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Medicare Part B Premium Jumps Dramatically for 2022

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stethescope on calculator Kiplinger recently shared information from the Centers for Medicare & Medicaid Services reporting that Medicare Part B premiums will jump dramatically in 2022. An increase of 14.5% or $21.60 from 2021. Deductibles will also show an increase of $30.00 going to $233 in 2022.

The article goes on to say that Medicare Part A will also see an increase in deductibles.

Medicare claims “the increases were due in part to rising health care costs and higher utilization of health care services.”

They further stated, Aduhelm, a prescribed Alzheimers drug was also to blame.

To read the article in it’s entirety visit:
https://www.kiplinger.com/retirement/medicare/603759/medicare-part-b-premium-jumps-dramatically-for-2022

The 2022 Medicare fee schedule has now been released for Wisconsin for 98940-42:

The Problem With Seminars

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the problem with seminars

I am all for seminars. Been to many myself. I know I have gotten useful information and, no doubt, have benefited from them.

But, their usefulness is often wasted.

I just talked to a business owner that came back from a seminar he and his doctors and staff attended. He told me that they have started hitting their best-ever weekly numbers. His office manager told me that everyone is excited.

For now.

I have seen it time and time again… go to a seminar, get stoked, come back, numbers go up for a month or so, and then everything returns to how it always was. In essence, the seminar was only a short-term, “acute care” fix that addressed symptoms. Nothing was really improved or corrected.

There is a solution on how to benefit the most from seminars. I discuss it in my book, The Goal Driven Business, from which most of this article is quoted from. The following is a story related to me from a chiropractic staff member a few years back:

“Our office was really slowing down last year. So, the owner decided to take everyone out of town to a weekend business seminar. The speakers discussed new and efficient methods for doing our work. It was entertaining and informative. Plus, we also gained some great marketing ideas. It was a fun seminar, so we were all excited when we returned to work after the weekend.

“On Monday, we agreed to get together at lunch to discuss how to implement what we learned. Some staff members had to take care of urgent matters first, so our lunch meeting started 30 minutes late. Once we finally got together in the break room and started eating, we began a good meeting, but then customers begin arriving for their afternoon appointments. We had to call the meeting to an end without getting through very much of our agenda, but we agreed to continue the meeting the following week. Turns out, we never did meet again about the seminar.

“But we were still pretty motivated from the out of town trip to the seminar and, as I recall, we had one of our best months ever. It’s my job to clean the break room and, after a few months, I noticed that the binders of information we received at the seminar were never opened; so I stored them for future reference. Now it is almost a year later, and everything is pretty much back to the way it was before we went to the seminar. Some of us are a little burned out and I don’t think we ever did implement anything from that seminar.”

Sound familiar?

I bet it does. I have seen it play out almost exactly the same way countless times. Starting, and not following through. No management and marketing system is set up, and no time scheduled to ensure the system is followed, and no lasting improvement is realized.

And I am sure, for most of us, this phenomenon applies to our personal lives as well. For instance, how is your exercise program coming along? Hmm? You’ve set goals to work out more often and eat better, right? To work ON your body, not just in it. Yet, my guess is it’s been pretty hit and miss.

We want to improve, we make improvement goals, but what happens? Why can’t we achieve them? Consistently. Is it that we’re all too busy? Too lazy? There seems to be no solution, so we accept our condition and do our best.

Yet, there IS a solution, and it’ll seem like science fiction—but, it’s actually a science fact.

The Goal Driven System of Business Development covers 20 Big Shifts, or actual office adjustments, that need to be made to reach your goals — and stay there. It takes you out of the Practice Roller Coaster that forces you to finally “settle” and accept a lower level of success because the stress of the ups and downs becomes too much.

Here’s how to get the most out of seminars from The Goal Driven Business.

goals lab goaldriven.com “BIG SHIFT #1: Introducing the Goals Lab
You can’t improve your car while you’re speeding down the freeway. You must take it to a mechanic at a garage. Athletes and musicians alike spend time away from their audience to practice their game skills or their music, always improving their performance. Businesses need to do this as well. But where? And when?

 

The answer is you need to create a Goals Lab where you go to work on your business.

Your Goals Lab is a special place, a laboratory, an oasis for change. Here, you can think, study, learn, practice, become inspired, and have conversations. Here is where you go to reset your thinking and improve your actions—and the actions of others in your office as well.

I call it the Goals Lab, but you can give it another title, if you wish. Whatever you call it, this is the first Big Shift you’ll take on your journey to achieving your new goals.

Goals Lab to engineer your best route to your goals, Goalddriven.com

Why do you need a Goals Lab? Because you simply cannot focus on the other Big Shifts when you are in your office, juggling customers, staff, bills, phone calls, emails, vendors, and everything else that consumes your energy and brainpower.

Management companies and consultants may have advised you to work on your business, not just in it. While the idea of working on your business, as opposed to in it, is a clever and useful concept, I have rarely seen it applied consistently or comprehensively. Why? Because real business improvement can be more demanding than meets the eye. It is a separate activity that requires its own distinct time and place, and it has its own rules which must be followed to be effective.

I use the term Goals Lab because it is a virtual location that you visit to improve business performance. As an example, you spend most of your time with your car driving it. But you also take time to take your car to a special place where you let a mechanic work on it.

Not knowing about this place, this Goals Lab, its rules, and how it operates, is a fundamental reason why all your management books, marketing manuals, and practice improvement notes from seminars rarely get implemented.

Your Goals Lab has been mostly hidden from you. It almost has a fourth-dimensional location, which is outside the time and space continuum.”

Why don’t we spend more time on improving the business, not just working in it?

This is the real question, and it is answered in the book, The Goal Driven Business. You can read about it now, or wait for my next article where I explain WHY business improvement is so difficult and what to do about it.

Meanwhile, keep improving.

Ed

Learn more about book and get it here: https://www.GoalDriven.com

the goal driven business by edward petty

Key Updates and Workarounds For the New ICD-10 Codes That Impact Your Office.

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icd-10, key updates for 2022Dear Chiropractors and Staff:

Are you having issues with not getting reimbursed due to the new ICD-10 codes and the deleted low back code? Having difficulty getting reimbursed from Humana and BCBS due to precertification requirements and other crazy denial codes?

