Tag Archives: michel

Chiropractic Patient Reactivation Program and Sample Postcard

Posted on by
Reply

We recommend offering a special promotion to patients who have not been active for 6 months or more.

The links below will take you to a couple of articles describing procedures that can be used to encourage less active patients to come in to see you.

The Reactivation Program has a number of sample letters and a sample postcard and the Reactivation Card is a sample post card that can also be customized for your email newsletter.

Sample Reactivation Postcard – Sample postcard layout and instructions on how to customize your postcard.  Information can also be used for email notification.

Reactivation Program An article on the importance of regular reactivation program.

Best Wishes for your New Year!

Phyllis To Speak at Parker Seminars – Las Vegas

Posted on by
Reply

Phyllis has been on the Parker Seminar speaker circuit since before starting with PMA.  She presents a powerful presentation to motivate and inspire doctors and staff alike.

Coming to you from Las Vegas Nevada, February 23-25, 2017, Phyllis will be joining other colleagues in the chiropractic profession to bring a well rounded presentation of new patient procedures, billing and coding, obtaining referrals, handling objections, creating great patient experiences, and much more specifically designed for your Chiropractic Assistants.

Don’t miss out on this amazing lineup of CA Speakers:

  • Kathy Mills Change, MCS-P
  • Phyllis Frase Charrette
  • Becky Walter
  • Heidi Farrell
  • Holly Jensen
  • Brandi MacDonald

For more information or to register visit parkerseminars.com

or download the flier here: Parker Seminar Flier

MACRA- New Info on Medicare!

Posted on by
Reply

rs-medicare-info-icon

New Info on Medicare!

Happy Holidays Chiropractic Friends!

First snowfall always seems to bring renewed energies and hope – my wish is you experience this, too.

Are you ready for January 2017? Ready or not, here it comes. Today I want to introduce and give you some of the latest and greatest on what’s happening with the new Medicare reimbursement model also beginning our new year.

To start with, six new acronyms to introduce to you: MACRA, MIPS, CHIP, APM, SGR, CPIA

  • MACRA: Medicare Access CHIP Re-authorization Act of 2015
  • MIPS: Merit-Based Incentive Payment System
  • CHIP: Children’s Health Insurance Program
  • APM: Advanced Payment Model
  • SGR: Sustainable Growth Rate
  • CPIA: Clinical Practice Improvement Activities

Here’s a bit of background for you regarding the initiative. In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act 2015 (MACRA). This is an act to transition Title XVIII of the Social Security Act to the Medicare sustainable growth rate and strengthen Medicare access. How? By improving physician payments and making other improvements, like the Children’s Health Insurance Program. We could say MACRA is the umbrella to the program.

What is the purpose of the change in reimbursement model? The purposes include simplifying reporting for the convenience and ease of the providers participating; decreasing the current costs of healthcare, allowing patients the best quality of care; and to make patient information sharing safe and easy. The blueprint for pay for performance is the Merit-Based Incentive Payment System, and the goal is to create an acceptable payment system for physicians and the program.

Who are the stakeholders in the broader MACRA program? They include beneficiaries (your patients), businesses, payers, providers, and state partners.

Are you eligible to participate?

Both participating and non-participating providers are eligible to participate if you meet both of the following criteria: 1) Have seen 100 or more unique patients in a year, and 2) Have billed for covered services at $30,000 or more a year. You are exempt from participating in 2017 if 2017 is your first year as a Medicare provider. You are also exempt if you do not meet one of the two criteria above.

How will it work?

CMS has indicated through various webinars that they will notify via written communication if you are or are not eligible to participate. Once you learn of your eligibility, the program will require participating providers to report on three categories for the Merit-Based Incentive Payment System:

  • Quality (i.e., Physician Quality Reporting System, also known to you as PQRS but with some tweaks).
  • Practice Improvement, focusing on clinical quality measures. For examples, patient outcomes; patient engagement and compliance; adherence to your practice systems and guidelines.
  • Advancing Care Information (this is the technical component; i.e., Meaningful Use and minimum five measures recorded in your practice’s healthcare technology).

Additionally, if you are eligible to participate and choose not to, there will be a negative adjustment of 4% to your Medicare reimbursement. If you are eligible and do choose to participate, you may receive a positive adjustment of 4 to 9% depending on your level of reporting involvement, as well as a minimum 0.5% bonus for exceptional performance if your final reporting score meets or exceeds a certain point value.

You will have two reporting options: You may report for the entire 2017 calendar year, or you may report for the partial year, one quarter, and may begin no later than October 2, 2017.

PM&A will continue to monitor any changes to the above information.

In addition, I will be conducting onsite MACRA readiness assessments at chiropractic offices and am available to visit yours. Please contact me if you are interested in learning more!

Best,

Lisa Barnett, Consultant
Petty, Michel & Associates

Call: nine two zero.334.4561

Email: Lisa@pmaworks dot com

How To Make Your Chiropractic and Natural Health Lending Library Work

Posted on by
Reply

lending-library

A natural health lending library is a very practical marketing tool – if used.

A lending library is a collection of books, DVD’s, and other information that you can loan your patients. It is part of an ongoing patient education program. The better your patients understand what you do and why you do it, the more likely they will be to stick to a long-term care program and to refer their family and friends for services.  Patient education, compared to other marketing activities, is not that expensive.  It has a good ROI!

Download a list of suggestions here for your chiropractic or natural health care library.  [Ideas for your Lending Library]  Please give us your suggestions as well.

This all is logical, right?  We all know this.

So…why is it rarely done? Most of the offices that I have seen with lending libraries have them on the bottom shelf in some corner of their office filled with books from a garage sale and old VHS video cassettes.

Everyone knows patient education is important. Like the Spinal Care Class, or new patient education class, everyone knows this is good for the patient and helps the office grow. Right?

Funny story… I attended a small get-together of chiropractors one evening here in Southeast Wisconsin. The presentation was given by the lead doctor of a multiple doctor office. Great doctor, nice practice. He had been in practice for years and looked weathered and ready for retirement. The talk was how to give an effective Spinal Care Class for new patients. The presentation was full of practical content. The only thing… the doctor wasn’t that cheerful about his presentation.

After he finished, and as he left the front of the room looking down at the floor, he muttered, as if passing on a confidential apology to another spy… “But we don’t do the classes anymore.”

So, no need to fool ourselves here. It might be just easier to buy some nice posters and be done with it.

Ah, but there is a trick to making your lending library work… and patient education in general work!

The lending library is primarily for YOU — and each member of your professional team.

We have been looking at it all wrong.  The lending library is a reflection of YOU!

If YOU study, and if your support team studies and learns, you all will be so enthusiastic about the information that you will insist that your patients learn this information as well.

Be curious and ask yourself some questions. For example:

  • Chiropractic adjustments have been shown to significantly lower blood pressure. Do your patients know this? How does it work?
  • Why do some intervertebral discs degenerate and others (in the same spine) do not?
  • Do your patients understand the myth of cholesterol, heart disease, and how statin drugs may be causing some of the symptoms they are coming in to see you for?
  • How is the adaptive immune response affected [during “cold and flu season”] by the adjustment?
  • Is the average time for a whiplash patient to achieve maximum improvement 7 months 1 week? If so, why? If not, what is it?
  • Nonsteroidal anti-inflammatory drugs for rheumatoid and/or osteoarthritis conservatively cause 16,500 Americans to bleed to death each year. Do your patients know this? Do their families?
  • Glutamate and aspartame can cause chronic pain sensitization, and removing them from the diet for 4 consecutive months can eliminate all chronic pain symptoms. Do your patients know this? Do their spouses? *

Read a book, watch a video, question authority, ask questions — seek the truth. Get excited about learning new things about your profession.

DON’T GET BORED. If you are bored, quit and go home!

Otherwise, be grateful for the opportunities we all have to learn and expand our knowledge and understanding of the services we provide and the world in which we provide them.

