Practice Management

Practice Smarter, not Harder!
Practice Management
Written by Mitchell E. Rubin   
Saturday, 15 January 2005 00:14

That Was Then

The old-school way of running a private practice was for doctors to refer patients requiring advanced medical testing or physical therapy services to their colleagues and golfing buddies.  And why not?  Money wasn’t an issue.  Twenty years ago, most doctors were earning six-digit salaries and building up their retirement nest eggs.

Today, business-savvy chiropractors focusing on their future and retirement years will make the smart choice to provide better, more controlled patient care, while taking steps to increase practice revenues and reduce overhead costs—working smarter, not harder, in an effort to grow their practices.  Factors to consider include other medical competition, providing better patient care, creating an additional practice profit center, per patient reimbursement, and future practice trends.

Today’s Competitive Medical Field

Who’s the competition?  In a competitive medical industry, the competition is no longer just the doctor down the street, but the hospitals, medical groups, and freestanding health clinics, such as physical therapy, rehabilitation, and sports medicine centers. In order to aggressively compete with these facilities, chiropractors need to stop referring their patients out for services they can perform in their own offices, where they can oversee the procedures and, more importantly, earn the fees themselves. 

Providing Better Patient Care

By utilizing and working with credible medical service providers that deliver on-site services, private practice chiropractors will gain financially, while improving the care they offer to their patients.

Recent medical breakthroughs in technology allow physicians to conduct, oversee, and grow their practices, utilizing many advanced on-site services, including nerve conduction velocity (NCV) testing, electromyogram (EMG) studies, somatosensory and dermatomal evoked potentials, ultrasound imaging, sleep studies, physical therapy, and magnetic resonance imaging (MRI), to list a few.

Providing patients who require advanced medical testing or physical therapy services with one-stop on-site services not only makes scheduling and receiving services easier for the patient, but also provides that patient with faster testing turn-around times and treatment options. 

Ancillary Services Provide Additional Practice Profit Centers

Health care reimbursements are either going to stay the same or continue to go down and will never be proportionate to the cost of living or the high cost of running a private practice.  Chiropractors who provide ancillary services within the scope of their office will continue to be successful and the doctors who do not will eventually die off, because they won’t be able to afford to stay in practice. 

Maximizing Per Patient Reimbursement

As the expenses of running a medical practice—overhead, staffing, malpractice insurance and marketing—continue to increase, insurance reimbursements have stayed the same or gone down, and the costs of collecting the money have gone way up.

According to the U.S. Department of Labor, Bureau of Labor Statistics, over the past five years, salaries have increased at a rate of one percent per year, which does not cover the cost of living increase, the cost of growing malpractice insurance, or the operating expenses of running a private practice.  Chiropractors who are not looking for new ways to develop their practices by creating an additional profit center and bringing ancillary services on-site are getting eaten up.

For example, in an effort to achieve the same financial result, a chiropractor that does not provide on-site ancillary services may need to treat 100 patients in the same time frame that another doctor, who does utilize ancillary services, treats only 33 patients.  It’s not about getting more patients in your door; it’s about maximizing the reimbursement for the patients you are currently treating.

The Successful Doctor of the Future

Ancillary health care services have always been out there, but they have mostly been based in freestanding centers.  For example: A physical therapy center on the corner.  Before there were surgery centers, patients were only operated on in hospitals.  As chiropractors became more entrepreneurial and looked for additional ways to earn income, surgery and physical therapy centers became more prevalent within the profession.

Chiropractors of the future will utilize hospitals and freestanding centers as little as possible because they will realize that hospitals and health care center operations aren’t their friends any longer—they are the competition.

Mitchell E. Rubin is founder and chief executive officer of VeridianHealth, LLC, which consolidates his diagnostic testing companies—Diagnostic Testing Centers of America (DTCA), ZT Technical Services, LLC, and HTZ Technical Services, Inc.—under one flagship entity, comprising the nation’s top providers of on-site neurological diagnostic testing and physical therapy services for physicians.

VeridianHealth operates within state and federal guidelines, offering a variety of compliance-driven practice models. For more information about VeridianHealth, LLC, call 1-877-837-4342 or visit

How Chiropractic Will Thrive in the 21st Century
Practice Management
Written by Gregg Friedman, DC   
Saturday, 15 January 2005 00:13

"That which is our greatest strength is also our greatest weakness.”  That sounds like a profound quote from some eccentric philosopher.  It’s not.  I just made it up.

But, as far as chiropractic is concerned, I’m convinced it’s the truth. Our offices are full of testimonials from patients who swear that we’ve helped them when no one else had.  Some of these testimonials sound like downright miracles!  So how is that a weakness?

The weakness of chiropractic care

I think it has to do with third party reimbursement.  When someone other than the patient is considering paying for our services, they DARE to ask us to prove that our patient has a problem and that we can actually help them! It’s just not enough anymore for our patients to just tell them how much we’re helping them.  So, now we’re faced with having to prove “medical necessity.” We’re also asked to document like a medical doctor. As a profession, we’ve never been good at that, nor have we really cared!