Please read below where I provide you three key updates to the ICD-10 Codes and some workarounds that are of interest to your revenue cycle.

UPDATES: ICD-10 code Changes relevant to chiropractic

1. Deleted code: M54.5 low back pain.

2. NEW codes to replace the above deleted code include:
• M54.50 Low back pain, unspecified
• M54.51 Vertebrogenic low back pain
• M54.59 Other low back pain

3. Other Chiropractic-Relevant New codes added:
• M45.A0: Non-radiographic axial spondyloarthritis of unspecified sites in spine
• M45.A1 : Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region
• M45.A2 : Non-radiographic axial spondyloarthritis of cervical region
• M45.A3 : Non-radiographic axial spondyloarthritis of cervicothoracic region
• M45.A4 : Non-radiographic axial spondyloarthritis of thoracic region
• M45.A5 : Non-radiographic axial spondyloarthritis of thoracolumbar region
• M45.A6 : Non-radiographic axial spondyloarthritis of lumbar region
• M45.A7 : Non-radiographic axial spondyloarthritis of lumbosacral region
• M45.A8 : Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region
• M45.AB : Non-radiographic axial spondyloarthritis of multiple sites in spine

NEW Cough codes:
• R05.1:Acute cough
• R05.2: Subacute cough
• R05.3: Chronic cough
• R05.4: Cough syncope
• R05.8: Other specified cough
• R05.9: Cough, unspecified

WORKAROUNDS
If you have claims to send (hopefully only a few) with DOS prior to October 1, with low back pain diagnoses, what should you do to ensure they do not reject by the clearinghouse and payer for adjudication? Your clearinghouse should, by now, be updated to include accepting claims with the old M54.5 code IF the DOS is prior to 10/1/2021. The commercial payer claims adjudication systems should also be updated now to accept claims prior to 10/1/2021 DOS if you billed with the old M54.5 code. Please make sure to get any outstanding claims with DOS prior to 10/1 submitted as soon as possible, if you have not already. If you only have a few claims going to commercial, you also have the option of sending these on paper instead of through your clearinghouse. Do not do both.

State Medicaid programs and Medicare will still require the use of the M99 codes for billing, so continue using those codes for these claims.

HUMANA is requiring pre-authorizations on all chiropractic therapy codes. The latest news is that starting in January, there will now be three entities that will be doing the pre-authorizations. a. Optum, b. Humana itself, or c. A new vendor, Cohere Health. Humana has advised us that the entity will be selected based on the patient’s policy.

When you verify a patient’s benefits you will need to make sure to ask:
if preauthorization on your therapy/rehab codes is required on the member’s policy,
which entity will be preauthorizing/reviewing,
and the process to follow when requesting services requiring preauthorization.

Not getting paid by BCBS, with crazy denial codes? No one at BCBS to help? You’re not alone. Offices across the country are experiencing this. So what can you do at this point? First, do a claims audit on your BCBS claims. Do you have the GP modifier attached? Is preauthorization on therapies required on the patient’s plan using AIM Specialty Health?

Your other option is to ask the patient to call into BCBS and advise that claims are being denied even though they have been billed out correctly. We do have scripting available to help your patients with the communication. Click here and request more information.

Questions? We’re here to help!

Lisa Barnett
PH: 920-459-8500
Email: lisa@pmaworks.com

“Increasing your collections through better billing and documentation”

The Mental Immune System

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mental health, immune system, goaldriven.com

A healthy body has a well-functioning system to protect it or make it physically immune from disease. I am sure you have seen this occur with your patients as you adjust and treat them.

But there is no doubt that the mind also affects the body. In your practice, could you improve your patient’s mental immune system? Of course, and already do. I am sure you bolster your patient’s mental immune system even though you or your team may not have looked at it this way. Providing your patients with genuine positive feedback and showing them gratitude for their regular visits can go a long way in enhancing their mental well-being.

A mental immunity system would help individuals be protected, or immune, from negative influences or circumstances in the environment. This would be the ability to “roll with the punches” and keep one’s stress level low despite potentially stressful situations. You can’t be expected to help your patients achieve this in all areas of life, but you can help them with this regarding their health.

Your patients and clients are under a constant deluge of frightening and drug-related messages that can be demoralizing and lead them to less than optimum health choices. There is not much incentive for large corporations to promote exercise, eat organic food, take vitamins, and encourage people to be nice to their neighbors. Instead, there is more money in promoting drugs and fast food, and beer. It took a long time and great expense to stop cigarette advertising, but pharmaceutical advertising has now taken its place.

So, it is for this reason I recommend positive health advertising to your patients regularly. The more they know and understand how to maintain their physical health, the better prepared they will be to critically interpret the corporate advertising of products masquerading as “healthy.”

Here are some methods to improve your patient’s mental immune system regarding health:

  • Extraordinary customer service. Through empathic communication, get to know your patients so that they know you care about them and can trust you. You are in their corner and have their “back.”
  • Positive reinforcement. Genuinely recognize their good efforts to improve their health and any positive responses to your program of care.
  • Table Talk. Listen to their stories and provide quick positive educational tips about health related to their story.
  • Educational themes. Pick an educational them each week and have literature for patients.
  • Patient successes. You can include notable case successes with your education themes each week or each month. Spread the good news!
  • Lending Library. Stock your book shelves with books on subjects you would like your patients to read. Encourage your patients and staff to study. (See a sample list of books we selected a few years ago over at pmaworks.com.)
  • Workshops. These can be done virtually or in person.
  • Newsletters. These can be electronic as well as hard copies by snail mail. They help “keep the conversation going.”

You are the positive lighthouse of health in a storm of gloom and unhealthy corporate products. You can improve the physical immune system of your patients by also improving their mental immune system regarding health.

Ed

the goal driven business by edward petty

buy the goal driven business by edward petty

Image from: Kellogg, Yevgenia Nayberg

KINDNESS and the Strength of Your Practice

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

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

I have used this definition for ages.

Customers, potential patients, and clients, seek you first and foremost for your services and results. This could be relief from a troubling condition, or perhaps general wellness care. Therefore, in marketing, you want to promote that you can deliver the outcomes people are looking for, and prove that you can produce them. There are many ways to do this, but this is the basis of direct marketing.

