Improved diabetes management (multiple studies, 2010s–2020s)
  • Stronger immune function (University of Utah & others, 2003–2021)

The list can go on and on.

Two Simple Ways To Use This In Your Practice Right Now

  1. With patients – At the end of a visit, ask your chiropractic and healthcare patients to name 3 things they’re grateful for today (family, a sunny day, the fact they can walk into your office, etc.). Studies show this tiny habit alone can accelerate their healing.
  2. With your team – End your next team meeting by going around the room: everyone shares one thing they’re grateful for in the practice. I have seen this done, and the practice has grown as a result!

The benefits of gratitude may seem obvious and something we already know, but they can be easily overlooked. We focus on our daily challenges and can take for granted the people who support us, and who have done so in the past.

Faced with patient and practice demands, we can under-appreciate the opportunity we have to live an extraordinary life helping others.

So it is good to take time – right now — to give thanks.

Best wishes to you this week, wherever you are.

All of us at Petty Michel & Associates are truly grateful for you – and all you do to make the world and your community a better place!

Sincerely,

Ed

P.S. (On the other hand, you have to be careful!- You know you’ve overdone the Gratitude Attitude when you stub your toe and automatically think, “I’m so grateful I have toes to stub! And a chair to stub them on! And nerve endings that let me feel pain! Pain is a gift. This is so much amazing!” Ha-Ha! A little humor for ya! 🙂

More P.S. Here’s an old-fashioned poem:

Thanksgiving (Edgar Guest 1881 – 1959)

Gettin’ together to smile an’ rejoice,
An’ eatin’ an’ laughin’ with folks of your choice;
An’ kissin’ the girls an’ declarin’ that they
Are growin’ more beautiful day after day;
Chattin’ an’ braggin’ a bit with the men,
Buildin’ the old family circle again;
Livin’ the wholesome an’ old-fashioned cheer,
Just for awhile at the end of the year.

Greetings fly fast as we crowd through the door
And under the old roof we gather once more
Just as we did when the youngsters were small;
Mother’s a little bit grayer, that’s all.
Father’s a little bit older, but still
Ready to romp an’ to laugh with a will.
Here we are back at the table again
Tellin’ our stories as women an’ men.

(The rest of the poem.)

Preparing for a Powerful New Year in Your Chiropractic Healthcare Business

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Previously posted on (Goal Driven.com)

petty michel and associates end of year business preparation checklist

42 more days until a New Year is here.

Before we know it, it will be at our morning doorstep. Like a happy eager dog ready to be taken for its morning walk, tail a wagin’.

But before we look at all what is coming, we have the next few weeks to wrap up 2025. This includes the Holidays, both in business and in our personal lives. We also have all the year-end admin details to complete.

NOW is the time to nail everything down — to plan the events and complete the admin tasks.

And while doing this, filling the end of the year with Christmas cheer, ready for 2026 — your best year yet!!

We’ll prepare for the New Year in a few weeks, but let’s finish off this year with a flourish. Consider these 4 actions:

  • Relationships. Focus on re-bonding with all your patients and supporters from this last year.
  • End of year care. Encourage them to come in and get care.
  • Referrals. Bring in their family and friends for an end of year check-up.
  • Year end admin checklist. Review and complete all year end admin duties that need to be done.

Most important is your connection with current and past patients and supporters.

Remember:

a practice is a network of relationships that is created and sustained through communication and service.

Be ready to take a little extra time to chat, to communicate, and to listen — and an extra “a cup of kindness, yet.”

Marketing. I gave a list of some marketing activities you can do for November and December in a recent newsletter. You can review them here. Get those planned and going.

End of Year Administrative Checklist for Chiropractic and Healthcare Businesses

In addition, we have put together a short list of administrative items that should be reviewed and completed by year end for your chiropractic and healthcare office. It is by no means complete, but the idea is you want to get them taken care of as soon as possible, or at least scheduled, so you can focus your creative energies on launching your 2026.

Block 2-3 hours in early December to work through this list. Delegate sections to your manager, billing staff, and bookkeeper.

You can also contact Lisa who is an expert in these subjects. You can contact her anytime.

Just Ask Lisa! (Lisa@pmaworks.com)

The checklist covers these categories:

2025 ADMIN WRAP UP CHECKLIST

  • FINANCIAL & TAX
  • CREDENTIALING & LICENSING
  • EMPLOYEE ADMINISTRATION
  • INSURANCE & PATIENT ACCOUNTS
  • COMPLIANCE & OPERATIONS
  • BUSINESS ENTITY & LEGAL

Download the ADMIN LIST below and tend to the admin.