Be curious.

Ultimately, you sell yourself before you sell your services. How can you sell a care class or an extended treatment plan if you are not truly excited about them?

Learning new aspects of chiropractic, health care, wellness, sickness, the sickness industry, how your patients are being manipulated and exploited… all this should agitate you one way or another.

For example, I watch Vaxxed – the movie — and then listened to Dr. Andrew Wakefield and Brandy Vaughn (former Merck employee) talk on YouTube about the movie and how they are now being covertly and overtly intimidated to shut up.  If this pharmaceutical company is trying to help members of your community get healthier, why are they now attempting to squash dissent and in such a sinister and yet powerful way? I can’t help but wonder: just how powerful are they at manipulating public opinion? How are they influencing my community and my family?

If you look further into the effects of pharmaceuticals, from Vioxx to statins to MMR and vaccines, and explore some of these questions, you can’t help but feel compelled to educate your patients on how to keep their children healthy and free from a toxic environment.vioxx

Some of the most successful offices I have seen have spent untold sums on going to seminars (and on coaches!). The verysuccessful can be reckless with book buying and webinar watching and seminar attending.

Continuing education isn’t just for re-licensing seminars. How dull!

If you are not impatiently curious about different aspects of your profession – its science, its philosophy, what it is up against in the market place, you are becoming part of the problem.

Stay curious. Question authority. Study.

Do this:

Assignment #1. You. Order a book – or video- from Barnes and Noble, your local books store, or Amazon. Read most of it on a weekend or weeknight evening rather than watching TV.  Present what you learned at the next staff meeting and put the book in your Library.

Assignment #2. Your Team. Have your staff read a few chapters from a book, or watch a video from your lending library and then give a presentation about it at a staff meeting. Everyone learns and the staff member learns twice! Give bonuses for outside study.

Just like we work on our patients, just like we work on our business, we must work ON our roles as professionals and we do this by studying.

Then, no doubt, you and your team will be dragging your patients over to the lending library to check out the latest editions to your collection.

And your patients will know that they came to the right place. They may think you are all a little nerdy, maybe even fanatical about better health, but they will know that you sincerely care about them and their wellbeing, not just in collecting some money for some fast or rushed service.

Assignment #3. Stay curious and learn – and provoke others to do the same.

Sincerely,

Ed

See our attached list of sample books and videos for your Lending Library Ideas for Your Lending Library

Please give us your suggestions for informative books or videos!

*Questions taken from Dan Murphy’s web site.www.danmurphydc.com

 

Rock Your Coding World! How to Evaluate Your Coding for Maximum Reimbursement

Posted on by
Reply
Lisa J. Barnett

Lisa J. Barnett

Download a PDF of this article

Hello Friends in Chiropractic!

Hope you had an awesome summer and took several opportunities to soak in some UV and Vitamin D.

This month I’d like to both expand on my July Medicare Documentation article and coach you on self-auditing evaluation and management (E/M) coding for reimbursement. Are you consistently under-coding your E/M services? It is not benefiting you to do this because more than likely you’re meeting required elements and not getting the best reimbursement available.

So, what exactly does an auditor, be it Medicare or a Commercial Payer look for in determining reimbursement for your evaluation and management services? It is pretty simple and based on both quality and as it turns out, more importantly, quantity of certain elements. Let’s look in depth how you can self-audit your E/M services*:

First, a coding history and review. In 1992, the current E/M codes were introduced as a result of a ten-year study by CMS(Centers for Medicare and Medicaid Services) and the AMA(American Medical Association). Then in 1995 and 1997, CMS and the AMA developed documentation guidelines (DG) for use of these E/M codes.

Without re-inventing the wheel, let’s lay out how you determine which code to use for your patient evaluations and management of care. To review,

  • New patient E/M codes include 99201, 99202, 99203, 99204, and 99205.
  • Established patient E/M, or re-exam, codes include 99211, 99212, 99213, 99214, and 99215.

Charting out information from CMS and ACA’s ChiroCode book, here is what we have as quantifiable elements to determine which code to bill for. Keep in mind that Necessity of Care drives our discussion below.

History, Exam, Complexity of decision-making are the three main elements in the evaluation and management note.

Let’s now diagram out for you each code and corresponding description of each element, using both New Patient and Established Patient criteria. What differences do you see? Which descriptions share commonality?

NEW PATIENT

 CODE  HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
99201 Focused/Minor severity  Focused Straightforward
99202  Expanded/Low-to-moderate severity  Expanded  Straightforward
99203  Detailed/Moderate Severity   Detailed  Low
99204  Comprehensive/Moderate to high severity   Comprehensive  Moderate
99205  Comprehensive   Comprehensive  High

 

ESTABLISHED PATIENT

 CODE  HISTORY  EXAM

COMPLEXITY OF DECISION-MAKING IN MANAGEMENT OF CARE
99211 No key component(s) required No key component(s)  required No Key component
99212 Expanded/Low-to-moderate severity Expanded Straightforward
99213 Detailed/Moderate severity Detailed Low
99214 Comprehensive/Moderate to high severity Comprehensive Moderate
99215 Comprehensive Comprehensive High

 

Building on that, here are the quantified components indicating the minimum number of each component’s required presence in the note to code appropriately and at the maximum level:

NEW PATIENT 

HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
 Code Chief Complaint HX  of Present Illness  Review of Systems Past Family/ Social HX  Exam (1997 DG)  Diagnoses  Data to be reviewed; # of Complaints  Risk Factors
99201 1  1  N/A  N/A  1 in affected body area  1  1  Minimum
99202 1  1-3  1 N/A  1-5  1  1  Minimum
99203 1  4+  2-9  1  6-11  2  2  Low
99204 1  4+  10+  2-3  12+  3  3  Moderate
99205 1 4+ 10+ 2-3 All components 4 4 High

All 3 elements are required in the new patient note to consider reimbursement: History, Exam, Complexity

ESTABLISHED PATIENT 

HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
 Code Chief Complaint HX  of Present Illness  Review of Systems Past Family/ Social HX  Exam (1997 DG)  Diagnoses  Data to be reviewed; # of Complaints  Risk Factors
99201 1 N/A  N/A  N/A N/A N/A N/A  N/A
99202 1  1-3 N/A N/A  1-5  1  1  Minimum
99203 1 1-3  1  1  6-11  2  2  Low
99204 1  4+  2-9  2+  12+  3  3  Moderate
99205 1 4+ 10+ 2+ All components 4 4 High

Two (2) out of the 3 elements are required in the established patient note to consider reimbursement: History, Exam, Complexity

As you may deduce from the above established patient table, 99211’s are rarely used in chiropractic offices. Can you see why?

Additionally, give your current score an extra two points for management of care, i.e., reviewing old records and summarizing in the note stability/worsening of condition, or, two points for obtaining history from someone other than the patient. Add one point for diagnostics performed and reviewed, (i.e., x rays).

Finally, make sure to attached your -25 modifier on all E/M codes if you are giving a CMT on the same DOS.