Next to results, your patient wants to be understood. They know that no matter how competent you are, unless you really understand their condition, you may be applying the wrong remedy. Plus, you may come across like you really don’t care. You show how much you care by seeking to fully understand how they feel about their condition. This is called deep empathetic communication – feeling how the other person feels.

I think just being genuinely interested in the other person brings about this kind of communication and feeling on the part of the patient that you do care.

This type of communication determines the quality of the relationship. But I believe that it can go deeper. Let’s look…

KINDNESS

Kindness is more than empathy.

It acknowledges not just how the other person feels, but in fact, that the other person is privately fighting their own personal battle.

Every one of your patients is suffering — to a greater or lesser degree — though they may not fully confess it. Yes, people are tough. They must be. But when they see you, they hope that you will understand their struggles, their fears and their challenges.

There are many ways you can let them know that you grasp their situation. Most of all, seeking to understand their feelings and letting them know you, now, have a better sense of what they are talking about is sufficient. You can repeat some of what they said to emphasize that you heard and understood them. You can let them know you have experienced something similar, if you have, and sometimes, as appropriate, touching them on the shoulder compassionately can go a long way.

But there is no gimmick that expresses kindness – it is just deep human empathy.

Kindness doesn’t cost you anything, except a few moments of present time consciousness and mindfulness. Yet it strengthens trust, alleviates fear, and can help your patient improve faster.

You want to be a positive coach. But in the beginning, all your advice, adjustments and treatments, education, scheduling, and payments, must be based upon the trust you earn from your patient simply through your empathy and kindness.

Patients will seek you for your services, but they will stay with you because of their relationship with you.

Deliver excellent outcomes and promote them, initiate and maintain empathetic communication, and be kind. Include these as your goals in your mission, core values, and complete outcomes and see your practice and business grow.

Edward Petty

“…in the world, what counts more than talent, what counts more than energy or concentration or commitment, or anything else – is kindness. And the more in the world that you encounter kindness and cheerfulness … the better the world always is. And all the big words: virtue, justice, truth – are dwarfed by the greatness of kindness.”

Stephen Fry (azquotes.com)

Download PDF copy

How To Develop Your Niche for Greater Profit and Better Care

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Develop Your Niche for Greater Profit and Better Care with goaldriven.com

You can try to sell ice water to Eskimos or sandbags to desert dwellers, but you would go broke.

You need to offer your services to those specific people who would want them. The more you do this, and the better you do this, the larger your customer volume will be and the more profitable your business will become.

So, what is your market? Who are those people who want to see you or are looking for what you have to offer?

It is people who want to relieve a health issue more naturally.

And this market is growing and certainly becoming more motivated.

You wouldn’t think it, though. The media would have you believe that everyone is spending their time in drug stores, behind masks, maintaining social distancing.
The governmental “agencies,” looking out for us, are warning us about new “variants” that are “surging.” But, what is apparent is what is NOT talked about!

What is that you ask? Oh, that would be Health!

Do you hear them talk about better food, more exercise, more sunshine, better nutritional support, or natural health care services? How about proven medicines already in the public domain? I don’t think so.

Why not? Well, I don’t know, it might have something to do with …money.

This may not seem marketing-related, but I think that it is essential to examine the environment that your market is dealing with. The people who want natural solutions to their health issues, those that you want to reach out to, find themselves in a sea of conflicting, even frightening, messages.

We can look at the ongoing debacle in Afghanistan. Scared civilians falling out of airplanes after we spent over two trillion dollars and the lives of 47,000 civilians over in Afghanistan. Why? Well, money. (1)

Was the “war” a failure? Not for the stock market, especially for Lockheed Martin, whose stocks increased 1,236 percent since 2001. Other weapons companies like Raytheon, Boeing, Northrop Grumman, and others all saw their stock climb. (2) So, the Afghan war was a success – for these companies and their CEO’s and stockholders. Selling the idea of stopping terrorists was a profitable campaign – for some.

Could there be a parallel scenario with drug companies? Could the government be working at the behest of another industry besides the Military-Industrial Complex? Well, for its COVID vaccine alone, Pfizer expects to generate 33 billion this year. (3)

In both cases, it was the marketing use of FEAR that justified enormous changes in our lives. Fear of terrorists, fear of a virus.

But here’s the thing: You can scare all the people some of the time, and some of the people all the time, but you cannot scare all the people all of the time.

There is a large percentage of the population that want better health naturally and do not necessarily buy into fear-based propaganda. In fact, the constant omission of health solutions amidst the drumming for drug solutions may just motivate health-oriented people to more staunchly pursue better health!

Look at the sales of organic food. As you can see from the graph below, organic food sales have been on a steep uptrend. Sales of organic food were 16 billion in 1999, and has been rising continuously, reaching 106 billion in 2019. (4)

And here is a more recent chart of health supplements and their expected rate of growth (5):

These consumers want better health. They don’t want poison. Big Tobacco was clever with its marketing strategy and fought hard, but it eventually lost. Monsanto (Bayer) has worked every angle, but it too is slowly losing its fight to keep Roundup, which contains a cancer-causing chemical called glyphosate, in the marketplace.

Though not broadly promoted, Big Pharma companies have been fined billions for their illegal activities, including killing people (Merck, Vioxx).

Your market is right there, with you. They may not all be speaking out, but they know, or at least sense, that something is not right. And, they want better health.

Almost every office we work with has been seeing their numbers rise over the last year or two. Why? I want to think our coaching and new systems have something to do with it, but the fact is, your market is hungry for trustworthy health solutions and providers.

You don’t have to froth at the mouth against Big Pharma, but you certainly can stand up for natural health. This is your province. You own it, and always have. So let your community know that you are on their side for health, natural and wholesome, without additives. Peer reviewed for thousands of years!

They are looking for you. Just let them know where you are, who you are, and what you can do for them. (You can also add, WHY you do what you do!)