Meanwhile, have a great time with your patients over the next 6 weeks.

And let’s prepare for your best year ever – in practice, in business, and in life!

And stay…Goal Driven,

Ed

Download the Checklists HERE

What is Special about L.L. Bean and How Does it Compare to Your Chiropractic or Healthcare Practice?

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“Originally published on Goal Driven.com – republished with permission.”

LL bean womens boot
The Key to Building a Chiropractic and Healthcare Practice that Lasts

L.L. Bean. You’ve probably heard of them.

I just received a Christmas shopping catalogue from them (hard copy!). They are a clothing company out of Maine. Founded in 1912 by Leon Leonwood Bean. I probably bought something from them years ago, and I am on their Christmas list.

We also receive a catalogue from Patagonia each year. It is another clothing company. It was founded more recently, in 1973 by a rock climber, Yvon Chouinard.

I like both companies and I will tell you why – in a minute.

= = =

Recently, I saw an ad of a young man (chiropractor) coming off a stage saying that he just sold his practice for “seven figures.” It was a bit of brag and sounded like he wanted to help other doctors reach that level. He said he was able to grow his business quickly and sell it thanks to his marketing.

I’m all for marketing, and I truly hope he can help with other chiropractic practices.

But it made me think: aren’t there significant financial advantages to owning a business in the long term that compound?

When you own a practice for 10-20 years, you’re not just collecting a salary — you’re able to take advantage of tax benefits that can add $30-50K annually to your real compensation! These can include vehicle expenses, health insurance, retirement contributions, continuing education, and equipment depreciation. These can all reduce your tax burden.

Over 20-25 years, these ownership benefits can add $500K-$1M in value that disappears the moment you sell.

And beyond tax advantages, long-term ownership allows your business equity to compound alongside your income. A practice worth $500K in year 5 might grow to $2M by year 10 or $5 -10M by year 25 – or more — IF you have good management, create a strong reputation, and even bring on other providers, or add other locations. And all the while — taking profit distributions, building retirement accounts, and enjoying the flexibility that ownership provides.

The doctor who sells early gets one payday; the doctor who builds strategically gets decades of tax-optimized income plus a potentially much larger exit.

Back to L.L. Bean and Patagonia

Now, back to those Christmas catalogues! Both show how patient, long-term ownership and excellent management, products, and services can build generational wealth over decades of brand-building and customer loyalty.

L.L. Bean, a billion-dollar empire, is still family-owned. Patagonia, now worth billions, wasn’t sold at all. Chouinard transferred ownership to the Patagonia Purpose Trust to ensure profits protect the planet in perpetuity.

Both companies show how owners who focus on purpose-driven growth and lasting customer relationships can build enduring companies that dwarf what any early buyer would have paid.

Purpose and Values of Your Healthcare and Chiropractic Practice

But here is what does not show up in the spreadsheets of these two companies: their values and purposes.

And, their discipline to stick to them!

Selling your business earlier rather than later can be a valid choice. However, if you ensure it remains focused on its purpose and values, you’ll enhance its profitability and make it more valuable for whoever takes ownership next.

L.L. Bean built its reputation on an unconditional guarantee and commitment to customer satisfaction. “At L.L.Bean, we design products that make it easier for families of all kinds to spend time outside together.”

Patagonia’s environmental purpose became so central that Yvon Chouinard ultimately gave away his $3 billion company. “We’re in business to save our home planet.”

The lesson is that a business rooted in purpose beyond profit attracts loyal customers and dedicated employees and creates a brand that competitors can’t copy.

Your purpose — and the discipline to stay creatively and positively true to your goals — pays off.

So…

Stay Goal Driven!

Ed

P.S. And have fun doing so – maybe fishing, camping, or just outside and enjoy the fall. (Or spring, if you’re Down Under.)

Ask Lisa – Compliance 201: Your Shield Against Bad Risk

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compliance in the health care field for chiropractorsAs a follow-up to our previous compliance articles, I thought what I’d do this month is put together a FAQ list for my dear readers and call it Compliance 201. Keep reading to learn about upcoming new requirements in the compliance/cybersecurity world to keep you at least safe-guarded when you are hit with a cybersecurity incident. Special thanks and credit goes out to ChiroArmour and Dr. Scott Muensterman for his research and presenting at the Chiropractic Society of Wisconsin Fall Experience last month on some of the content in my FAQ.

