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Ask the Advisor Q&A with Lisa and Larry
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Written by Larry Goodman, D.C.   
Thursday, 23 September 2010 15:29

Ask the Advisor Q&A with Lisa and Larry

by Larry Goodman, D.C.

 

Q: What can I do to bring more money into my practice?

A: Bringing more money into a practice usually means one of two things, possibly both: increasing the number of patients or increasing reimbursement per visit. If bringing in more patients is the answer, then new marketing programs would be effective. There are marketing programs out there anywhere from $50 to $3,000. There is a marketing program out there that uses the Internet search engines to bring you more patients, which ranges from $50.00 to $200.00 per month. There are also many companies out there that are willing to take you on a small term contract, just remember that when taking on a new vendor negotiate terms on every level. When talking to marketing companies, we feel that they are really quick to try and sell us something. Did you know that there are many companies out there that will do a complimentary marketing analysis? It is always helpful to see your practice through somebody else’s eyes. Allow yourself to get a free marketing analysis and ask what else the company offers.

Reimbursement per visit is usually not the same for every practice. It is important to understand the patients’ diagnosis’ and symptomology while keeping in mind what other services they may need. At the same time, it is important to keep in mind the payer mix that your practice has. There are some questions to ask yourself in order to determine what would enhance revenue for your office. Ask yourself how many types of products and services you send out to other doctors. Are there any of those things that can remain in house? There are a few things that you need to know:

You need to know how many patient visits you are doing a week

Insurance Plans that your patients are on (to make sure you are able to get on those plans)

Have you surveyed your patients to see if they would be able to utilize the services of an MD?


Q: I’m thinking of bringing an MD into my office. What are some things that I need to know before doing this?

A: Be aware of your cash flow. Be prepared to set up a budget, get information and do a cross analysis of how much a doctor is going to cost you. Know the hourly rate for a doctor and include the cost of malpractice insurance, and understand that the doctor will not be paying for him/herself for at lease 90 to 120 days.


Q: How can I cut my overhead without cutting service and efficiency?

A: There are a lot of programs out there that will actually increase efficiency and cut overhead. For example, one of the things that we recommend is an automated phone service that will actually confirm appointments for you. This alone will cut your administrative staff by 20 hours a week. This is also the time to look around your office and track your expenses so that you can try to save some money. Something that might seem very simple like changing a malpractice carrier can actually save you up to 25% to 30% alone.


Q: I am frustrated in my office because I am having a hard time with my collections and my colleagues have suggested that I search for a billing company. What are some of the things to look for in a billing company; they all seem so much alike?

A: First of all, the one question that everyone asks a billing company is what the percentage that they keep is. The percentage is important, but do not get fooled by a low percentage. Low percentage could mean low service. You want to know what the percentage is and if they collect, you have to make sure that they not only bill but they also collect. When you interview billing companies, find out what their appeals process is and if you are able to access that information at any time. Also, ask if they give you anything free, some billing companies will throw in an EMR system at no cost.

 

larry_goodmanDr. Larry Goodman is a chiropractor and a psychologist who has been doing consulting and practice management for 15 years. He also works for the University of Miami. He is also the clinical director of Physicians Choice Concierge, which is a company specializing in revenue enhancement for chiropractors, medical doctors, and multi disciplinary practices across the nation.

Lisa Goldberg is the executive director of Physicians Choice Concierge (PCC) and All Care Consultants.

Dr. Goodman is the lead advisor for PCC, a company specializing in revenue enhancement for chiropractors, medical doctors, and multi disciplinary practices across the nation. All Care Consultants specializes in physician staffing and placement. If you have a question you’d like Lisa and Larry to answer in an upcoming issue, email to: lisa@allcare

 
Editor's Memo
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Written by TAC Staff   
Thursday, 23 September 2010 13:58