Here are few steps to better engage your niche – and help more people:

  1. Position yourself as a natural healthcare office, clinic, or facility. “See us to feel better and be healthier — naturally!”
  2. Celebrate your patient and client successes. Be happy with your patients. They may underappreciate their health successes. Most do, in fact. Be their cheerleader and give them positive, but genuine, support for their health improvements.
  3. Get their OK, in fact encourage them, to Share the Care.
    1. Patient testimonials published on all media – website, social platforms, even YouTube.
    2. A homemade monthly newsletter from you.
    3. Case histories you talk about
    4. Staff successes! Patients look at how cool the office is. If the team says it’s great, well, it probably is!
  4. Take time to study your market and the environment it is dealing with. Yes, this will take time. But you are a professional and a leader. To educate others, you need to be educated yourself. Study the science, get the verifiable stats, the first-hand reports of others, and draw your conclusions. No one is sitting out this game. You need to be prepared.

There are many different methods you can use to tell people where you are, who you are, and what you can do for them. But know that they are out there, people who want healthier solutions to their health issues. This is your niche.

And they are looking for you right now.

Seize the week and help more people.

Ed

 

And buy my book – The Goal Driven Business. Read and use it. It will help take you to your next several levels!

Download the PDF [HERE]

What is an Adjustment

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B.J. Palmer

What is an Adjustment by B.J. Palmer

An adjustment (“setment”) is one if not THE most exact in operation in the world; greater by far than ripping out an appendix, etc. It requires that “intuitive” sense of direction, proportion, distance, and ability to deliver just that and all that, and nothing more; a sense of fitness to do this one thing, which few seem to possess, which can be acquired if one is willing to pay the price in thought, study, development of mind and body.

I have spent 40 years to do what I can do today. The “follow thru” of an adjustment IS IMPORTANT, but not nearly as important as “the approach.” If the “approach” is natural, easy, perfectly timed and distanced, then follow-thru is The sportsmanship of adjusting subluxations is no different than the perfection in tennis football, baseball, or any sport where ONE gets this top, MANY drag behind, and MANY are way down at the tail of human endeavor.

The MIND thinks all action. As the MIND understands, the muscles deliver. I will spend no less than ONE HOUR studying a DISlocation before I adjust it. WHY? The mind THINKS all action, and the MUSCLES deliver. The more the MIND knows, the better will be the delivery of MUSCLES. I had a child-like that recently — 6 months old — a DISlocation to correct. It was done in a split fraction of a second. When your muscles come through, THEN they haven’t time to think action. Action must be formed IN THE MIND ahead of time.

(Page 844, Up From Below the Bottom, B. J. Palmer, 1950)

PDF Version for downloading: What is an adjustment by B. J. Palmer

The Future Belongs to the Best

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Time spent on business improvement projects in your "Goals Lab," or during down time. From GoalDriven.com (c)2021

A few years ago, a staff member at an I office visited confided in me and told me the following story:

“Our office was really slowing down last year. So, the doctor decided to take everyone out of town to a weekend practice management seminar. The speakers discussed really cool methods for doing our work. It was fun and we learned a lot. Plus, we also went over some great marketing ideas. We were all pretty excited when we returned to work after the weekend.

“On Monday, we agreed to get together at lunch to discuss how to implement what we learned. Some staff members were still dealing with patients, so our lunch meeting started 30 minutes late. Once we finally got together in the break room and started eating, we began a good meeting. We were interrupted with a few phone calls, and some patients started arriving early for their afternoon appointments. We had to cut the meeting short and didn’t get to discuss much of topics of the seminar, but we agreed to continue the meeting the following week.

“As it turned out, something always came up each week and… we never did meet again about the seminar.

“But we were still pretty pumped from the seminar and we had one of our best months ever. It was my job to clean the break room and, after a few months, I noticed that the binders of information we received at the seminar were still on the break room table, never opened. I stored them away for future reference.

“Now it is almost a year later, and everything is pretty much back to the way it was before we went to the seminar. The numbers are back down, some of us are a little burned out, and I don’t think we ever did implement anything from that seminar.”

—

Sound familiar?

I bet it does. I have seen it play out almost the same way countless times.

We are in the improvement business. We help people improve their health. We should be able to do the same for our business and for each other. In fact, if you are not constantly improving, your patients will seek practices that are.

In this new decade, apart from the many new events and changing tides of culture, technology, and mega-corporate influence, your future success is up to you. And it will be primarily based on the quality of your service and your outcomes – the experience your customers receive.

A report from a survey by Microsoft underlines this:

“As customer expectations continue to climb, it becomes more challenging for brands to set themselves apart from the competition. Markets are increasingly crowded, and both price and product are being steadily overtaken by customer experience as the number one brand differentiator” (Microsoft 2018, State of Global Customer Service Report).

More than any other short-term marketing tactics you may be using, only the best offices will thrive in the long run. And those will be the offices that are working on consistent improvement. Mediocrity could get you by in the past. But now, the future belongs only to the best.

But I have noticed that most offices just do not spend enough time consistently on improving their performance. After studying this for some time, I have observed a number of obvious and even hidden barriers that prevent us from working on improvement. I will explain what these are in a later article, but the following steps can help you ensure that you work ON your business to improve it, not just work IN it.

Your Improvement Clinic – Your Goals Lab

  1. Time spent on improvement doesn’t cost. It pays! Some business owners are concerned that time spent on improving the business or staff is too costly. It can be if the training or planning is poorly done. But remember that:
    a. Better team efficiency generates better revenue.
    b. Better trained and focused team members generate better revenue.
    c. Better outcomes generate better revenue.
  2. Head Coach. As the owner and CEO, you are also the Head Coach. How your team does – the business – is in large part based upon your coaching.
  3. Give it a name. In my new book, The Goal Driven Business (to be launched on July 4th of this year), I use the term Goals Lab as it is a location where you can go to work on getting to your goals faster. It could be your breakroom, a restaurant, a park, the reception area – anywhere really. You can call it your Practice Field, Improvement Dojo, or Mystic Garden! Just consider it a place and time that is separate from your time with patients.
  4. What gets done.
    a. Team meetings for communication, review, coordination, and planning.
    b. Team training and practice.
    c. One-on-one training and practice.
    d. Personal training, study, meditation.
  5. Schedule these routinely – weekly, monthly, quarterly, and as needed.
  6. No interruptions, no calls, 100% attention present.
  7. Be challenging. You don’t get better unless you question what you have been doing to see how it could be better.
  8. Go over this with your team. Let them know that they, too, are coaches. And players as well. So, improvement is a team activity, one that requires responsibility and professional discipline.