Q: What is HIPAA and HITECH?
A: HIPAA is the acronym for Health Insurance Portability and Accountability Act of 1996, in which uniform standards and requirements for the electronic transmission of certain health information were put into place and made into law. HITECH is the acronym for Health Information Technology for Economic and Clinical Health Act of 2009, a countrywide adoption and standardization of information technology to securely support the sharing of clinical data.

Q: What is Cybersecurity?
A: Cybersecurity is the practice of protecting digital systems, networks, and data from malicious attacks, damage, and unauthorized access.

Q: Is there a checklist available to ensure we are in compliance?
A: Yes. Current and Active PM&A clients have access to our HIPAA/HITECH compliance checklist, on the PMA Members Site, and compliance services are included upon request from the client.  If you are currently inactive or not a client, we can provide you with the checklist for a nominal fee. Please keep in mind your staff are already very busy, so ask yourself who is going to take on ensuring compliance at your office and going through the checklist? We can help.

Q: Isn’t it a matter of IF a cyberattack at my office occurs, not WHEN as you stated above?
A: On average there are 11 to 12 cyberattacks happening per minute in the US. So in today’s world yes, it is a matter of when, not if. And after research, it has been found that small businesses are more of a target for an attack than large organizations mainly because large organizations can put more dollars into security measures.

Q: What does Windows 10 and Windows 11 have to do with compliance?
A: Windows 10 no longer supports the security patches it used to support, effective 10/25/2025, so all of your computers must be operating on Windows 11 at minimum by this time. You CAN extend your Windows 10 protection for 1, 2, or 3 years at a significant price, but your software vendor may not honor the upgrade.

Q: I heard that there is something called an OIG Exclusions report – what is this and does it affect me and my practice?
A: The OIG Exclusions database is a reporting site listing every individual who is prohibited from seeing Medicare/Medicaid patients due to prosecution of a criminal activity, which can include being found guilty of fraud against Medicare/Medicaid, non-compliance of court-ordered child support payments, and illegal drug convictions. It is and will be a requirement to run a report MONTHLY on every person in your office including owners, subcontractors, and upon a new hire.

Here’s the link to check names: https://exclusions.oig.hhs.gov/
If you don’t see your name, that’s a good thing. Some of you are already running and checking this report due to insurance contract requirements. Save or print and file the results page.

Q: How can I confirm if my practice management program is fully compliant?
A: The website for verifying compliant healthcare software programs is down as of this writing, so for peace of mind if you are not 100% certain, call your software company or IT person.

Q: When do changes/new requirements occur?
A: As of now, no date has been set by HHS, but if you are doing the above steps and have written policies in place, you should not worry, but watch for future communications. You can subscribe to HHS email notifications here: https://cloud.connect.hhs.gov/subscriptioncenter

Q: What does Medicare documentation have to do with cybersecurity?
A: To avoid a documentation audit and subsequent potential visit from the OIG to further audits on compliance with HIPAA and your cybersecurity policies, keep your documentation and billing practices solid per Medicare chiropractic documentation standards, and make sure to securely send your notes to Medicare upon audit (and any other payer group who requests) to ensure you are staying HIPAA compliant.

Q: Can my staff be our Security officer?
A: By law, yes, but you as the doctor owner are always ultimately responsible for any attack or breaches, and payments to the government, so it is strongly recommended that the doctor owner be the compliance security officer for the business.

That concludes our FAQ for now. I know you’ll have additional questions. Feel free to reach out with those we’ll respond within three calendar days!

Stay Secure,

Lisa

References: ChiroArmour

 


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Fun and Effective Promotions for November and December

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food drive grocery cart for chiropractic and healthcare facilities

Spark Some Magic in Your Chiropractic Practice This Season!

Special Promotions for November and December 2025! These are loud and lively events that engage the entire team!

Why do them?

  • Increase new patients with great offers.
  • Energize less active patients and get them back.
  • Build greater team spirit for a shared purpose.
  • A reason to promote your office and let patients and your community know how active you are!
  • Increase your presence as the Health Hero’s in your community.

Even without an offer, just the fun of giving back will boost your visits and instill greater loyalty.

Read the full Goal Driver Newsletter at Goal Driven.com and checkout the fun, festive promotions that will spark magic in your office this holiday season!