Have a specific patient in mind and you’d like to find out if you coded and billed at the most appropriate and highest level? Contact me on how you can qualify for a complimentary audit!  Call 920.334.4561 or email lisa@pmaworks.com

Sincerely in Chiropractic,

Lisa Barnett,
PM&A Coach and Consultant
Where Managing by Numbers and Progress Says It All.
My purpose is to be the Best Chiropractic Advocate in the World

*EHR systems may already have built-in features to automate the components for you via their macros/templates.References:

  • American Chiropractic Association ChiroCode Deskbook, 2014-2017
  • Centers for Medicare and Medicaid Services, 1997 Documentation Guidelines for Evaluation/Management Services, Reference II, Medicare Physician Guide, A Resource for Resident Physicians, Practicing Physicians, and Other Healthcare Professionals
  • Centers for Medicare & Medicaid Services, Medicare Learning Network, ICN006764, August 2015, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
  • Gwilliam, Evan M., DC, MBA, BS, CPC, NCICS, CCPC, CCCPC, CPC-I, MCS-P, CPMA

List of Components:
History of Present Illness – Elements:
Location (example: left leg); Quality (example: aching, burning, radiating pain); Severity (example: 90 on a scale of 1 to 100); Duration (example: started 3 days ago); Timing (example: constant or comes and goes); Context (example: lifted large object at work); Modifying factors (example: better when ice/heat is applied); and Associated signs and symptoms (example: numbness in toes)

Review of Systems:
Constitutional Symptoms (for example, fever, weight loss); Eyes; Ears, Nose, Mouth, Throat; Cardiovascular; Respiratory; Gastrointestinal; Genitourinary; Musculoskeletal; Integumentary (skin and/or breast); Neurological; Psychiatric; Endocrine; Hematologic/Lymphatic; and Allergic/Immunologic

Past Family/Social History:
Past history includes experiences with illnesses, surgeries, injuries, and treatments/medications. Family history includes a review of medical events, diseases, and conditions that may place the patient at risk. Social history includes an age-appropriate review of past and current lifestyle activities.

To download the article in it’s entirety click the here [LINK]

Changes to ICD-10 Codes That May Affect Chiropractors

Posted on by
Reply

We know all too well how keeping abreast of all the changes in the insurance world can sometimes be overwhelming for your practice so we wanted to simply help you out by sharing some recent information regarding ICD-10 codes.

ChiroCode Institute recently published the changes to ICD-10 Codes that are going into effect October 1st.  While there are thousands of code changes, we have listed below the codes most relevant to chiropractors.  To download a printable copy of this list click here [ICD-10-Changes-Oct-2016]

  • G56.03  Add   Carpal tunnel syndrome, bilateral upper limbs
  • G56.13  Add   Other lesions of median nerve, bilateral upper limbs
  • G56.23  Add   Lesion of ulnar nerve, bilateral upper limbs
  • G56.33  Add   Lesion of radial nerve, bilateral upper limbs
  • G56.43  Add   Causalgia of bilateral upper limbs
  • G56.83  Add   Other specified mononeuropathies of bilateral upper limbs
  • G56.93  Add   Unspecified mononeuropathy of bilateral upper limbs
  • G57.03  Add   Lesion of sciatic nerve, bilateral lower limbs
  • G57.13  Add   Meralgia paresthetica, bilateral lower limbs
  • G57.23  Add   Lesion of femoral nerve, bilateral lower limbs
  • G57.33  Add   Lesion of lateral popliteal nerve, bilateral lower limbs
  • G57.43  Add   Lesion of medial popliteal nerve, bilateral lower limbs
  • G57.53  Add   Tarsal tunnel syndrome, bilateral lower limbs
  • G57.63  Add   Lesion of plantar nerve, bilateral lower limbs
  • G57.73  Add   Causalgia of bilateral lower limbs
  • M21.611  Add   Bunion of right foot
  • M21.612  Add   Bunion of left foot
  • M21.619  Add   Bunion of unspecified foot
  • M21.621  Add   Bunionette of right foot
  • M21.622  Add   Bunionette of left foot
  • M21.629  Add   Bunionette of unspecified foot
  • M25.541  Add   Pain in joints of right hand
  • M25.542  Add   Pain in joints of left hand
  • M25.549  Add   Pain in joints of unspecified hand
  • M26.60   Delete  Temporomandibular joint disorder, unspecified
  • M26.601  Add   Right temporomandibular joint disorder, unspecified
  • M26.602  Add   Left temporomandibular joint disorder, unspecified
  • M26.603  Add   Bilateral temporomandibular joint disorder, unspecified
  • M26.609  Add   Unspecified temporomandibular joint disorder, unspecified side
  • M26.61  Delete  Adhesions and ankylosis of temporomandibular joint
  • M26.611  Add   Adhesions and ankylosis of right temporomandibular joint
  • M26.612  Add   Adhesions and ankylosis of left temporomandibular joint
  • M26.613  Add   Adhesions and ankylosis of bilateral temporomandibular joint
  • M26.619  Add   Adhesions and ankylosis of temporomandibular joint, unspecified side
  • M26.62   Delete  Arthralgia of temporomandibular joint
  • M26.621  Add   Arthralgia of right temporomandibular joint
  • M26.622  Add   Arthralgia of left temporomandibular joint
  • M26.623  Add   Arthralgia of bilateral temporomandibular joint
  • M26.629  Add   Arthralgia of temporomandibular joint, unspecified side
  • M26.63  Delete  Articular disc disorder of temporomandibular joint
  • M26.631  Add   Articular disc disorder of right temporomandibular joint
  • M26.632  Add   Articular disc disorder of left temporomandibular joint
  • M26.633  Add   Articular disc disorder of bilateral temporomandibular joint
  • M26.639  Add   Articular disc disorder of temporomandibular joint, unspecified side
  • M50.02   Delete  Cervical disc disorder with myelopathy, mid-cervical region
  • M50.020  Add   Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
  • M50.021  Add   Cervical disc disorder at C4-C5 level with myelopathy
  • M50.022  Add   Cervical disc disorder at C5-C6 level with myelopathy
  • M50.023  Add   Cervical disc disorder at C6-C7 level with myelopathy
  • M50.12  Delete  Cervical disc disorder with radiculopathy, mid-cervical region
  • M50.120  Add   Mid-cervical disc disorder, unspecified
  • M50.121  Add   Cervical disc disorder at C4-C5 level with radiculopathy
  • M50.122  Add   Cervical disc disorder at C5-C6 level with radiculopathy
  • M50.123  Add   Cervical disc disorder at C6-C7 level with radiculopathy
  • M50.22   Delete  Other cervical disc displacement, mid-cervical region
  • M50.220  Add   Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221  Add   Other cervical disc displacement at C4-C5 level
  • M50.222  Add   Other cervical disc displacement at C5-C6 level
  • M50.223  Add   Other cervical disc displacement at C6-C7 level
  • M50.32   Delete  Other cervical disc degeneration, mid-cervical region
  • M50.320  Add   Other cervical disc degeneration, mid-cervical region, unspecified level
  • M50.321  Add   Other cervical disc degeneration at C4-C5 level
  • M50.322  Add   Other cervical disc degeneration at C5-C6 level
  • M50.323  Add   Other cervical disc degeneration at C6-C7 level
  • M50.82   Delete  Other cervical disc disorders, mid-cervical region
  • M50.820  Add   Other cervical disc disorders, mid-cervical region, unspecified level
  • M50.821  Add   Other cervical disc disorders at C4-C5 level
  • M50.822  Add   Other cervical disc disorders at C5-C6 level
  • M50.823  Add   Other cervical disc disorders at C6-C7 level
  • M50.92   Delete  Cervical disc disorder, unspecified, mid-cervical region
  • M50.920  Add   Unspecified cervical disc disorder, mid-cervical region, unspecified level
  • M50.921  Add   Unspecified cervical disc disorder at C4-C5 level
  • M50.922  Add   Unspecified cervical disc disorder at C5-C6 level
  • M50.923  Add   Unspecified cervical disc disorder at C6-C7 level

ICD-10 Reference:

Gwilliam, Evan M, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA, ChiroCode Institute

If you have any questions regarding these changes Petty, Michel and Associates would be glad to help guide you in the right direction.  Please email to services@pmaworks.com or call us at 414-332-4511.  We are here to help!

Using the Power of Simplicity to Develop Your Practice

Posted on by
1

“The way we’re running the company, the product design, the advertising– it all comes down to this: let’s make it simple, really simple.”     Steve Jobs  (Walter Isaacson) 1.

If you could simplify your business even more than it is, you would make more money and have less stress.

There is a direct relationship between simplicity and productivity, and an inverse relationship between complexity and productivity.

The most successful businesses have capitalized on this fact. This was one of Apple computer’s unique selling propositions – to focus on the simple and eliminate what wasn’t essential.