Your car mechanic can’t work on your car when you are driving it down the freeway. You can’t see patients while they are driving their forklift at work or cooking dinner for their kids at home. You need a separate time and place dedicated to work on improvement.

Your goal is to create an expert office that generates expert results and gives your patients the best experience they can receive from any other comparable health care business.

Imagine your business being so good that patients not only drive in from across town, or even across the state, but fly in from all across the country to receive your services. Imagine that there is such a demand for your care that you even build a motel next to your facility to accommodate the out-of-towners.

Well, there was a Doctor of Chiropractic who was just that good. His name was Clarence Gonstead. His advice?

“Practice. Practice. Practice. Never stop.”

Ed

Ed Petty - author

What Do You Think of When The Phone Rings?

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This New Year has reminded us of a powerful fundamental principle in practice management and marketing.

It started with an office out West. 2020 was a bad year for them. There was COVID, of course, but there had also been repeated staff turnover and other issues. A once busy office in an upscale mall, it had seen better days. The doctor, staff, and I just could not find a way to get the office going like it once was. New patients had decreased to a trickle. We tried one thing and then another – nothing worked. With little fanfare, sometime in late fall, the lead doctor finally resolved a long-term personal challenge that had been haunting him for years. Not much seem to change in the office, but when I got the numbers for January and plotted them, they were literally off the chart. Somehow, doing nothing really that different, the office saw its highest number of new patients since it began, over 20 years ago.

Just last week, we had another reminder. Over in another part of the country, an office had been struggling with some recent procedural changes, and December and January (last month) saw its lowest new patient numbers in years. Ordinarily a high volume two doctor office, the first week of February wasn’t looking any better. We got together on a conference call to sort things out. Then, the team got together for a comprehensive meeting with doctors and staff and worked out confusions and log jams, focused on the mission and its WHY. Just a few days ago, the second week of February, they reported their highest number of new patients in months.

What does this tell us?

A few years back I wrote an article that I think explains this phenomenon.

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

What Do You Think About
When the Phone Rings?

You are sitting there, trying to finish your notes. You hear your phone ring. You are a bit behind. Maybe slightly irritated by an arbitrary denial of an insurance company and you haven’t yet planned out tonight’s evening with the family, spouse, or friend.

The phone rings again.

What are your thoughts? What are your feelings?

Do you kinda wish it wouldn’t ring? Is it a bit of an interruption? Do-you-just-want-to-answer- the – dang-phone-to-stop-the-ringing-so-you-can-get-back-to-your-work?

Essentially, your thought is “Stop.” It is: “Don’t call me.” “Phone, don’t ring, don’t interrupt me!” I am sure this has happened to you – even if ever so slightly or subconsciously.

Now, imagine if your front desk has these thoughts when the phone rings?

To some degree, even the most devoted and hard-working staff can reactively feel put upon by phone calls. Or, in fact, by walk-ins. Or, in fact, by any patient encounter. I have seen this happen on the front desk when the doctor was busy with patients. But remember, this can happen with even the most ethical team member, including you! I have seen doctors do this often. (Extreme examples: “Oh, only two patients coming in on Saturday, go ahead reschedule them. It is MY office, and I can do what I want.”)

Our thoughts can and do determine our behavior and affect how we treat others. Our environment mirrors our thoughts.

Going back to your front desk, realize that the staff on the front desk have tremendous control over the office, nearly as much as the doctor does. The front desk can be a magnet for your patients and attract or repel them.

When the phone rings, you want your front desk, and all staff, including yourself, thinking “YES.” “Call me. Phone – ring now!” “I can hardly wait to talk to this person and see how they are. I am interested in them and how they are doing. I want to help get them to come in for care — and their family too.” “They must be really really cool and nice if they are calling us.” “I WANT to know more about them.” “I am grateful for their call and appreciate the effort they made in calling us.”

These are good thoughts. These are positive thoughts that can help bring in more patients.

You can practice this with your staff at a team meeting.

For example, someone acts as the prospective patient calling. The person acting as the front desk assistant should answer the phone with the attitude of really not wanting to talk to the person. Act it up. This can be funny. Try it a few times.

Then, do the same rehearsal with the front desk assistant positively anticipating the phone call, wanting the phone to ring, and then eagerly answering and talking to the prospective patient.

Keep the role-playing brief. You can and should do it again. It should be fun and act as a reminder to one and all that we should want to meet new people, talk to existing patients, and look forward to phone calls. We can always dismiss the occasional telemarketer or wrong number.
This can also be rehearsed in other types of patient encounters, from taking the new patient back to the exam room, sitting down to do a financial consultation, or checking a patient out and collecting their payments.

And speaking of how our environment does mirror us, here is a little trick you can use. Get a real mirror, about 4 inches by 4 inches, and put it at the front desk counter so that the team member can see it. You can write something on it like: “Are My Teeth Showing?” “Am I Smiling?” And staff, you can also put one of these in your doctor’s office on any day that he is feeling grumpy. It applies to us all.

So, the next time the phone rings, smile. Be interested and curious in who is taking the time to call. Make your thoughts happy so they help create an office that is brilliant, colorful, and full of happy patients.

Ed

The Morale Virus: What doctors say and how they are combating it

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Over the last few months, I have been noticing a particular phenomenon in offices that I don’t think I have seen before… maybe ever. It is like noticing a slight hand tremor that you never knew you had or a buzzing sound from outside that has become increasingly loud and annoying.

2020 was a long year, a stressful one. And you all have been in the thick of it. Daily, seeing more people in one day than most providers see in a week – or more.

My old football coach, Johnny Pappa from Davis, made a big impression on me as a young freshman when he said: “When the going gets tough, the tough get going.” In my then youthful life, I had never heard such profound words. They still apply – especially to you. You are tough!

But stoicism has its limits. The cognitive dissonance can finally get to you.

One doctor expressed to me extreme frustration about two young and very healthy patients, who exercised, got adjusted, ate well, took their vitamins, but decided to discontinue taking their outdoor walks for fear of COVID.

Another doctor, venting his dismay, told me that he couldn’t bear to watch the medical bureaucrats talk about masking and vaccinations as the only remedies to COVID when he knew of so many methods that have been demonstrated to ameliorate the virus. “People are frightened and told to stay at home, don’t socialize, wear a mask if you go out, and wait for the vaccine. That’s it? That’s all you got for people? This really shuts people down.”