2026 Marketing Habits for Your Chiropractic and Healthcare New Year

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social media marketing for consistent marketing in the Chiropractic Practice for 2026

2026: The Year to Make Your Healthcare Practice Thrive

2026 will be a make-or-break year for healthcare business owners—potentially your best ever. More details in future newsletters, but for now: build unbreakable marketing habits starting today.

Trust: The Core of Healthcare Marketing

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” – Aristotle (via Will Durant)

You’re selling the invisible—outcomes patients can’t see upfront. That’s why trust is everything. Build it through:

  • Consistency
  • Empathy
  • Proven Results

Your brand = how you consistently show genuine care and deliver excellence.

The #1 Killer of Momentum?  Stopping What Works

I’ve seen it repeatedly:
Q: “What were you doing when patient numbers were high?”
A:

  • “We sent newsletters.” → Not anymore.
  • “We called new patients post-visit.” → Nope.
  • “We did thorough financial consultations.” → Are you kidding? No!”

Stopping proven tactics = death by roller coaster.
You lose trust, momentum, and the systems that made it effortless.

Your Fix: The Recurring Marketing Checklist

Discipline is hard—but checklists make it stick. Systems atrophy without them.

Monthly Discipline Hack:

  1. List your top 10 internal + external marketing actions (70–80% of your total efforts).
  2. Assign ownership to your manager.
  3. Review at every staff meeting.
  4. Grade % completed—full accountability.

Layer In: Special Promotions

With recurring actions locked in, plan 2–3 months ahead for:

  • Facebook ads with a partner
  • Food drive with a local pantry (especially needed now)
  • Health talk at a yoga studio

Deliverable:Monthly Marketing Planner
→ % of recurring actions completed
→ # of special promotions scheduled

Let’s Make 2026 Your **Best Ever**

Download Free Tools:[LINK]
— Ed

The 4-Hour Fix for the Chiropractic Healthcare Practice Roller-Coaster

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the ups and downs of the Practice Roller Coaster stay Goal Driven to stay up

One Simple Role to Streamline Chiropractic Marketing and Growth**

Chiropractic practices often face inconsistent growth due to a Practice Roller Coaster, where marketing drives patient numbers up, but attention shifts to patient care, staff management, and other tasks, causing marketing to stall. This leads to fluctuating growth. To address this, assigning a trusted staff member as a part-time Marketing Coordinator (4 hours/week) can ensure consistent marketing efforts. Their role is not to handle all marketing but to keep systems like recalls, referrals, and metrics tracking active.

The Marketing Manager System, developed by Edward Petty in the early 2000s, emphasizes four key issues: marketing fails when it’s not done, no one is in charge, insufficient time is allocated, and the coordinator needs support and accountability. To succeed, the clinic director should schedule weekly marketing time, hold monthly planning meetings, track metrics with charts, and ensure accountability through written plans and reports. This approach eliminates marketing bottlenecks, sustains momentum, and reduces stress, helping practices grow steadily.

Note: A Monthly Marketing Manager Program to support coordinators with training and systems is planned for launch soon.

Building a Practice Through Relationships

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a happy bus driver like a chiropractor with happy people on their bus

Advertising has always been important. When we grew our Wisconsin network to 25 offices, we invested heavily in newspapers, shared mailers, radio, and even TV. Today, the focus has shifted to social media, SEO, and now Artificial Intelligence — positioning your practice for AI discovery will soon be essential (more on that later!).

But advertising is expensive. What truly sustained our growth was relationship marketing — connecting authentically with patients, referral sources, and our own team.

What Is Relationship Marketing?

Relationship marketing involves creating trust-based relationships with patients and referral sources, generating loyalty and organic referrals through genuine care and ongoing connection.

Examples:

  • Host a community event like a holiday food drive — invite patients and their families to participate and offer consultations in exchange for donations.
  • Encourage patients to refer loved ones with a personal touch (“Let’s check your spouse before their next soccer game!”).
  • Build partnerships with local professionals — massage therapists, trainers, or nutritionists — and support each other through referrals or shared promotions.

Your Most Important Relationships

Don’t overlook your team. When doctors and staff work together with shared purpose and positive energy, patients notice. It’s almost magnetic — phones start ringing and old patients return.

As Stephen Covey reminds us in The 7 Habits of Highly Effective People, success comes from empathy, communication, and a win-win mindset that creates synergy — or, as some might say, Universal Intelligence at work.

GETTING AND KEEPING PEOPLE ON YOUR BUS

As a doctor and clinic director, you are like a bus driver. You aim to make sure you are on time and complete your shift according to schedule.

