Diagnostic procedures are a part of almost every clinic operation today, from those as basic and standard as the physical examination of the patient and X-rays, to specific and higher levels of diagnostics. These can include blood work, nutritional analysis, functional capacity evaluations, musculoskeletal ultrasound, digital analysis of X-ray films, MRI/CT scans, videofluoroscopy, neurological studies and many other procedures.
The general goal of management is to deliver services effectively, efficiently and profitably. Health care is a service business, your patients are your clients, and the treatment and care you provide is your core product. You share common issues with many business: Selling your product (treatment and care), acquiring, maintaining and increasing your client (patient) base, while creating efficiencies within the business (your practice) to increase your profit.
There are two ways to increase profit—decrease expenses or increase revenue. Economy and efficiency help a business decrease expenses, even in a growth mode. Business revenue can be increased by providing services to more clients or by providing more necessary services to existing clients. Diagnostic procedures are another tool, when used appropriately, that can help you accomplish this.
Some factors in the determination of diagnostic services you can provide and how you deliver them within your practice are the specialty and patient volume of your practice, the type of practice structure you have—straight chiropractic, holistic or integrated multi-disciplinary, for example—as well as scope of practice limitations within your state for your specialty or structure. These form the basis of a cost versus benefit analysis for implementation within a practice of a diagnostic procedure or service.
Many practices obtain X-ray films on their patients and can utilize services, at no cost to the clinic, to perform a digital analysis of those films. A service that includes comprehensive biomechanical and pathology reports with AMA Guide Impairment Ratings by Board Certified Radiologists can provide you the documentation to justify additional treatment and, ultimately, better care for your patient. No additional equipment, staff, training or costs are necessary for almost any chiropractor to use this diagnostic procedure.
Blood work and/or nutritional analysis are diagnostic procedures that can be provided within many practices to help uncover hidden systemic problems or imbalances within patients. Many of these, once identified, can be addressed through treatment or supplementation to restore health to the patient. Some additional equipment, training and/or certification may be involved when offering these procedures.
Functional capacity evaluations, musculoskeletal ultrasound studies and neurological testing (nerve conduction studies, Evoked Potentials) are services that are necessary to document patients’ conditions and justify treatment and can be offered within many practices. Testing interpreted by an independent specialist often provides the best benefit and most objective documentation. Necessary equipment falls within the affordability range for many chiropractors; however, extensive training and consistent use are required to maintain proficiency. Additionally, some procedures are time consuming and not an efficient use of time for the chiropractor as technician. Leased equipment, trained technicians and interpretive services are cost-effective solutions available in most areas of the country.
Dedicated facilities offering MRI scans certainly fall on the high end of the cost scale and there are practices and clinic groups that can support such a facility. There would be a reasonable expectation that, for the same patient volume, more patients would be indicated for MRI studies from a practice specializing in accident and injury cases than from a family wellness practice. There are options available in many areas of the country, mobile units and leased time, for example, that would allow a chiropractor to provide MRI services.
Medical necessity should be well substantiated for any diagnostic service you recommend for your patient. This is crucial if you expect to be reimbursed for diagnostic services performed within your practice. Also, beware of any situations that may be construed as kickbacks or payments to you for the referral of your patient.
You can ethically and legally add revenue with diagnostics, improve patient care and provide services to more patients. These are just a few of the diagnostic services you could employ within the management of your practice to obtain that goal.
Ms. Plank has an extensive background in medical and facilities management. Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory. During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology. She is currently the Vice President of Corporate Services for Practice Perfect. Contact her at