You find how to identify and resolve scoliosis much more effectively and thoroughly as well as  many other extreme health challenges! On the cover is Dr. Gary Deutchman and Dr. Marc Lamantia who have written a book called A Home Educators Guide to Scoliosis, which is a book that helps teach parents how to screen their children at home for Scoliosis and Kyphosis. Tracy’s daughter, Marlaina, age 17, can be found on pp. 24-26, where you can read about her first case study with Dr. Dennis Woggon at the St. Cloud Clear Institute! Dr. Woggon is constantly using new techniques and strategies to improve the curve in young and old spines. Sometimes, when not used correctly, chiropractic can actually be contraindicative when Chiropractors have the best of intentions. Othertimes, Scoliosis and all health challenges take a lot of continued care and oftentimes many different techniques used together are the best solution! For this reason, in the next issue, TAC will also have some candid pictures of our visit to NY to see Dr. Deutchman and Dr. Lamantia, at Scoliosis Systems, who will be fitting Marlaina with a SpineCor Brace to further improve and stabilize the curve in her back between visits to see Dr. Woggon. See the fun pictures below of Marlaina and Tracy’s trip below to MN to see Dr. Woggon, on our second visit and while there we stopped in on Core Products and got an unexpected adventure with Phil Mattison!!

For chiropractic.

Tracy Busch Pate, BA

Managing Editor

Jaclyn Busch Touzard, BA

Executive Editor / This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 
The Scoliosis Care Foundation Calls on the Chiropractic Profession for Help
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Written by TAC Staff   
Thursday, 23 September 2010 13:52

The Scoliosis Care Foundation Calls on the Chiropractic Profession for Help

 

TSCF

Dr. Mark Lamantia (Left) and Dr. Gary Deutchman (Right)

 

THE SCOLIOSIS CARE FOUNDATION IS A recognized 501(c)3 organization dedicated to improving education, treatment and diagnosis of scoliosis. The Foundation is calling upon the chiropractic profession to become more involved with public education programs and is offering materials such as Slide Presentations, screening forms and continuing education opportunities for the treatment of scoliosis. New for 2009, the Foundation has created The Scoliosis Awareness Program. This 90 minute, parent-oriented slide show is available from your Chiropractic State Association, or directly from the scoliosiscare.org website. The Foundation’s Science Advisor, Marc J. Lamantia, D.C., D.A.C.N.B., is currently seeking chiropractors who are interested in becoming regional representatives for the Foundation, as well as assisting in a multi-clinic study to document the chiropractic profession’s ability to co-manage cases, without the need for orthotist/orthopedist intervention. History: Dr. Gary Deutchman founded the SCF in 2001 because of his belief the watch and wait approach to early detection was harming the future well-being of our children. From a clinical standpoint, if chiropractors co-manage cases when curvatures are below 20 degrees (Cobb), “oftentimes we can keep that curvature from worsening and, in most cases, reduce the curvature in a signifi cant manner,” says Deutchman. With nearly 25 years of clinical experience and 10 years of full-time scoliosis care, Dr. Deutchman is confi dent chiropractors are the best providers to manage scoliosis. Currently, Dr. Deutchman co-manages 100% of his cases with other chiropractors in an attempt to offer the most appropriate care possible. Deutchman says, “I know I can offer patients certain aspects of their necessary care, like Spinecor bracing and exercise training, but I co-manage cases with other chiropractors who can offer things I can’t, such as Chiropractic Neurology, weekly chiropractic adjustments, cervical and pelvic realignment, things that need to be done day in and day out.” The Scoliosis Care Foundation is making available the Scoliosis Awareness Program in an attempt to make more families aware that chiropractors can offer comprehensive care to patients with scoliosis. To become more involved with the foundation or to make a donation, visit www.scoliosiscare.org. Doctors interested in becoming regional representative for the Foundation can email their CV’s to This e-mail address is being protected from spambots. You need JavaScript enabled to view it . In the News: The Congress of the Chiropractic State Associations (COCSA) has announced it is adopting the Scoliosis Awareness Program as a National Outreach Project. COCSA’s board of directors voted to join forces with the Scoliosis Care Foundation in offering all chiropractic state associations access to educational materials from the Foundation. Dr. Gary Deutchman, Director and Founder, believes scoliosis is being mismanaged by the current healthcare system. According to the COCSA President, Dr. Jeff Fedorko, “COCSA supports this project because scoliosis curvatures are being missed by school systems that rely solely on the Adams test. Current standards of care do not include chiropractic management, and orthopedic approaches offer few options.” Commonly, children and adolescents diagnosed with scoliosis do not have pain and will only exhibit minor postural changes in the early stages of the condition. This makes better screening procedures essential to early detection. Furthermore, only 26 states currently mandate scoliosis screening in the public schools. According to Dr. Deutchman, “This leaves literally millions of children without adequate screening.” Although scoliosis progression slows after the pubertal growth spurt, curvature progression in adulthood is common. It’s also very common for adults with scoliosis to have chronic pain syndromes, dizzi ness, digestive problems, and early spinal degeneration. Dr. Deutchman and Dr. Lamantia teach CE accredited courses designed to help chiropractors offer better care plans to adults and adolescents with scoliosis. Chiropractors interested in taking these seminars can contact the Foundation to fi nd out when and where sponsored continuing education is available. Currently, both Dr. Lamantia and Dr. Deutchman are Adjunct Faculty at Life West Chiropractic College and New York Chiropractic College. Upcoming seminar dates can be viewed at either Colleges’ website www.lifewest.edu or www.nycc.edu. The Scoliosis Care Foundation is providing. at no charge, an Adobe Acrobat fi le format presentation to all chiropractic state associations to distribute to their membership. The slide presentation is designed for the chiropractor to present to parents in his or her own community. The presentation will help teach parents how to become better observers of their child’s posture. For more information, visit the Scoliosis Care Foundation website at www. scoliosiscare.org or call the Foundation at 1-800-391-8837.