One day, you turn around to look at the back of your bus and wonder why there are so many empty seats. “Where is everyone?”

Well, maybe you missed some stops and the people never got on! Or, you didn’t take time to say “hi” when they boarded, so they all left at the next stop. Or, you were so busy driving, you didn’t ask about your assistant’s new workout routine.

Take time to connect with people.

More than anything, you are in the people business.

Enjoy the ride!

Ed

“What’s Wrong with a Chiropractic and Healthcare Personality Practice, He Asked?”

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a group of women sitting at a chiropractic vendor booth waiting for potential clients to stop by and visitJust wrapped up an outstanding chiropractic convention put on by the Wisconsin Chiropractic Society here, you guessed it, in Wisconsin!

We enjoyed catching up with old friends, some we’ve known for decades. And making new friends.

For more on the Convention, you can check out our Facebook site, link below.

Personality Practice

While I was out listening to a presentation, I was told that a doctor dropped by the booth and asked about my book, The Goal Driven Business. He was told that it was about how to improve profits and outcomes by shifting from a personality-driven practice to one that was goal-driven. He felt that the personality practice was better.

I am sorry I wasn’t there to explain more – and hopefully he is reading this email.

Let me explain: A Personality Driven practice is propelled by the doctor’s behavior – their feelings, attitudes, and habits. What they personally do.

When opening a new office, the new business owner, of course, builds their new business on their behavior. It is their ambitious determination that is driving the initial growth of the practice. So, yes, a Personality Driven practice works at the launch of a new endeavor. What else is there? A dream, and the raw desire to manifest it.

So, the Personality-Driven practice works — at first.

However, after the practice is up and running, it needs to transition into a Goal Driven and systematized business.

The concept of a systematized business was hugely popular in the 1980s, thanks to Michael Gerber’s book, The E-Myth. In it, he says:

“The system runs the business. The people run the system.”

B. J. Palmer said something similar, much earlier. And he built a school that many of you may have attended. In his book, Up From Below the Bottom, he says:

“The size of a chiropractor’s business depends upon:

1st – His ability to notify people who he is, what he is, and where.

2nd – His systematization to take care of it as it grows and increases in volume.”

Gerber comically explains what happens when you don’t have systems running your business.

“If your business depends on you, you don’t own a business—you have a job. And it’s the worst job in the world because you’re working for a lunatic!”

–Making the Shift from Personality Driven to Goal Driven–

Making the SHIFT from a Personality Practice to a Goal Driven business is not easy. This is because you have established survival habits that have shown you that the practice depends on you, your feelings, attitudes, and overall behavior. You are the doctor, after all. You see the practice as DOCTOR-CENTERED.

A better approach, I recommend, is to keep it GOAL-CENTERED.

There are two echelons of goals to consider:

  1. Higher goals, including your purpose and “why.” This is your North Star.
  2. Practical goals, or outcomes. For example, you could have front desk goals (percentage of appointments kept), Billing and Collections goals (percentage of collections), and marketing goals (new patients and returning patients), and patient goals (patient completing tx program with an excellent review.)

Get your team on board with these goals. If you do, they can now help you put together the best approach to achieve your goals. These are the systems.

So: Personality Practice – YES! When starting a new business.

But once it is running, NO. Gradually back out and put in place goals and systems. And train your people on these.

For more details, read The Goal Driven Business.

If you want help with this, contact me. I’d love to help. (Been doing this for a while, so lots of tips!)

Services@pmaworks.com

Stay Goal Driven. Stay Free!

Ed

Photos of us and our friends at the Chiropractic Society of Wisconsin Fall Experience

Ask Lisa: Cracking the Code – ICD-10 Code Revisions Start on October 1

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lock and key cracking the code of ICD-10 insurance codes

Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes for proper reimbursement. The translation is called the International Classification of Disease codes, or ICD-10-CM*. There are annual updates which may include deleting codes, adding codes, and minor edits to existing codes.  Keep reading for information regarding ICD-10 changes for 2026.

Although there are very few changes in 2026 relevant to chiropractic coding, the updates contain 487 new, 28 deleted, and 38 revised codes. The 2026 ICD-10 codes will be used for patient encounters from Oct. 1, 2025, through Sept. 30, 2026.