This is where my story comes in. Several years ago, my bills began to be denied more and more often by insurance companies, because, they said, I did not prove medical necessity.  In addition, the personal injury arena seemed to change right before our eyes.

We just weren’t good at proving that the patient was injured and that what we did had helped.

Toward evidence-based

So, I embarked on a mission.  What I discovered amazed me.  The exam that we all learned in chiropractic college just wasn’t cutting it anymore. As I did more digging, I discovered that we needed to go toward an “evidence-based” model of chiropractic.  We needed to do things in our exams that not only fit with our philosophy, but also were accepted in the medical and scientific community.  Fortunately, I realized that the exam we needed to do was mentioned, in bits and pieces, all over the place.  I found components of the exam in the Health Care Financing Administration’s Evaluation and Management Guidelines, as well as in the AMA Guides to the Evaluation of Permanent Impairment.  Even one of our own, Dr. Arthur C. Croft, discussed the “evidence-based” examination in his Treatment Guidelines for Cervical Acceleration/Deceleration Injuries.  Once I began doing this exam and documenting it the right way, I soon found that my claims were not being denied for lack of medical necessity, my patients were complying more with my treatment recommendations, and they were being sent for IME’s less and less frequently.  The IME thing bugged me so much that I took training and became certified by the American Board of Independent Medical Examiners.  I found out that the IME’s that I’ve seen all these years were bogus.  They did not follow any semblance of objectivity or even an evidence-based exam, and were full of subjective and biased opinions. 

Where does this lead?

There is software and equipment available today to help us demonstrate the efficacy of chiropractic care.  No matter how we may want to treat our patients, our entire standard of care must revolve around the right kind of objective, evidence-based exam.  If we are to prove to the world that chiropractic is as effective as we say it is, evidence-based chiropractic is the way we must do it.  Our examinations must include scientifically accepted, objective methods that test for changes in function.  We must be able to document these objective, functional findings easily and quickly.  We must be able to do this with honesty, integrity and dignity.

And that is how chiropractic will thrive in the 21st century.

Dr. Gregg Friedman is a graduate of Arizona State University and Los Angeles College of Chiropractic.  He is certified in the treatment of sports injuries, is a Fellow in the International Academy of Clinical Acupuncture and is a Certified Independent Chiropractic Examiner by the American Board of Independent Medical Examiners.  He has been practicing in Scottsdale, Arizona, for more than 17 year.  He teaches the Bulletproof Seminar more than 40 times each year all over the country.  For more information about the Bulletproof Seminar, please visit

How Do You Avoid an On-site Privacy Rule Investigation? COOPERATE!!!
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Tuesday, 14 December 2004 23:14

Ring.… Ring!

You answer the phone and an investigator with Health and Human Services’ (HHS) Office for Civil Rights (OCR) is on the horn. What you say and do during this phone call could mean the difference between a slap on the wrist and a visit from the OCR’s investigators.

First: Answer All Correspondence ASAP: In cases for which OCR suspects an entity of a violation, the enforcement agency will make direct, verbal contact with your organization. Make sure you get in touch with OCR immediately upon receiving their message, advises William Pierce, a spokesperson with HHS. If you receive a message from OCR, contacting them immediately to address the complaint will earn you some good credibility.

Second: Don’t Panic–Just Cooperate: The worst thing you can do if you receive a call from OCR is panic. Sure, it’d be frustrating to receive a call like this; but, remember, OCR knows that sometimes a violation reported by an angry patient really isn’t a privacy rule at all. The agency’s first goal is to determine what violation, if any, occurred.

If a violation did happen, they want to know why. The best thing you can do is answer OCR’s questions as honestly and as fully as possible. After that, OCR will work with you to fix any problems and to ensure that a privacy breach doesn’t occur again. After all, the complaint could’ve arisen from “a simple mistake or error—or it could be a lack of knowledge [about the privacy rule],” says Pierce.

Also, keep in mind that OCR must show “clear cause and motivation” when it submits a complaint to the DOJ. As long as you cooperate with the agency and answer all of the investigator’s questions, you shouldn’t have to worry about any on-site investigations, much less incurring a fine, assures Pierce.

Advice Straight from The Source: Pierce sums up OCR’s enforcement goals with some advice for covered entities: “What [OCR] really wants to do is they want you to know what the rule is—to know what you’re supposed to do—and to implement it. Remember, “The ultimate goal of the privacy rule is to protect an individual patient’s medical record. Everyone shares that goal. Nobody’s working at cross-purposes here,” Pierce says.

Some Real Life Situations

About HIPAA on the Net

Question:  "If a recipient wishes to have results sent to him via e-mail and has signed a consent form for this communication, with the understanding that our office does not encrypt the message, are we still permitted to send this information along to him? Do we have any other responsibilities under HIPAA with regard to this request?”