From its inception, the Apple Macintosh computer was designed with simplicity in mind.  Other companies have focused on simplicity: McDonalds order via drive-through, Ikea with its simple design, and Amazon with one-click ordering.

Simplicity Pays

Siegal-Gale is an international marketing firm that has studied simplicity in business and has been able to profile and rank businesses according to their simplicity. They call this the Global Brand Simplicity Index and have found that those companies that rank the highest, also outperform companies that rank as more complex. Their report states (2):

  • 214% – How much a portfolio of the world’s simplest brands has beaten the average global stock index since 2009
  • 69% – The percentage of consumers who are more likely to recommend a brand because it provides simpler experiences and communications
  • 63% – The percentage of consumers willing to pay more for simpler experiences

What Does This Mean for Your Practice?

You want to simplify the experience your chiropractic (or other) patient has in your office. From the first phone call, first appointment, examination, report of findings, patient finances, and scheduling, discover ways to simplify your procedures.

Your intake forms may be redundant or complicated, there may be too many rote statements or “scripts” for your staff to say to patients, or there can be extra pathways that your patients have to travel, like so many rabbit trails, where they can get confused and the flow slows down.  Staff, or doctors, may have too many decisions to make at each visit.

For example – what extra therapy should the patient receive? Not knowing, I have heard support staff simply ask the patient what therapy they wanted today, as if they were ordering a latte.  And as we know, there are definitely too many codes and documentation rules to follow for the doctor. Going total cash is one solution, but intelligent software, dictation, and scribes are other solutions.

Many, if not a majority of the more profitable offices that I have worked with over the years practiced what could be called “straight” chiropractic.  The straight practice (no additional modalities) works well, when it does, because its procedures and flow are simple. It is usually more profitable because extra overhead hides in the complicated.

Focus: Eliminate All but The Essential

Steve Jobs again: “People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are. You have to pick carefully. I’m actually as proud of the things we haven’t done as the things I have done. Innovation is saying no to 1,000 things.”— Steve Jobs, WWDC 199(3)

I am not advocating no supplements, no exercise physiology, no electrical therapy. But to be honest, how much of this gets used in your office? I know offices — right now, and have known hundreds more, that have equipment lying around unused or bottles of vitamins collecting dust on overlooked shelves.

444378-simplicity

You have to embrace first only those unique outcomes that you can deliver. Work backwards and add only the most critical steps. “Begin with the end in mind”, as Stephen Covey observed in high producers.

For the Chiropractor – Adjust

For a chiropractor, this means adjust. (For other professions: what is your core function?) One of the first doctors I worked with when I moved to Wisconsin in 1988 worked closely with Clarence Gonstead. His license plate read: I ADJUST. He had a full practice, chuckled a lot, and seemed to make a nice living.

Start with this first, and then add additional services carefully – if you want.

Educate – In and Out Of The Office

Secondly, educate. Educate your patients, your team, and your community.  But your education has to be simple.  Your message has to be concise. One doctor we have worked with over the years has a waiting list practice, with nonstop patient, and even some MD, referrals.   He doesn’t do a 4-day report of findings and he doesn’t do a 2-day report of findings on new or reactivated patients.

He just very intently adjusts and talks about the adjustment and what he is adjusting.  From there, he then also gets into other health topics such as toxins (vaccinations), nutrition and weight, and exercise.

This is a good model: start with your core service and move out from there. For chiropractic education, you can use simple metaphors like “pinched nerve,” “garden hose,” “rusty gate hinge”, and how the body fighting toxins creates heat (inflammation), etc.

And keep educating your patients with care classes, lending library, table talk, movie nights, special speakers, case histories, and testimonials.

And do this first and continually with your support team.  This is not done enough!

One method to discover what to simplify is to regularly practice your procedures. For example, do a rehearsal of what happens when a new patient comes into your office on their first day, 2nd day, 3rd day, etc. You will flush out confusions, redundancies, and extra motions that complicate the patient experience.

Outside of your office, the same applies. Educate your community on what you do.  What is your simple selling proposition that people want?

For example, someone asks you “what do you do?”: “Well…

we help to improve your health, we relieve your pain,

and we increase your game – naturally!

No drugs, no surgery, and we guarantee you have fun in the bargain.”

How’s that? A simple and a desirable unique selling proposition (USP). (You can use this in all your marketing communications – no charge!)

Make it Fun – and Have Fun

Lastly, there is fun. You can and should have fun doing this. And so should your patients and support crew.

Patients will mostly remember how they feel after leaving your office.  Was it a pleasant, enjoyable experience? Was it fun?

Practice life can often bring about a kind of serious hue over the office. Administrative errors, missed appointments, a dissatisfied patient, a staff member out for the day, too many bills – all of this can create an extra layer of anxiety or seriousness in the office.

Fight this by being grateful for all the wonderful outcomes of your patients.  Work on having a “the gratitude attitude.”

And as you simplify your processes, you will find that everyone’s attention becomes freer to enjoy helping each other — to help the patients.

Simple is more fun and profitable.

So here is a question for you: Which comes first, the fun or the smile?

Well, you can kick things off right now… right now with a smile.  Actually, smiling is simpler and requires less muscles than frowning.

Frowning is complex, so start right now by smiling.

Try it.

See? Already your business and life is simpler and better – and funner.

-Ed

MAGNET003

(To help you keep things simple, you can order two magnets of the above image for your office, courtesy of PM&A while quantities last. Click here to order.  We will mail them to you at no charge.)

For a printable copy of this article click [The Power of Simplicity]

Chiropractic & Practice Marketing Ideas for Fall 2016

Posted on by
Reply

Autumn pumpkin background

(Download a PDF of this article)

3 Echelons of Practice Marketing: Motivation, Management, Procedures

Most attention is usually put on marketing procedures. That is fine but when marketing fails, it is usually because the procedures just didn’t get done, or only half done. And this is because no one was put in charge of them and given the time to execute them. Pretty obvious, but easily overlooked. This was the essential theme of the Marketing Manager System I published in 2000. It is out of print now but much of the info is on our PM&A Member’s site.

And underneath it all is motivation. Who really wants to do the marketing? You may get excited from a seminar or about an event you have planned. But motivation can dissipate quickly and too often we are not active enough in keeping ourselves and our teams passionate and determined about providing more and better service.

So all three levels or echelons of marketing need to be in place. What follows is a brief list to help you set up effective marketing activities for the next 4 months.

 

QUALITY SERVICE AND CARE COMES FIRST
It goes without saying but it needs to be said – from an executive point of view, quality care and service comes first. Ultimately, an office that gives “WOW” service and produces extra-ordinary outcomes generates enough word of mouth to create a waiting list practice. Think of Clarence Gonstead.

MOTIVATION
Plan weekly motivational talks at your team meetings and major motivational activities each month. These can be discussing case successes, watching Doctored, or doing a free clinic for the underprivileged. Keep the saw sharpened. Keep reminded of WHY you all are doing what you are doing and your greater purposes. This is the fire that drives the engine of your practice.

MARKETING MANAGEMENT
Someone to Coordinate
Delegate someone to be the marketing coordinator. You could have someone for just internal and someone for external events. These roles are only a few hours per week as coordination jobs. The actual work is delegated as separate duties so that everyone on your team has a role in marketing. Your entire office is the marketing department but it helps to have duties assigned just like you do for the front desk or billing dept.

So Many Procedures, Which Should You Pick?
Select the marketing activities that have worked for you in the past and add a few at a time. Pilot each and see what works better for you. Marketing is all about testing. Find out what works and then put it in a system. Keep it simple. Get your marketing systematized and departmentalized and delegated.

Time to Plan
Part of marketing management is setting aside time to plan and coordinate upcoming events. At least monthly, schedule time aside to review past promotions and plan new marketing for the next few months.

Calendar
Make sure you have a large calendar to post all of your upcoming promotions.