The new codes listed below may be relevant to your patient encounter:

  • Pelvic Pain
  • R10.20 Pelvic and perineal pain unspecified side
  • R10.21 Pelvic and perineal pain right side
  • R10.22 Pelvic and perineal pain left side
  • R10.23 Pelvic and perineal pain bilateral
  • R10.24 Suprapubic pain

And new codes related to socioeconomic circumstance:

  • Z56.6 Other physical and mental strain related to work
    • Workplace stress
  • Z56.89 Other problems related to employment
    • Furloughed
    • Underemployed
  • Z59.02 Unsheltered homelessness
    • Lives in a homeless encampment
  • Z59.19 Other inadequate housing
    • Poor housing weatherization
  • Z59.86 Financial insecurity
    • Z59.861 Financial insecurity, difficulty paying for utilities
    • Difficulty paying for electricity
    • Difficulty paying for heat
    • Difficulty paying for oil
    • Difficulty paying water bill
    • Utility disconnect notice due to inability to pay
      • Excludes2: inadequate housing utilities (Z59.12)
    • Z59.868 Other specified financial insecurity
      • Bankruptcy
    • Z59.869 Financial insecurity, unspecified

Coding and Billing Tips:

  • Make sure if you use a new code listed above, you relate it in your SOAP note to the patient’s condition and why they are seeking care.
  • If you bill a 98941: 3-4 region adjustment, make sure you have at least three ICD-10 subluxation codes (The M99.0X series) on the claim.
  • If you bill a 98942: All 5 regions adjustment, make sure you have at least five ICD-10 subluxation codes (again the M99.0X series) on the claim.

If you are interested in obtaining the entire file of new/updated/deleted ICD-10 Codes, click this link from the Centers for Medicare and Medicaid Services:

https://www.cms.gov/medicare/coding-billing/icd-10-codes#CodeFiles

And, BTW… we still make house calls!  Not collecting what you are owed? Something just doesn’t seem right with collections and your deposits? Give us a call to discuss if an onsite visit or video conference is right for your office.

Happy Birthday Chiropractic! Celebrate the entire month of October!

Lisa

920-334-4561

*CM refers to the ICD-10 coding system used in the United States.Sources:

Sources:

ChiroCode
Center for Medicare and Medicaid Services (CMS)

Why Clear Roles Build a Stronger Chiropractic & Healthcare Practice

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team players wearing staff hats front desk billing promotion marketing

Better teamwork, smoother operations, and improved patient care all start with clarity.

Years ago, I visited a chiropractic office where the doctor was frustrated: patients weren’t keeping appointments, and he blamed his front desk staff, “Sue.” The problem wasn’t effort—Sue was polite and friendly—but she had no clear job description, no checklist, and no real understanding of her responsibilities.

Once we clarified her role, outlined simple procedures, and scheduled regular reviews, the practice quickly improved. Patients kept their appointments, and both the doctor and Sue felt more confident and motivated.

This is a common issue: when roles are vague, results suffer. But when roles are clear, teams thrive.

—

The Three Elements of Every Role

According to the Goal Driven System, each role should include:

  1. Purpose – Why the role exists.
  2. Outcome – The measurable result it should achieve.
  3. Procedures – The specific actions to reach the outcome.

Example – Front Desk Role:

  • Purpose: Help patients achieve health goals by ensuring they stay on schedule.
  • Outcome: Patients consistently keeping appointments.
  • Procedures:
    • Greet every patient with a smile.
    • Answer the phone warmly.
    • Confirm each patient leaves with their next appointment scheduled.

—

 Action Steps for Your Practice

  1. Have every team member list their roles.
  2. Define the purpose, outcome, and 5–10 key procedures for each.
  3. Add measurable indicators (e.g., % kept appointments, total visits).
  4. Review and rehearse roles regularly, just like a winning sports team practices.

Clear roles create accountability, boost morale, and drive better patient care. Keep it simple, keep it consistent, and keep it fun.

Stay Goal Driven,

Ed

Want More New Patients in Your Chiropractic or Healthcare Practice? Start Here.

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chiropractic team going over stats to improve care and service

Most doctors think the first step to getting more new patients is marketing. But that’s not always true.

Years ago, a large chiropractic office asked for help because their new patient numbers were slipping. After analyzing their situation, it was clear their promotions were weak—but the real problem went deeper.

The senior doctor, in practice for 20+ years, had become bored. Patient visits felt routine. Long-time staff were stuck in old habits. Meanwhile, the two younger doctors had enthusiasm but lacked confidence and experience.

We started by focusing on quality of care, not ads. The senior doctor began coaching the new doctors on cases and patient communication. Staff refreshed their service procedures and rehearsed ways to create a stronger patient experience.