One doctor I talked to who, after dealing with depressed and suicidal patients, many of them vets, has become depressed himself. Another wonders what the hell is happening to our chiropractic colleges – have they all been taken over by medical bureaucrats? Is chiropractic finally squashed?

Your good nature can become frayed, your patience worn thin, and regardless of your professional composure and your disciplined countenance, the stresses can have an affect. I mention this because most of you are tough as nails – you have successfully dealt with many types of stressful situations in the past, as a doctor, professional, and for many of you, a business owner.

Morale Virus

So if you are feeling a bit off, recognize that you might be affected by a contagious “Morale Virus.” The Morale Virus is what I call the social sickness that occurs as an emotional response to continual fear-baiting. Frightened, your patients are told they can’t do this and shouldn’t do that.

The Morale Virus is not caused by hardship itself. It is caused when you are pushed into a corner and given no way to fight back. You tend to give up. (Or go stark raving mad!) (Reminds me of the movie, One Flew over the Cuckoo’s Nest when the star, McMurphy (Jack Nicholson), says: “You guys complain how much you hate it here, and then don’t even have the guts to leave! You’re all crazy!”)

There has been a constant assault of bad news emanating from officials and authorities. Yes, and I know the media plays a part — it is mostly owned and controlled by just a few rich people and corporations who have their own agenda — namely, more money. But still – no one buys boring newspapers. Sensation sells the news, and we, the consumers, buy it. We listen and read the “news” that riles us up and confirms our bias. Social media does the same, times ten.

Dirty Laundry (Song by Don Henley) 

I make my living off the evening news
Just give me something, something I can use

People love it when you lose. They love dirty laundry
We got the bubble-headed bleach-blonde who comes on at five

She can tell you about the plane crash with a gleam in her eye
It’s interesting when people die, give us dirty laundry

Morale Virus Disinfectant

Here are some ideas on how you can fight back, disinfect your office from this disease, and better help your patients regain their spirit of hope, kindness, and free enterprise. And yours as well.

Good Vibe Year

One doctor we work with likes to anchor her practice around a yearly theme. For 2021, she is calling 2021 the year of Good Vibes and has events planned to support this philosophy. And just to reinforce the idea, she has T-Shirts made that say Good Vibes. (And by the way, she has a bustling two-doctor office.)

Study. Acquire More Knowledge. Teach

Fear is often a byproduct of lack of knowledge – so arm yourself with the facts.

For example: Roommate 1: “Oh my god! (A panic shout is heard.) The television isn’t working and the game is on. What will we do?” (Drama ensues.) Roommate 2:(Calmly) “Check the remote for new batteries.”  Roommate 1: “Ah, that fixed it, thanks.”

Study, use critical thinking, avoid bias – your own and others. Go to the sources – research studies and from people who are actually working on what you are studying. Then, please educate your patients and clients on how to be happier and healthier. And educate your team, help them increase their knowledge. Arm them as well. Doctor comes from the Latin to docere – “to show, teach, cause to know.”

Leverage Point

What area in your office, if changed, will produce the most significant effect?

Obviously, first and foremost is the doctor. Each day should be a trip to the playground, the ski slope, the baseball field, the dance floor. Ideally, each day is a fresh opportunity to accept the privilege of helping as many people from suffering as possible, to teach them, and have fun doing so.

In most offices, I would also say it is your front desk. The front desk’s power is so poorly recognized in most offices that at least 20% or more production is lost. A vibrant, aggressively friendly, caring, mission and goal-oriented front desk can and will boost your volume – this week. Front Desk team members may need more support and less admin (billing) duties. They may need a better understanding of the mission and how your office is helping people.

Entrepreneur Harder

During cultural upheavals and shifts, entrepreneur businesses remain and often thrive. New opportunities open up. More established and larger companies are weighed down by dogmatic rituals, have high overhead and many vice presidents, and vast networks of suppliers. Change is difficult. But not for the entrepreneur. Most entrepreneurs are all too “change-happy.” You can adapt, innovate, and overcome quicker than companies who are afraid to or can’t. So what if in-person care classes are out for now? Get everyone on a Zoom class, give them a secret word. Test them when they come in again and if they answer correctly, give them a gift – a bottle of Vitamin D or a lunch at another patient’s business.

Stay Out of the Weeds

One doctor told me that her solution was to “stay out of the weeds.” To stay in her lane and just keep helping people and not get caught up in the storms of controversy. I suggest that this is the best course of action. You want news? Sensational news…? Just listen to your patients and staff and community. But stay on the fairway and don’t get sidetracked, mentally or in real life.

Goals

Stay with your goals. Goals are agreements that you made with yourself, and usually others. If you stay true to them, they will lead you out of the den of the morale sickness. Staying true to your goals is a point of integrity. Your goals are not in the weeds – they are straight ahead. Figure out new and better ways to get there or resurrect old ways that worked. Fall down 7 times, get up 8. Each day and each week — begin with the end in mind.

Your goals are in three categories:

  1. Financial. This includes marketing and production.
  2. Service. Developing individual and team expertise with constant improvement..
  3. Purpose. Your higher purposes, those goals outside of work that are greater than this week and that are most meaningful need to be integrated into your work-life.

The Future is Bright and Roaring!

We have seen harsher times. The past is easily forgotten, and we think we are in the worst of times. Well, the 1918 flu was much worse than COVID. Plus, we were sending our young boys to suffer in horror and die in the trenches in Europe in the Great War. But society prevailed and soon ushered in the Roaring 20’s, a time of economic growth and cultural freedom.

Prepare to roar!

Carpe Deum (Seize the Day)

Ed

Ed Petty - author

This is such an important subject, I encourage you to share it with your team and colleagues:  To print out a hard copy

New Year = Coding Changes.

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As we leave the crazy year of 2020 and enter a fresh 2021, here is a summary of  Coding changes taking place that impacts your clinic operations and bottom line:

I. CPT Code 99201 is being deleted effective 1/1/2021

A. Documentation for CPT Codes 99202 through 99205 will be required using criteria of Medical Decision Making OR Time element to determine the level of coding.

o Medicare requirements remain the same for medical decision-making criteria using P.A.R.T. (Pain, Asymmetry/misalignment, ROM decrease, Tissue tone changes) OR diagnostic imaging with documented report of objective findings.