MARKETING PROCEDURES
COMMUNICATION CHANNELS
All your marketing does no good unless it is communicated. Marketing IS communication, so keep the communication going – in and out of the office. Make sure each month you promote via team members, “table talk”, e-newsletters, posters, Facebook, etc.

Recurring Procedures
The most important marketing activities are your usual, recurring procedures that you do on a daily and weekly basis. Many of these are already embedded in your routine procedures. Because they are done routinely, the usual and everyday procedures can be overlooked or not given the importance needed. For example, just answering the phone can make a big difference. Don’t let the routine become the mundane. Practice new ways to have fun with your recurring procedures.

Community Services
This is what I call the free or discounted services you provide in your community. Health screenings, workshops, networking events, setting up alliances with dentists, for example, or just conspicuously showing up at the Lions Club breakfast. I would delegate this to one person and give them 4-6 hours per week to schedule events and to help coordinate who attends these events. There is a good deal of administration in this role. I have seen events scheduled a year in advance that generated new patients and referrals from alliances that come in years after they were initially set up because the relationship was well maintained.

  • External Workshops and “Lunch and Learns.” Schedule external classes for January and February now. Business “Wellness Programs” or lunch and learns at the local YMCA or Senior center. Include massage to make it even more attractive.
  • Local Health Fairs. Contact all the locations you have held events in the past year and schedule events for the New Year.
  • Contact local businesses for health fairs in the New Year and get them scheduled.

Internal Workshops.
Internally, you can also schedule special classes over the next 4 months, including “Natural Approaches to Flu Prevention”, “New Healthy Ways to Lose Weight and Get Fit This Winter,” etc.

Google Reviewsgoogle-review
If you get 4-5 star reviews on Google, you will get new patients. This is proven. It is true. Assign it to someone and do it. Now. It may take a few months, but if you do it, they will come.

Patient Education: Table Talk and the New Patient Care Class
In my opinion, educating your patients is more important than adjusting or treating them. Not all patients are easy to educate, but all can be gradually persuaded to understand the value of your services: what they do, how they work, and why they are important. Educated patients refer more. They stay with you longer. They are more enjoyable to care for. And, most importantly they are healthier. Table talk is an excellent practice with each patient. But your new patient care class is a proven winner. It just takes your intention to do it. Two times per month. Do with the fervor of a Sunday sermon or with the frankness of a fireside chat with old friends. It will boost your practice and you. And… how much does it cost? That’s right… nothing.

Care to Share
There are many ways to do this program but I like it because it encourages your patients to help you get the word out about their successes so that others do not have to suffer as long as they did. It gets them to help their community. It taps into their greater purposes and gives them an opportunity to help others. Set up a monthly drawing and give away a modest prize or two. Enter the drawing by submitting a Google review, by bringing someone into the office for a no charge consultation, or by getting a workshop set up in their place of employment. Run the program monthly or every other month.

Special Promotions
These are the big events that can be fun and energizing which you hold in your office every couple of months or so. I list some ideas below.

OCTOBER
October is National Chiropractic Health Month. (The International Chiropractic Association and the American Chiropractic Association once recognized October as Spinal Health Month, but now it is simply called Chiropractic Health Month.) This can give you a reason to do many different promotions. For example:

  • A banner in your office for patients to bring in family members for a free “Check-up.”
  • Reactivation Month – send postcards to all inactive patients who have not been in for at least one year or more for free spinal checkup: “Chiropractic Check-up Time.” Use an image of an alarm clock.
  • The ACA has other suggestions on its site. (http://www.acatoday.org)

Child Health Day
Under a Joint Resolution of Congress, the President of the United States has proclaimed National Child Health Day every year since 1928. It was originally celebrated on May Day, May 1, each year until 1960, when the date was moved to the first Monday in October. Use this as a great opportunity to have a Kid’s Day. (Google it. Many differen sites offer suggestins.)

National School Lunch Week
National School Lunch Week takes place on the second Sunday in October (http://www.nea.org/tools/lessons/48412.htm ) You could have a workshop on fast and nutritious meals for kids targeting parents and moms.

Awareness Weeks
If workshops aren’t your thing, then set aside one week to focus on a particular condition, such as headaches and call it “Headache Awareness Week”, or “Pinched Nerve Awareness Week”, “Neuropathy Awareness Week”, etc. Schedule one a month where possible for the next 5 months as part of your Community Education Program. Detail procedure with posters in your Marketing Manager System Toolkit and on your PMA Members site under: “Community Education.” Offer free consultation, screening, and information regarding the condition.

Crazee Dayz
Select a day and make it special for your patients. Only one day a week is necessary otherwise it’s not special. It can be once per month or every week. Serve extra treats. You can have the staff dress out of uniform coordinated to the day. This can add some extra fun to the office and help with retention and long term referrals.

  • Muffin Mondays – Serve up a selection of health bran, blueberry, or gluten free muffins.
  • Two for Tuesday – Bring a friend for a complimentary spinal exam and offer the patient a free adjustment. “Two Fer Tuesday.”
  • Whacky Wednesdays – gag gifts for patients, “adjust-a-mints”, etc. (http://www.bannermints.com/)
  • Thirsty Thursdays — Organic apple juice served in plastic wine glasses with a sliced green apple on the rim. NA margaritas.
  • Fruity Fridays – Bowl of local fruit.

Chiropractic Opportunity Week (“The doctor is having a COW.”) (patient referrals and advertising new patients) Free consultation, exam, and x-ray if needed.

Hair Dresser/Beauty Salons/Spas

  • Offer a workshop on “How to Stay Fit While You Clip.”
  • Free massages (and screenings) for customers

Kids and Halloween Party
With Casper as inspiration, a kid’s Halloween party with a friendly ghost theme has the right mix of tricks and treats. Invite the young ghouls to come dressed up, but you can also have them make ghastly masks as part of the fun. Other ideas include spooky decorations, scary snacks and a friendly ghost hunt.

NOVEMBER
Thanksgiving Turkey Drawing Poster

  • Refer a friend and enter the drawing for a free turkey
  • Special for Organic Turkeys – announce in your newsletter
  • Make arrangements now with your local supplier

Thank a Veteran Day
Veterans Day – November 11. It is no secret that the physical and mental health support veterans receive is inadequate. This good time to set up a promotion honoring those who served. Special promotions including free or discounted services or donations to local Veterans organization. (More info: http://en.wikipedia.org/wiki/Veterans_Day )

Donation Drives (patient referrals, advertising new patients)
Holiday time always brings an increased demand for helping those less fortunate. Within your office set up a collection area for any of the following programs and promote it in your newsletter.

  • Coats for Kids
  • Food for Families
  • Toys for Tots
  • Blood Drive
  • $25 in exchange for first day services.
  • Also, you can support drives at local church or gyms. EG “Free first day services for every donation a member of YMCA makes to the homeless fund.”

Deer Widows Week
During hunting season or first week of December offer complimentary massage for your patients who refer in a new patient

Girl’s Night Out
This is a shopping/gift exchange that can take place in your office. Have patients who have little businesses set up booths in your office and stipulate that they have to bring guests. Supply some refreshments and promote as great way to “Shop Local” for Christmas presents. Enlist the help of massage therapist, local spas and direct marketing consultants. You can provide free screenings.

DECEMBER
Holiday Coupons – Gifts Certificates (patient referrals)

  • Good for Massage, consultation, exam, x-ray
  • Denominations: Free, $25, $25 or food donation to charity.

Poinsettia Give Away
Give away free poinsettias, one per family. Include in the cards a gift certificate for family members or friends. (See Member’s site for gift card)

Saturday with Santa

  • Set up Santa in your reception room corner
  • Treats for the kids
  • Pictures with Santa
  • Free spinal check with Doc

Appreciation to External Referral Sources
Deliver a fruit basket or other present personally during December with a card of thanks and mention how you are looking forward to another year working together. This would go to any location where you had an external community services type of event, such as a screening or workshop. Include: “Looking forward to working with you next year.”