The result? Without launching a single new promotion, new patients and visits went up. Only after that did we create a marketing calendar—because now they had something truly worth promoting.

The Lesson

Before you spend time and money on external promotions, make sure your practice delivers the kind of care that inspires patients to return and refer. Quality care and continuous improvement are the foundation of real growth.

As Stephen Covey said, “Sharpen the Saw”—renewal and improvement keep the drive alive.

Stay Goal Driven

Ed

Read the full article here: Goal Driven Blog

Ask Lisa:What’s up with BCBS and Therapies Reimbursement?

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Within the last two years, Blue Cross Blue Shield started requiring precertification (precert or pre-auth) on select plans for therapy codes. This came about because by Insurance Equality law they can’t require precertification for chiropractic services 98940, 41, 42, and 43, so they got around that by requiring it for many therapy codes regardless of the provider type.

If you call to verify coverage for “chiropractic”, the customer service representative (CSR) may tell you that there is no precert required for chiropractic. They may or may not understand that they have separate precerts for physical therapy codes. You’ll need to give the CSR the specific codes you want verified for coverage and limits.  You can also verify benefits and usually are able to request authorization for therapies using Availity: https://www.availity.com/providers/

Specific Claim Tips for billing BCBS: 

1)  Qualifier 431: Make sure you are entering in Box 14 OR 15, the 431 qualifier to indicate onset date within a treatment plan.

2)  Taxonomy code for chiropractic, which is 111N00000X, in Box 33. Some states’ BCBS plans require the use of a ZZ prefix before the taxonomy. Please ask when verifying benefits with your patient’s state plan what their billing requirements are. For example, is the ZZ required in front of the taxonomy code? You can add the taxonomy code for specific payers by going into your Maintenance application in your practice management software, and once added to the payer information, it will automatically generate the claim form with this information defaulted.

3)  Modifiers: I understand some of you are using XS GP for therapies and are getting paid. Great! But use this with caution. The XS modifier indicates a separate and distinct service done by a different provider than the one billing under. Better to use GP and 59 for accurate billing if one licensed provider did the therapy and chiropractic adjustment. Your 59 modifier indicates a separate, distinct service but does not distinguish between providers.

What about 98940-98941-98942? For your Medicare Advantage plan patients, make sure to use AT modifier indicating the treatment was active care vs. maintenance/supportive. BCBS usually will not pay for the GA modifier use indicating maintenance/supportive care services were provided. You’ll want to advise the patient ahead of time they will be financially responsible for their maintenance/supportive care, while presenting your cash options or packages offered. Use AT when billing BCBS Medicaid plans, all states, while the patient is under a care plan.

Where are the preauthorization requirements headed?

Here’s a recent (June 2025) article from Blue Cross Blue Shield regarding precertification requirements going forward:  BCBS News

Here’s what it states: 

“Reducing prior authorizations:

BCBS companies routinely review their prior authorization requirements, and many have taken steps to reduce the volume of prior authorization requirements in recent years. We will build on these efforts and commit to reduce in-network prior authorization for medical services as appropriate for the local market each plan serves with demonstrated reductions by Jan. 1, 2026.”

Reach out to us lisa@pmaworks.com or dave@pmaworks.com, and we can give more “boots on the ground” info for your specific state.

Lisa

920-334-4561

Please share this newsletter with your colleagues so they may benefit from this information too!

Improving Case Acceptance and Patient Follow-Through in Chiropractic Care

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chiropractor discussing patient finances and treatment plan with patient

Seven tips to help others achieve their health goals.

I often read promotions from other chiropractors emphasizing the importance of “Day 2.”

And I have no argument about this.

However, I have known chiropractors who did well with a 3-day onboarding process, as well as a 1-day process.

Everyone does what they feel comfortable with. You should, too. But you should always strive to improve. This will show up in your statistics;

  • First Visits to New Patient Percent
  • Patient Visit Average (Retention – Visits/New Patients)

We routinely monitor these with our clients and discuss them monthly in our management meetings where we set up monthly strategies for improvement.

There are many details involved in setting up the best practice for onboarding patients. Again, everyone has an individualized approach.

I want to highlight seven factors that are sometimes overlooked.