 
Whole Body Vibration and Scoliosis Treatment
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Written by Christian H. Reichardt, D.C.   
Thursday, 23 September 2010 13:46

Whole Body Vibration and Scoliosis Treatment

by Christian H. Reichardt, D.C.

 

OVER THE LAST CENTURY, CHIROPRACTORS HAVE COME UP WITH A variety of protocols for some of the milder forms of scoliosis as well as a number of stabilization therapies to prevent the catastrophic outcomes of severe scoliosis. This article will not concern itself with the discussion of the more severe form of the disorder, nor with the philosophical reasoning of whether chiropractic is the treatment of choice. However, I shall outline how Whole Body Vibration can assist the practitioner in the field and their patients in their efforts to treat scoliosis. Most doctors today agree that sensible Scoliosis treatment protocols are clearly geared towards mobilization, correction and stabilization.

Treatment Concepts

The concave side of the scoliosis pattern typically presents itself with shortened, tight and connective tissue fibers, decreased ROM, osseous fixation and hypo-mobility, often leading to chronic pain. The convex side, alternatively, often presents itself as hyper-mobile, with fi bers which are overstretched and lack integrity or strength, often causing the acute pain cycles. The primary goal of treatment, thus, should be to increase motion fi rst in the fi xated areas, then stabilize the hypermobile areas. Research by Prof. Vladimir Janda, MD, showed that a patient’s awareness of their position in the 3-dimensional room is of great importance in the treatment of musculoskeletal disorders. This falls under the category of proprioceptive training and occurs in the stabilization phase.

Whole Body Vibration (WBV)

Whole Body Vibration is a modality in which a mechanical stimulation is produced by an oscillatory motion of a platform. The user is then placed on the platform. The motion of the platform creates a rapid acceleration/deceleration motion of the body part aligned with the stroke motion of the platform. Any tissue directly in line with the motion of the platform is now exposed to a rapid loading and unloading. This creates a physiologic response in those tissues equivalent to exercising. Basically, WBV produces an adaptive response in tissues and this response is both morphological as well as neurophysiological. Forty years of research has clearly demonstrated that these adaptive responses can be utilized to either loosen tissues by lengthening muscle fi bers or to strengthen muscles. WBV drastically reduces the time required to achieve these physiological outcomes; a proper WBV work out routine requires as little as 12-15 minutes training per ession, at 2 to 3 times per week intervals.