Health Never Takes a Holiday
Post a sign in your office in December that “Health Never Takes a Holiday” and review and re-schedule patients through December to January.

Giving Tree/Angel Tree
The Giving Tree/Angel Tree Project is a great way to bring community awareness to your office. It is a simple project that gets your patients be involved to help others where they might not otherwise have the opportunity to do so.

JANUARY AND FEBRUARY
Winter Workshops and Movie Nights – Internal
These, of course, can be done anytime of the year. Whether it is how to make organic soup for the week, or a talk on vaccinations with an MD, winter has been a good time for internal events. Weight loss, fitness, and food have seemed to be popular. These should be planned by December or even November. Ideally, plan your workshops with a guest speaker such as a holistic MD, biological dentist, midwife, etc.

We have a great deal of information on our PMA member’s site for those of you who are active clients, much of it compiled from the Marketing Manager System I published quite a few years ago. There you can find readymade posters and detailed information on how to do many of these projects.

Yes, I know some of the posters are old but we are not in the graphic arts business and neither are you. But they are on Word files and can be easily changed. A simple graphic and title is all you need with the specifics in bullet points. Depending on the level of your program, we can also put together simple posters to help promote your particular project.

If you are not active with PM&A, you can still find a great deal of info on our web site at www.pmaworks.com/observations.

With shared intentions to get more people healthier and smarter about their health!

Ed Petty
September, 2016

Phyllis Frase to Speak at the Chiropractic Society of Wisconsin Fall Summit on Referrals and Retention

Posted on by
Reply

p-frase-hs2

Welcome back to Wisconsin Phyllis!

We are excited to have Phyllis returning to Wisconsin to join us at the Chiropractic Society of Wisconsin Fall Summit.

The Fall Summit will be held October 21st through the 23rd at the Kalahari Resort in Wisconsin Dells.

Are you and your team registered?  If not you will want to as Phyllis will be presenting to doctors and staff all day Friday.  She will be covering the following topic:  

“The Secrets of Referrals and Retention”

What’s the secret? The pixie dust? The magic potion to creating patients that stay pay and refer for a lifetime?

In this class you will walk away with what makes a patient pay and value their chiropractic care. This interactive class will help you create great customer service and learn easy, solid systems and procedures that will take your practice to the next level.  Included is low stress, low cost marketing ideas that you can implement on Monday morning.

For more information on Phyllis visit: Our Experts

To register for the CSW Fall Summit visit: CSW Fall Summit 2016

 

Wisconsin License Renewal Requirements

Posted on by
Reply

REMINDER:  Wisconsin License Renewal Credentialing Requirements

Doctors of Chiropractic (DCs):

  • Continuing Education: Forty (40) hours minimum of state board-approved courses; four (4) of the 40 in nutrition
  • Maintain Current CPR
  • State Approved Course Listings are updated regularly, and can be found at: DC Approved Courses

Starting in October 2016 and prior to December 14th, renew online:  DC Renew

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses
  • State Approved Course Listings are updated regularly, and can be found at:
  • CT Approved Course Listing

Starting in October 2016 and prior to December 14th, renew online: CT Renew

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses
  • State Approved Course Listings are updated regularly, and can be found at:
  • CRT Approved Course Listing

Starting in October 2016 and prior to December 14th, renew online at: CRT Renew

TIP:  Keep your transcripts and file them safely, in the event of a continuing education audit.

All licenses (DC, CT, CRT) expire on December 14, 2016 at midnight.