Answer:  In this type of a situation, it would be advisable to have the patient sign an authorization to disclose protected health information via e-mail, says Laura Scallion, president and CEO of AllSource Technical Solutions, Inc., in Portland, OR. “The authorization should include language that clearly informs the patient that the e-mail is not encrypted and the internet is not secure. If the patient authorizes, it’s permissible to send the results via e-mail,” she notes. These forms should only be given on request, she advises.

The Bottom Line:  You are permitted to send non-encrypted documents containing Patient Health Information (PHI) to patients via e-mail, as long as you first obtain a signed authorization from the patient, explaining that transmissions sent over the internet have vulnerabilities or are not 100% secure.

Can we share?

Question:  “One of our office employees moonlights at a long-term care facility. Under what circumstances can he share PHI with our staff about a patient he cared for at another facility?”

Answer:  Sharing PHI is “not appropriate, unless it’s particularly for treating the patient,” Kirk Nahra, a partner in the D.C. office of Wiley Rein & Fielding, advises. If both facilities have an established treatment relationship with the patient, the employee could provide valuable information that would benefit all parties. However, if he is sharing the information simply because he is aware of it, or for the purposes of gossip, that is inappropriate and violates the patient’s privacy, he says.

If the employee has information about misconduct or abuse of a patient, then he should address those concerns to his supervisor at the facility where the behavior is occurring or, if necessary, to law enforcement. This disclosure is protected under HIPAA’s whistleblower provision.

The Bottom Line:  If your employee is sharing infor-mation about patients for reasons other than treatment, payment or health care operations, that behavior violates HIPAA and must be reported and corrected before it adversely affects your facility. Any whistle blowing should happen internally, unless law enforcement must be involved.

Dr. Eric S. Kaplan is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide.  For more information, call (561) 626-3004.

Maximize your Practice's Potential: Collection Department
Practice Management
Written by Daniel Dahan, D.C.   
Tuesday, 14 December 2004 23:12

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas is being dealt with sequentially in The American Chiropractor.  By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

4. The Collection Department: Where it counts!

The Bottom Line:  Every doctor knows that, even with the most accurate and appropriate billing codes, it is in the collection department where the final decisions are made.  Irrespective of the volume of patients or the type of care rendered, regardless of the location or type of marketing, the monthly collections show the “bottom line” of an office.

Consistency and Organization:  The collection department requires constant attention and detail-orientated information.  Data must be gathered consistently and in an organized fashion.  The information must be logged in by patient account and followed up regularly and consistently.  A good collector needs to be aggressive, but understanding, direct, professional, determined and, especially, focused.

Break It Down:  Account audits need to be done weekly and broken down by alphabets (Part I: A-F; Part II: G-M, etc.)  Each week you should be concentrating on a separate section, to insure a comprehensive and thorough knowledge of where the money is.  The collection department needs to be evaluated by its total efforts; goals need to be set up weekly, monthly, and quarterly.  Bonuses are a must and should be clearly spelled out.  Remember, the “best doctor/office” in the world cannot keep its doors open, unless money keeps coming in.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit

Practice Management Tips
Practice Management
Written by Mark Sanna, D.C.   
Tuesday, 14 December 2004 23:11

Q: What differences did you see in your health growing up as a child in a chiropractic family?

A:  Neither I, nor my two sisters was ever vaccinated, something that was practically unheard of in the 1960’s.  Mom and Dad tell the story of finding a pediatrician who would falsify our paperwork so that it indicated that we had been vaccinated.  He even had to scratch our skin without inoculating us so that we would have the telltale signs of vaccination for the school authorities.  These measures wouldn’t have to be taken today, but it gives a good idea of the attitudes prevalent at the time.

I attribute the fact that I have never suffered from a serious illness, and can’t remember the last time I had a cold or the flu, to the fact that I was never vaccinated and my immune system was allowed to develop naturally.  When we were children, my sisters and I would bounce back from the occasional cold or flu long before the other kids.  While, from a parent’s point of view, having a healthy child is a great thing, having a chiropractic parent meant never being able to use the excuse, “I don’t feel good today,” to get out of going to school!  My parents tell the story of when I got the mumps as a toddler.  Dad woke up and adjusted my feverish body every hour on the hour all night long. By the next morning the mumps were completely gone!  That care plan certainly doesn’t match up with the three visits a week regimen that many chiropractors robotically prescribe today!

Q: What legacy would you like to leave personally and professionally?

A:  I’d like to leave behind a world better off for the contribution chiropractic makes to the health of individuals, communities, societies, nations, and the brotherhood of man.  A world in which children and adults aren’t indiscriminately drugged and where Senior Citizens experience a vibrant quality of life and abundant health until the day they lie down to their final rest.  A world in which it is accepted knowledge that health comes from within and not from outside the body.  A world where men and women respect their bodies and the world they live in, and recognize that the two are inseparably connected. A world in which chiropractic receives the rightful recognition it deserves!

Dr. Mark Sanna is the CEO of Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and multidisciplinary practices throughout the country.  He can be reached at Breakthrough Coaching, LLC, by calling 1-800-7-ADVICE.


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