Physics of WBV

The intensity of the vibrations is determined by 3 factors: amplitude, frequency and magnitude of the motion. The height of each movement determines the amplitude, generally expressed in mm. The rate of oscillation per second determines the frequency, which is usually listed as Hertz (Hz); i.e., 10 Hz represent 10 oscillations per second. The rise of each scillation determines the magnitude, typically expressed in g-forces. Most research studies have focused on ranges from 10 to 50 Hz, which is considered low frequency, low amplitude vibration. Mechanical platforms tend to displace anywhere from 3 to 10 mm and produce acceleration factors of 1.8 to 15g, depending on the manufacturer.

WBV and Scoliosis Treatment

A number of doctors around the country have already created specialized protocols incorporating various combinations of WBV, traction and rehab exercises in the treatment of scoliosis.1 As mentioned above, the purpose of scoliosis treatment is to

a) Improve the pliability in the areas which are too rigid

b) Reposition the osseous structures via manipulation.

c) Improve strength and power in the tissues which lack strength.

d) Stabilize the structures, and

e) Improve the patient’s proprioceptive abilities.

WBV can help limbering and loosening tight tissues.

The vibrating impulses stimulate the Golgi tendon apparatus in muscles that have become tight and constricted. This activates a stretch and release reflex similar to the mechanisms used in the PNF (Proprioceptive Neuromuscular Facilitation Technique), resulting in a high measure of muscular relaxation.2 Secondly, WBV helps to strengthen tissues. Vibration stimulates innate muscle spindle activation by increasing the load on the tissue. This rapid continual fi ring is known as the Tonic Vibratory Refl ex. It is regulated via spinal refl ex arc not unlike the Knee Jerk Refl ex. Years of  research of WBV have shown marked improvements in static, dynamic and explosive strength and power.3 Finally, the body responds to Whole.

  1. Clear Institute for treatment of Scoliosis- www. Clear-Institute.org.
  2. A-Acute Effects of Whole-Body Vibration on Lower Body Flexibility and Strength. Patricia A. Burns1; Kristina S. Beekhuizen1,2; Patrick L. Jacobs, FACSM1,2. University of Miami School of Medicine, Miami FL. 2) Miami VA.
  3. Effects of whole-body vibration and pnf stretching on the flexibility and range of movement in elite Australian Rules football players Ben Hinton1, John Quinn2, Michael Newton1, and Michael McGuigan11Edith Cowan University, AU.
  4. WILL WHOLE-BODY VIBRATION TRAINING HELP INCREASE THE RANGE OF MOTION OF THE HAMSTRINGS? ROLAND VAN DEN TILLAAR. Journal of Strength and Conditioning Research, 2006, 20(1), 192–196q 2006 National Strength & Conditioning Association.
  5. Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players. D Cochrane and S Stannard, Massey University, Sport and Exercise, Palmerston North, New Zealand.  Br J Sports Med. 2005 November; 39(11): 860–865. doi: 10.1136/bjsm.2005.01995.
  6. Effect of WBV on musclestrength and propri ception in females with knee osteoarthritis.  Trans T, Aaboe J, Henricksen M, Christensen R, Bliddal H, Lund H.  Clinical Motor Function Laboratory, The Parker Institute, Frederiksberg Hospital, Denmark.
 
How to Relieve a Headache in Seconds on One Patient after Another!
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Written by Dr. Stephen Kaufman, D.C.   
Thursday, 23 September 2010 13:41

How to Relieve a Headache in Seconds on One Patient after Another!

by Dr. Stephen Kaufman, D.C.

 

I HAD A CONSTANT HEADACHE FROM BIRTH UNTIL THE AGE OF TWENTY-THREE, SO I’VE HAD A LIFElong interest in this topic. My mother was also frequently incapacitated with migraines, and died at a young age, possibly of a stroke. (Female migraine sufferers with aura are seven times more likely to have a stroke than women who don’t get migraines.17)

 
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