Questions?  Contact Lisa Barnett, PM&A Consultant, at 920-334-4561

~~~~

Links

DC Approved Courses: https://dsps.wi.gov/Default.aspx?Page=b74564c8-7d6c-4258-9809-cd118336a9f5
DC Renew: https://online.drl.wi.gov/UserLogin.aspx
CT Approved Course Listing:http://dsps.wi.gov/Default.aspx?Page=830a2718-a0f7-414c-8e97-2481f983bc78
CT Renew: https://online.drl.wi.gov/UserLogin.aspx
CRT Approved Course Listing: https://dsps.wi.gov/Default.aspx?Page=bcfb3543-eb0a-46bf-ba89-8f1fe6d84325
CRT Renew: https://online.drl.wi.gov/UserLogin.aspx

Printable Version of this quick checklist of requirements. [LINK]

The Importance of Compliance in a Chiropractic Office – HIPAA, Covered Entity, OSHA, HITECH

Posted on by
Reply
Lisa J. Barnett

Lisa J. Barnett

HIPAA, Covered Entity, OSHA, HITECH – – Compliance. What’s happening in the world of compliance and why do you as a chiropractor need to be educated and remain in the know? Find out below . . .

First and foremost, according to the Health and Human Services (HHS), chiropractors are included in the covered entity category, and this is regardless of whether or not you have received Electronic Health Records incentive monies. Covered entities are required by federal law to comply with all areas of protected health information and employee safety standards. Impact of non-compliance? In February 2016, a covered entity was fined $239,800 for non compliance.

Further, according to a March 2016 survey among small practices designated as covered entities, 60 percent of the 900 plus professionals surveyed are still unaware of pending compliance audits, and 58 percent have not appointed a securities/privacy officer in their practice. Audits to our profession are forthcoming, and we cannot opt out. Keep reading on how to safeguard yourself and your practice. Also keep in mind that it takes approximately 40 to 50 hours to develop and secure a compliance program.

The three main areas of compliance you need to be aware of, educated in, and be an active participant include: HIPAA, OSHA, and IT Securities.

Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act (HIPAA) law of 1996 was enacted to improve the portability and accountability of health insurance coverage, and it brought individual privacy rights to patients and requires that we notify them of their rights. It also serves to eliminate fraud, waste, and abuse in healthcare. The focus here is to safeguard your practice by securing personal (patient) health information (PHI) and personal identifiers, be it paper or electronic (ePHI). This can include data encryption, secure messaging, compliant Cloud storage, compliant software, and unique password setups. One of the areas I assess when I visit a clinic is locating where the patient paper files are kept and if they are well out of viewing from others.

Your HIPAA requirements to be compliant at the clinic level include:

  • Designating a compliance/privacy officer whose primary responsibility is to ensure compliance with the regulations
  • Establishing and implementing at least annually, training programs for all employees and doctors.
  • Implementing appropriate policies and procedures to prevent intentional and accidental disclosure/release of PHI or ePHI. Encrypting your data for example will lower your chances of ransomware or cyberattacks.

OSHA
The United States Occupational Safety and Health Administration (OSHA) Act was signed by President Nixon in December 1970. It is designed to protect worker safety and promote healthy work environments. Some of you Docs have been involved in workplace safety and onsite workplace assessments in factories. Kudos to you! You were advocating OSHA’s mission by: Educating your client and their employees on workplace safety by conducting posture and ergonomic assessments, and finding the best ways for workers’ compensation patients to get back to work and continue contributing safely and appropriately within their restrictions.

At the clinic level (can be delegated), your requirements to meet OSHA requirements include:

  • Displaying the required workplace safety and employee rights posters for all employees to review
  • Establishing annual training for yourself and your employees. Local fire departments usually are able to conduct these trainings and are willing to include other participants.
  • Developing a written emergency plan in case of fire, severe weather, etc.
  • Drawing up an exit plan and post for employees and patients to see. See example below:

evacuation map

  • Developing written procedures (universal precautions) to minimize risk exposure to bodily fluids such as blood, vomit, saliva.
  • Obtaining Safety Data Sheets for disinfectants used at the clinic, as well as if you process X-rays.
  • Have handy your Quality Assurance X-ray manual, follow it, and ensure it is accessible to those who take/process X-rays.
  • Ensuring ergonomic workplace assessments are conducted at the clinic and documented. This could include posture screenings for your employees and requiring stretch breaks – for you, too!

Information Technology (IT) Security/HITECH

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of HIPAA and the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Section 1176(a) of the Social Security Act was revised during this timeframe to allow for significant monetary penalties up to $1.5 million for breaches/violations of protected health information. However, an interim revision (later known as The Omnibus Rule) set prohibitions on enforcing such significant monetary penalties if it was found in investigation that the covered entity did not know and with the exercise of reasonable diligence would not have known of the violation. In these cases, the breaches were punishable under the lowest tier of penalties, and further, prohibited the imposition of penalties for any violation corrected within a 30-day time period, as long as the violation was not due to willful neglect. A final ruling in January 2013 reiterates all of the above standards.

Your responsibilities to get IT Securities compliant include:

  • Assigning a securities officer
  • Conducting a risk assessment
  • Ensuring your EHR vendor and billing clearinghouse are HITECH/HIPAA compliant
  • Ensuring every vendor you work with has signed a Business Association Agreement with your office and you have those Agreements on file. These need to be updated at least annually.
  • Ensuring the clinic’s computer systems are backed up regularly, have virus-checking software, firewalls, and encrypted operating systems
  • Establishing securities policies and procedures, including on your social media networks.
  • Creating a disaster recovery plan
  • Creating a policy and procedure of notification, in the event of a data leak or leak of PHI/ePHI

Impact of non-compliance? Another covered entity was fined $25,000 for posting patient information online.

Feeling overwhelmed? We can help. Contact me on how you can get an initial Compliance Assessment and a Medicare Documentation Assessment with a Report of Findings sent to you, for a ridiculous low price of $299!*

References:

  • nueMD Cloud-based health information technology, http://www.nuemd.com/webinars
  • HIPAA Journal, http://www.hipaajournal.com/
  • United States Health and Human Services, http://www.hhs.gov/hipaa/
  • United States Occupational Safety and Health Administration, www.osha.gov/
  • Federal Register/Rules and Regulations Publication Vol. 74 No. 209
  • Federal Register/Rules and Regulations Publication Vol. 78 No. 17
  • Emergency Exit Diagram: www.steamwire.com business continuity templates

*Mileage cost may apply.

Medicare in Your Chiropractic Office: Is Your Documentation In Order?

Posted on by
Reply
Lisa J. Barnett

Lisa J. Barnett

Have you ever thought you could be both a great documenter and repeatedly educate your patients on their innate intelligence . . . if you only had the time? Keep reading on how to both bulletproof your documentation for a potential audit and maintain the energy of our profession’s principles.

Let’s help build your ammunition.

First . . . did you know that the US Health and Human Services advised Medicare to target chiropractors to curb questionable and inappropriate payments, projected at $280,000,000? Seriously! And clinics are, as I write this, being audited. How do I know? Because we’re receiving phone calls and emails asking, “What do I do? I received a letter from Medicare.” As a result, I’m traveling around to help chiropractic offices prepare.

To insure yourself and what you’ve worked hard for, make sure your documentation (that is, every single note in the patient’s file/your EHR software) is citing the following information:

  • History Obtained at Initial Visit:
    • Symptom(s) causing patient to seek care
    • Family history if relevant
    • Past health history (general health, prior illness, injuries, hospitalizations, surgeries, current medications)
    • Mechanism of trauma
    • Quality and character of symptoms/problem
    • Onset, duration, intensity, frequency, location, radiation of symptoms
    • Aggravating or relieving factors
    • Prior interventions, treatments, medications, secondary complaints
  • Initial Visit or New Onset
    • History (as stated above)
    • Description of the present illness:
      • Mechanism of trauma (how did it happen?) For example, getting out of bed, twisting, gardening.
      • Quality and character of symptoms/problem
      • Onset, duration, intensity, frequency, location, radiation of symptoms
      • Aggravating or relieving factors,
      • Prior interventions, treatments, medications, secondary complaints
      • Symptoms causing patient to seek care. Symptom(s) must be related to the level of the subluxation documented.
    • Evaluation of spine/nervous system through physical examination.
      • PART: pain and tenderness, asymmetry/misalignment, range of motion abnormality, tissue, tone changes
    • Diagnosis: Primary diagnosis must be a subluxation, including the level or identified descriptive term of location, i.e., condition of the spinal joint involved, direction of position assumed by the named bone.
    • Treatment plan, to include the following:
      • Recommended level of care (duration and frequency of visits), specific goals, objective measures to evaluate treatment effectiveness, date of the initial treatment.
      • Though not a documentation requirement, this is where you will educate the patient face to face, as to their subluxation and what will happen if they don’t get it corrected, as well as educate them on their innate intelligence.
  • Subsequent Visits:
    • Review of chief complaint, changes since last visit, systems review if relevant
    • Physical Exam
      • Exam – area of spine involved in diagnosis
      • Assessment of change in patient condition since last visit
      • Evaluation of treatment effectiveness.
      • Though not a documentation requirement, this is a perfect time to re-educate the patient on chiropractic principles.
      • Documentation of the presence or absence of a subluxation
      • PART: pain and tenderness, asymmetry/misalignment, range of motion abnormality, tissue, tone changes
    • Documentation of treatment given on day of visit (technique(s) used and areas adjusted)
    • Progress or lack thereof, related to goals and treatment plan (is the patient meeting goals?)

Let me be clear: The above documentation requirements are not PM&A’s. They are Medicare’s.

Other Tips:

  • Your subjective findings in initial visits/new onsets should tell a story about what happened, how it happened, and when it happened.
  • The Visual Analog Scale (VAS) is not sufficient documentation as your sole objective tool. Use additional tools to measure objectives findings.
  • See below for a typical VAS:

VAS-Lisa

  • You should self-audit your documentation on a regular basis.

In closing, get out there, do what you do best to attract and help anyone with a spine, and follow the above documentation requirements to armor yourself in the event of an audit by Medicare and other payers. Need help staying relaxed and focused, and getting paid? Give us a call. That’s why we’re here.

Sincerely in Chiropractic,
Lisa

Lisa is now providing a no charge initial consultation regarding your Medicare documentation. You can contact at (920) 334-4561 or by email at Lisa (at) @ pmaworks.com