B. CPT 99211 (re-exam) is not being deleted but not used very frequently, and some payers do not pay chiros for this code. You may still bill 99211 when a CT licensed in history-taking and exams performs a re-exam.

C. The 2021 treatment plan model will be the same as 2020:

o Number 1 documentation priority Medicare is looking for: Goals (time or distance element, for example ADLs or specific exercise)
o Number 2 element = duration of care (for example 24 visits)
o Number 3 element = frequency of care (Example – 2X/week for 12 weeks)

II. Changes to ICD-10 codes relevant in chiropractic

1. The following codes have been Added:

A. Arthritis of temporomandibular joint

i.   M26.641 right
ii.  M26.642 left
iii. M26.643 bilateral
iv. M26.649 unspecified

B. Arthropathy of temporomandibular joint

i.   M26.651 right
ii.  M26.652 left
iii. M26.653 bilateral
iv. M26.659 unspecified

2. Deleted ICD-10 Codes:

A. M92.50, M92.51, and M92.52 deleted. (Juvenile osteochondrosis). Use M92.8 or M92.9 instead
B. R51 (this headache code deleted). Here are two specific codes added, to use instead:

i. R51.0 Headache with orthostatic component, not elsewhere classified
ii. R51.9 Headache, unspecified

III. Medicare 2021 Reimbursement on covered CMT
Please note a significant reduction in reimbursement across the board for select specialty physicians and surgeons. Here is the chiropractic fee schedule:

Referring back to the exam discussion above, you may want to consider raising your E/M code fees. However, be advised insurances will not reimburse at your full fee, and Medicare as well as most Part C plans as of this writing do not pay for exams performed by Doctors of Chiropractic. These charges are patient responsibility.

Questions? We’re here to help!

Call 920-334-4561 or email lisa@pmaworks.com

Cheers!

~Lisa Barnett
Increasing your collections through better billing and documentation.

References:

New Medicare ABN-effective 1/1/2021

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Medicare has released a new ABN which will be implemented starting January 1, 2021.  There are two versions, an English and Spanish version.  Click the link to download now.

ABN English

ABN Spanish

Remember . . .
The ABN is required for your Medicare patients to sign when:

They transition from Active Treatment to Maintenance or Wellness Care.

The ABN is voluntary when:

It functions as your financial policy, and the patient is still on Active Treatment.

GUIDELINES:

  • Do not have the patient sign an ABN at every visit, per CMS.
  • When the patient presents with a new episode/injury, the current signed ABN on file is nullified.
  • When the patient transitions back to maintenance/wellness, have them sign a new ABN.
  • The signed ABN is good for one year.
  • The patient/guardian should be the one to choose between Option A, B, or C, with the staff. explaining what each option entails. This prevents potential doctor liability down the road, i.e., the patient or guardian states to Medicare that they were forced or pressured into choosing a certain option.
  • Use an AT modifier when billing Medicare for Active Treatment (ABN not required).
  • Use a GA modifier if the patient chose the option on the form to bill Medicare, and an ABN is on file. Then the Medicare remits can be forwarded or are crossed over to the Medicare supplement plan for possible payment.
  • Use a GZ modifier when billing Medicare for maintenance/wellness care but an ABN is not on file. (The most common reason is the clinic got busy and missed having the patient sign it).
  • The ABN is not used with Part C/Medicare Replacement plans. Only use for Medicare Part B plans.
  • You may begin using the new ABN in December. The new one will be required as of 1/1/2021.

Questions? I am here to help! Contact me at lisa@pmaworks.com, or call 920-334-4561

Lisa
“Increasing your collections through better billing and documentation”

Wisconsin License Renewal Requirements – 2020

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REMINDER:  Wisconsin License Renewal Credentialing Requirements

*Please Note:  Due to the pandemic, usual and customary continuing education requirements are waived this biennium.   However, even if you did not complete your hours, you still need to renew your license.

A review of the usual requirements follow:

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

Starting now and prior to December 14th, renew online: https://online.drl.wi.gov/UserLogin.aspx

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses

Starting now and prior to December 14th, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticTechnician/CE.aspx

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses

Starting now prior to December 14, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticRadiologicalTechnician/CE.aspx

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

Approved course listings can be found here:
https://dsps.wi.gov/Pages/Professions/Chiropractor/CE.aspx

All licenses (DC, CT, CRT) expire on December 14, 2020, at midnight.

Questions?

Contact Lisa Barnett
PM&A Consultant
920-334-4561

GENERAL MARKETING STRATEGY — December 2020

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marketing for prefessionals Time to prepare for the New Year’s marketing.

But before we leave 2020, here are a few tips to help you round out this crazy year and lay the groundwork for a fresh, New 2021.

For December, work “internally” with your existing network, including your active and inactive patients and your external referral sources. But prepare for external marketing for the New Year now.

INTERNAL

The Team – Your First Line of Marketing
Every member of your office is a marketer – everyone sells health. 2020 has been one heck of a year. Why not acknowledge your staff as Health Hero’s with a pin, a certificate, or plaque, perhaps with a bonus if there are any funds available? You all deserve many “thank you’s.”

Holiday Cards and Letters to your Patients
Send cards and letters to both active and inactive patients. Recognize their good efforts to improve their health during this peculiar year and tell them that you look forward to helping them and their family stay healthy in 2021.

Health Never Takes a Holiday
Post a sign in your office in December that “Health Never Takes a Holiday” and schedule patients through December to January. We have a customizable poster on our Member’s site, and sample posters here.

Keep the Conversation Going.
Send out regular emails to patients. Email is more effective than social media, according to many studies, but social media has its place too. Assign email and social media posting to someone. A simple four-paragraph informal health tip from the doctor shows that you care and help improve your patient’s health. It is better that your patients hear from you than from the local chain store pharmacist.

Poinsettia Giveaway
Some offices have done well by giving away free poinsettias, or another holiday plant, one per family. Include a gift certificate with the plant for family members or friends. (See Member’s site for gift card samples.) Make a special arrangement with your local florist for a discount.