In Chiropractic, It Starts With Trust

 

  1. Day 1. Before working on your Day 2, review your Day 1.Your prospective patient wants to know that you know them. Seek to really understand them and their complaint. It’s OK to go off script – what are you curious about?The byproduct of this, aside from learning about their condition, is establishing trust. By reason of your genuine curiosity, you demonstrate that you care about them as an individual, not just as a “new patient.”
  2. Specific. After day 1, you know them, their subjective complaint(s), and have discovered the objective cause.In your Report of Findings, you want to be specific about what is causing their issue. “Right here, Mrs. Jones, you have a subluxation at L-4, irritating your low back and hip.”This may not be the words you use (or might not be clinically correct). But your patient wants to know definitely what is causing their issue. Be as specific and as objective as possible.
  3. Certainty and Confidence. Communicate clearly with confidence your ability to help them get better. This begins the healing.
  4. Patient Financial Consultation: Prepare chiropractic payment agreement forms in advance, using insurance or cash details. Ideally, staff should meet with patients before treatment to outline payment options, agree on the best form of payment, schedule appointments, review procedures, and provide information about available family discounts. *(Contact Lisa for tips on this procedure. She’s an expert!)
  5. Flow Chart. List all the key procedures on Day 1, Day 2, and each day thereafter that you and your team will do to start a patient on a care program and keep them coming back to complete their care plan. Review this list with your team every two months, or more as needed.
  6. Practice. How does every athlete or musician maintain their edge, let alone improve? They practice! Set aside your ego and practice with one of your doctors or a staff member. Let everyone participate in improving the procedures. Use the flow chart as a guide.
  7. Manager. Your practice manager should work with you regularly to ensure that these steps are in place. We cover this on our Practice MBA this October. Consider enrolling them in this program.

There are certainly more steps involved — but they all rest upon the foundation of the trust you built on Day 1. If you have low conversion or if patients are dropping out of care, look to Day 1 first and then work forward from there.

Help patients achieve their health goals and…

Keep them Goal Driven,

Ed

*Shout out to Dr. Brad Glowacki and his seminar that goes deeply into Day 1 and Day 2. [Link]

Hobby, Practice, Business. Which is it for You as a Chiropractic Doctor?

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The 3 Phases of Practice Evolution

Is your work as a doctor a hobby, a practice, a business—or simply a job? Let’s explore.

1. HOBBY

Every practice begins as a hobby—or at least, it should. Early in your career, you’re driven by fascination with the science, philosophy, art, and technique of chiropractic. Your passion keeps you going, while business operations take a back seat.

2. PROFESSIONAL PRACTICE

The next phase is building a true professional practice. This stage is entrepreneurial and personality-driven, fueled by your presence and commitment. You create strong patient relationships and build loyalty through consistent care and connection.

3. PROFESSIONAL SERVICE BUSINESS

Finally comes the service business stage. Here, your practice is structured, systematized, and able to operate independently of your constant management. You may step into a CEO role or scale back to part-time patient care, but either way, the business runs on clear goals and proven systems. This is what people call “scaling.”

DIFFERENT PATHS, DIFFERENT GOALS

Not every doctor wants to build a business. I once knew a chiropractor who loved nothing more than adjusting patients. He wasn’t concerned with scaling or management systems. His secretary kept the office running, his patients were happy, and so was he. That was enough.

Most doctors, though, do want to grow—to serve more people, expand their caseloads, and run a strong practice while still enjoying their profession.

Then there are the entrepreneurial doctors who aim to scale beyond themselves. By setting goals and creating reliable systems, they can expand without adding more hours or overwhelming overhead.

But many who try to scale fall into what I call the Practice Roller Coaster. The excitement of practice gets buried under stress, inconsistency, and management struggles. What once felt like a calling begins to feel like just another job.

BREAKING THE ROLLER COASTER CYCLE

There are exceptions—many doctors do successfully build thriving service businesses. I’ve helped dozens achieve exactly that.

Five years ago, I wrote The Goal Driven Business after observing this cycle of burnout. In the book, I explain the hidden barriers to growth and outline the step-by-step process for building a scalable, independent practice.

If you find yourself on the Roller Coaster, here’s how to reset:

  1. Hobby – Fall back in love with chiropractic. Make practicing fun again.
  2. Professional Practice – Build and enjoy your patient community while earning a solid living.
  3. Professional Service Business – If you’re ready to scale:
    • Read The Goal Driven Business for a complete roadmap.
    • Or, reach out to me directly through our Goal Driven Consulting program for hands-on help building a profitable, self-sustaining business.

Take back your future. Build a business that runs without depending on your daily management.

Stay Goal Driven,

Ed