More information on Lisa[LINK]

Download a printable copy of this newsletter [June newsletter]

Download a customizable copy of the Checklist: [Medicare Documentation ChecklistDOC]

Print Checklist (PDF)[Medicare Documentation Checklist-PDF]

 

Your Perennial Waiting List Chiropractic Practice: Like Daffodils, Your Patients Keep Coming Back

Posted on by
Reply
petty michel and associates on creating a full office

Daffodils from Linda’s back yard in Wisconsin, 2016

Spring is finally with us and the flowers and trees are beginning to bloom up here in the northern Midwest.

What is amazing to me is that I start seeing flowers pop up where I must have planted them, or someone did, a few years past. Pop, pop… a daffodil here and tulip there, some lilies and Astors and I don’t know what! Who planted these?

Growing, developing, and sustaining a chiropractic practice corresponds in many ways to the laws of nature or the laws of a farm. What makes these plants bloom are many things – the warmer weather, some biological clock, water, of course, and sunlight. Maybe some organic fertilizer now and then.

They also have something else. Something that has allowed them to weather the snow and the cold and the storms so that they are here now… waving to us in the still cool of early spring.

A few years ago I wrote an article about roots and patient retention. I know… seems like an odd comparison, but it’s not really. The thing with roots is that they are not seen and not always appreciated. I made the analogy of having a good root system in your practice – which would be the loyalty your patients have with you. I discussed methods to create and improve this relationship in the article, Chiropractic Root System

I just reviewed the article and realized that I omitted a key component in creating great patient loyalty, patient retention, and patient referrals. It is actually pretty obvious and something I see in the offices I visit.

But first, let me include here some survey information from the 2010 Customer Experience Impact Report (CEI) for North America by Rightnow Technologies* that will help make my point.(My underlines and bolds.)

“WORD OF MOUTH IS MIGHTIER THAN THE SWORD
Consumers aren’t only demonstrating their power with their wallets, but they are influencing those around them as well. Whether a consumer has a positive or negative experience, their friends, family, colleagues and networks are sure to hear about it and what they are saying carries weight.

Customer service is the most influential thing a company can do to increase customer advocacy.

55% (up from 53% in 2009) of consumers recommend a company because of its customer service, compared to products at 49% and price at 42%.

But those who have issues are also voicing their opinions and it can have a severe impact on a company’s reputation and ultimately bottom line.

Imagine the result of 66% of a company’s frustrated customers on a mission to discourage others from buying from that company. Consumers aren’t just complaining when something goes wrong, they are determined to have their presence felt by the company at fault:

  • 79% of consumers that had a negative experience with a company told others about it
  • 97% used word of mouth as their preferred method to share their experience

WHAT MAKES A GREAT EXPERIENCE?
Consumer expectations continue to rise, but their requests are reasonable and within reach. Put simply, consumers want easily accessible, accurate information to make well informed buying decisions. And they want to be respected, treated well, and have their issues resolved in a timely fashion.

Of those who decided to stop doing business with an organization,

  • 73% was a reaction to rude staff
  • 51% reacted to unknowledgeable staff
  • 55% were because of issues that weren’t resolved in a timely manner.”

Finally, it all comes down to this:

“WHEN YOU HAVE A BAD EXPERIENCE, YOU DON’T GO BACK.
This has been a mainstay result from the Customer Experience Impact Report (CEI). The fifth annual report cited that 82% of consumers have stopped doing business with a company as a result of a negative experience.”

So, it is not “time” or “money” as the primary reason patients drop out of care. Simply put – their experience was not AWEsome enough!

This is why Google Reviews or any legitimate review has such a strong impact on referrals. It is Word of Mouth marketing.

But how do you create it? Is there some fancy form or new procedure? A Dx code perhaps? Well, there are forms and procedures, but these are 20th on the list. The first 19 have to do with excellent communication and service. Communication that is genuine and caring.

In the article about increasing patient retention and the root system, I do give a few ideas on how to improve your service and, in turn, retention and referrals. But… so apparent to me now, I left something out!

Time and time again, where I see an office struggling to get new patients… I also notice a low morale office.

The low morale may not be obvious. In fact, studies show that the majority of employees (70%) are really not engaged in their work, but simply go through the motions.** This is so common that blasé, disinterested employees or time crunched, rote professionals seem to be the cultural norm.

But I routinely interview staff and work with office managers and hear THEIR side of the story, at least part of it.

If a team member is disgruntled, disaffected, discouraged, or in any way “dis”, the quality of service they provide to the patient will be affected. Let’s put it another way: if your team is anything BUT happy and cheerful and truly looking forward to their day with YOU and the patients, you have a problem.

There are many studies that show the cause and effect of employee morale and customer service. But I have personally observed it many times myself.

The offices with the HIGHEST patient retention and most patient referrals are the ones where the support team and doctor, or doctors, have a great relationship with each other. In fact, aside from the now and then stress points, you could say that they truly like and admire each other and respect each other’s good work.

Adding to this, these offices also have dedicated a continuous effort for training and education. Webinars, seminars, internal trainings, coaching (Hi there!), and books – one of the most overlooked training tool.

Now, what hampers all this is the stress of running a business. Doctors like to “doctor.” Chiropractic, or whatever good care you provide, does not fail. Doctors can always improve, and should, but it is usually the support organization that finally jams up on itself like railroad cars banging into each other, or even jackknifing.

As many of you know, I am working on a practice CEO training program. After a certain point of practice growth, it becomes difficult to continue to grow the business as a doctor. There is just too much to do. This is why you now need to learn and implement some fast flow procedures as a CEO, procedures which are very different from a doctor.

The CEO is a leader. John Maxwell*** lists five levels of leadership. At the first level people will follow you because they have to. At the second level they follow you because they actually like you! You have a relationship with them. At the third level they see that you get real results for the organization. Fourth… you are helping them become leaders! The last level is many orders of magnitude above the others… they follow you because of what you represent. Think of Martin Luther King, Gandhi, etc.

Practical Steps to Take to Improve Morale, Customer Service, Patient Retention and Referrals:

  1. Improve your communication with your team. That’s it. If it is good enough for your patients and for your family and friends, it is also good enough for your team members. As the doctor, of course, you are very busy. You are here for the patients and we are here for you.  But… as the CEO, you are here for us. Please listen to us, help us get better at helping you and the patient. Schedule time to do this each month with your veteran team members. A few minutes in the office, or even a lunch now and then.  It will pay off! And besides, it is only the decent thing to do.
  2. Plan events or projects to improve everyone’s competence. Schedule the team for training and coaching (Hi, again!) …or have them propose learning activities. Help them become leaders. Help them become expert. Lots of study and training and coaching.

As this happens, a lighthearted sense of pride and confidence will grow in your office. Synergy will improve. Staff will be engaged with the patients more and the patients themselves will also become part of the synergy.

Your practice will become well-nourished and strong, like perennial plants and trees that flower each spring.

Your patients will keep coming back.

#   #   #

Learn to look after your staff first — and the rest will follow.Customer service can make or break a business. If you treat your staff well, they will be happy. Happy staff are proud staff, and proud staff deliver excellent customer service, which drives business success.  – Sir Richard Branson (Virgin Companies)

=====================

Chiropractic Root System and Patient Retention

  *Rightnow Technologies. Download the report here. http://media.stellaservice.com/public/pdf/Customer_Experience_Impact_North_America.pdf

**http://www.gallup.com/poll/181289/majority-employees-not-engaged-despite-gains-2014.aspx

*** John Maxwell, The 5 Levels of Leadership

Your Most Important Set of Chiropractic Office Procedures

Posted on by
Reply

An Introduction to the Practice Development Process of Continuous Improvement

A key difference between a successful and profitable chiropractic business and a roller coaster type practice can be traced back to procedures and systems.

Many practice problems occur because procedures are not established, consistently followed, and regularly improved.   This has been the secret to franchising. Starbucks may offer new products and services now and then, but for the most part, they follow their checklists and manuals of successful procedures.  The local New Age coffee shop down on the corner with the unemployed guitar player usually lasts for about a year before the owner’s savings and inspiration dry up, along with the last cup of coffee.

chiropractic practice playbook

Of all the categories of systems in your office, what would you say would be the most important?

☐Patient Accounts (Billing/Collections) Systems
☐Marketing Systems
☐Front Desk Systems
☐Therapy and Clinical Support Systems
☐ Doctor Systems
☐ Business Systems (Payroll, Financial Planning, Taxes,)
☐ Leadership
☐Office, Practice Management Systems

My guess is that you usually keep most billing procedures in place as… obviously, you need to be paid.  And, you will usually keep most front desk procedures in place. These deal with patients and patients are obviously in the office, or not. And you, of course, follow your clinical procedures.

Your marketing procedures come and go, at least they do in most offices. They are just not consistent. This is why I put together the Marketing Manager System in 2000. The biggest error in most offices with their marketing is that it simply isn’t done consistently.

But the most important category of systems is not so obvious. These are the management procedures and systems.  Why are these most important? Because they keep all the other procedures in place and are continually being improved upon.

Why do you think CEO’s are paid so much money? Because they are in charge of the management of a business and are able to increase its bottom line by the millions.  They have procedures that they follow and insist that others do as well. These procedures all add up to systems.

Over the years, Petty Michel and Associates has been very successful at increasing the revenues of practices. One of the reasons is that we implement what we call the Practice Development Process. It is a monthly system of management that gradually works to objectively improve the business, repetitively over and over.  It integrates into your current systems and does not take that much extra time.  But in the end, it saves you a great deal of time, extra work, and lost revenue.

To learn more about the 3Goals Practice Development Process: 3Goals PDP