Patient Education
Now, more than ever, provide health tips for your patients to combat the heavy advertising of COVID-related reports. Stress is amplified by a lack of knowledge. Good education can help lessen the fear and help keep your patients stay healthier and happier. Plus, educated patients remain with you longer and refer more. There are many approaches that work, including: table talk, newsletters, whiteboards with “Patient Education Prompters,” and short five-minute weekly video health tips. The more you teach, the more you reach.

Donation Drives
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. There are also other times of the year where donations are welcomed and needed. These can be scheduled throughout the year. Here are some sample donations:

  • Coats for Kids
  • Food for Families
  • Toys for Tots
  • Blood Drive
  • School Supplies
  • Animal Shelter $25 in exchange for first day services.

Also, you can support drives at local churches or gyms. EG “Free first-day services for every donation a member of YMCA makes to the homeless fund.”

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 can assist your patients to help others where they might not otherwise have the opportunity to do so.

EXTERNAL

Show Appreciation to External Referral Sources
Send a Holiday Card to any business or individual outside of your office who referred a patient to you or helped you with your marketing. Make sure you include a card of thanks and perhaps a fruit basket or other small gift. Let them know that you are looking forward to another year working together for better health.

Internet
Review your website with your Internet company. Set up a consultation with someone to review how well it is drawing new visitors. Make plans for improving traffic and conversion for the first three months of 2021.

Sample Plan for Special Events
January. Video series about improving the immune system: 10 Proven Shortcuts to Improving Your Immune System: 15-minute video every Friday. Include guest providers. PROMOTE these.
February. Valentines. Have a Heart gift certificate. Donation Drives.
March. Saint Patrick’s Day – Leprechaun Appreciation Day – A special kid’s day.
April. Earth Day. Community Clean-up Drive. Include external alliances to help.

100’s More Marketing Ideas
For 100’s more marketing ideas that have worked, if you are active with PM&A, go to our Member’s site, www.pmamembers.com. If not, we still have many effective marketing procedures right here on this blog.

Meet with Your Consultant
All offices are different. Some need fast action direct marketing — others benefit most from long term development of their external network. Meet with your consultant to make plans for the first part of 2021.

MARKETING MANAGEMENT

In over thirty years of marketing practices, I have found the following two factors to be the most important:

Someone to Coordinate
It is essential that you delegate someone to coordinate your marketing as a project manager. Too often, marketing does not get done because, well, no one person is responsible. This is a major cause of the Practice Roller Coaster. While your entire office and everyone in it, staff and doctors, have marketing roles, one person aside from the doctor needs to ensure each project and procedure is implemented.

Goals and Attitude
Commitment to your goals and the right attitude undercuts everything. How strong is your desire to fulfill the mission of your office? Does the WHY? of your business enliven you each day, and are you happy about it? (Yahoo! Can’t wait to get to the office to see my next patient!!)

Of all the projects and procedures mentioned and the hundreds not mentioned, your drive to your goals and your attitude about achieving them is the most fundamental component to marketing success. Work and improve on this each day.

Ed Petty

Bonus Article: Health Tips from Mercola.com

Selling the Invisible — Patient Education: An Inexpensive Marketing Procedure with a Big Return

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1

[Link to a checklist of patient education procedures below.]

Educate your patients!

There are so many reasons why — let’s look at a few of them. Then, I will show you how your team can implement your patient education procedures.

1. Selling the Invisible. Unlike buying a refrigerator, your patients are purchasing something they can’t see.

They are receiving a service for which there are no concrete, tangible references for them to judge whether the services were excellent, complete, or long-lasting. Outside of immediate relief from their symptoms, they may wonder if you provided a great service, shortchanged them, or are recommending more than they need.

On the other hand, you know the length, breadth, and depth of what you provide. Virtually, you can see the outcomes, know the measurements, understand the symptoms and know what they point to. But to your patients… it’s all an illusion. They have to trust you and what you say.

Typically, once the symptoms are relieved, many patients believe that the condition is resolved. But through education, your patients can understand how your treatment recommendations are a pathway to fully resolving their condition.

2. Beyond Your Services – Your Patient’s Optimal Health. Beyond your services and the treatment program you suggest, your patients will benefit from general health knowledge. Health is a lifestyle, including exercise and nutrition, but the healthy way of living is distorted by unrelenting drug advertising and propaganda.

Low-fat diets, diet soda, statins and other drugs are still an accepted part of the conventional health model. Pharma is increasingly pouring billions into advertising — $328.6 billion in 2016 from $116 billion in 1997.(1 ) In addition, there are untold sums spent on lobbying your elected officials and paying for their election expenses.

Health reality is being manufactured for corporate profits rather than for personal and family health and longevity. Your patients and neighbors in your community don’t have a chance without your calm teaching of the facts on how to achieve a healthy and long life.

3. Customer Education — From a strictly commercial point of view, other businesses are seeing the advantages of customer education. According to learning industry analyst John Leh, “In a world where customer success increasingly determines overall business success, customer education has become an imperative.”(2)

Studies support the idea that customer education pays off. According to studies by ThinkJar, a customer strategy consultancy, “Customers are thirsty for more information and knowledge.”(3) And a study by Eisingerich and Bell conclude that customer education improves the trust in the company.(4)

Major businesses are investing large sums in educating their customers, and a leading customer education platform, Skilljar announced it has raised $33 million in funding. That is a significant investment! Their goal is to provide tools to companies to better onboard, engage, and retain customers at a large scale.

So if you want healthier patients and a healthier community, and if you would like to generate more profit, simply spend more time educating your patients. It is not that expensive! But as with most value-added programs in a practice, projects rarely start, and when they do, they are abandoned almost as soon as they begin.

To avoid this, use a checklist!!

Download the Patient Education Checklist for some ideas on what you can do to educate your patients. Assign a team member this checklist and give them 1-3 hours per week to work on selected projects and report on them at your meetings. They can take on the role of Patient Education Coordinator and help everyone on your team up their game in patient education.

The more your patients know, the further they (and you) will go.

Ed Petty

1. Consumer Reports, January 14, 2019 
2. Avramescu, Adam. Customer Education: Why Smart Companies Profit by Making Customers Smarter.
3. Interview with Kolsky, Foundoer of ThinkJar. Huffpost, 10/15/2015
4. Andreas B. Eisingerich, Simon J. Bell, February 1, 2008 
Photo from UCLA

Selling the Invisible – a favorite book of mine by Harry Beckwith