Practice Management

Practice Management
Written by Mark Sanna, D.C.   
Thursday, 08 July 2004 21:21

Q: What effects have the increase in patients seeking alternative healthcare had on the chiropractic profession?

A:  The chiropractic profession is situated at the pinnacle of the Mount Olympus of the multi-billion dollar complementary and alternative medicine (CAM) marketplace.  More and more patients are seeking the trusted advice of their doctor of chiropractic in matters of nutritional supplementation and alternative healthcare.  Chiropractors can capitalize on their knowledge and grow their practices by providing healthcare lectures to community clubs, organizations, and social groups.

There is a tremendous interest in wellness, longevity, anxiety, hormone replacement, and other “alternative” medicine topics.  These topics provide an excellent springboard to deliver the chiropractic message to your community that health comes from within the body.  Once attendees get the “big picture” about chiropractic, they are eager to learn more.  When state law allows, you can increase your effectiveness in converting your audience members into new patients by offering them a complementary examination so that they can personally experience the benefits of chiropractic care.

Q: What have you found to be the most direct competition for DC’s?  What is the best way to compete?

A:  Chiropractors are their own worst competition.  The mindset that there are not enough new patients to go around limits growth and stifles opportunity.  Every man, woman and child on the planet today has a spine and needs a chiropractor.  Eliminating the thought that medical physicians, physical therapists, massage therapists, or other alternative practitioners are your competition is the first step to unlimited new patients.

Chiropractors should seek to become proficient in the techniques of their choice and to deliver the highest quality care possible.  When you are the best, there is no competition!  Focus on polishing your patient communication skills so that you can confidently express your message at every opportunity.  Placing the focus on these two important skills will leave you with little time left to worry about the “competition.” TAC

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.

Can a 'Value-Added' Strategy Boost Revenue?
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Thursday, 08 July 2004 21:20

The answer is simply yes.  The key is to provide more services, not bill more for the same old services.  The future of our profession is bright.  Technology is adding a new paradigm to the 21st century.  Professional athletes are getting results and honoring chiropractic like never before.  Often, this is done by adding new technologies to your clinic.  How old is Ultrasound, Electric Muscle Stimulation?  Recently, one of my clients and, now, my partner, Dr. Gerald Mattia, was featured in The Orlando Sentinel.  Why?  Because of his treatment of athletes and the technology he has utilized.  The key to getting reimbursed is not “doing the same thing the same way and expecting a different result.”  We must grow and improve our practice with the times.  This is one way to avoid the insurance trap.  I have watched doctors flock to cash practices.  Why?  You need to have a hybrid, an insurance and cash component to your practice.  What this means is simple:  In a time of declining insurance reimbursements, your practice does not have to decline.

One Way to Fight Declining Reimbursement

There are three basic ways your practice can generate more revenue.

1. Deliver more of the same services.
2. Expand to deliver new services.
3. Charge more for the same services.

Granted, charging more is largely a theoretical option in today’s reimbursement environment. But there are different ways to charge more for essentially the same service–without triggering a fraud investigation. Just ask the “manufacturers” of bottled water.

The technique is called “value-added marketing”. Simply put, it capitalizes on consumers’ willingness to pay more for an enhanced level of goods or services. In certain situations, doctors can apply it to their practices.

Going First Class

Many people–especially baby boomers and subsequent generations–love the perception that they’re getting a better product or service than other folks. More importantly, they’re willing to pay more for such enhancements. People stand in line to pay three or four times more for a cup of coffee similar to the one they’d buy at Dunkin’ Donuts. Starbucks absolutely sells top-of-the-line coffee, but the product’s cache allows the company to charge higher prices–and operate with a fatter margin–than a donut chain that’s simply been selling a first-rate cup of Java with its crullers for many years.

You might be able to take advantage of this concept by discovering what your patients want and are willing to pay for. Begin, by looking at your specialty’s core services. Consider what life events bring patients into your practice–and how you can add value to what you already provide.  The world is leaning toward alternative health care. Starbucks brought a better line of coffee; we need to provide the better paradigm of healthcare.

Clinical Standards

Value-added marketing is not about different levels of clinical quality. It’s about added features. The passengers in the first-class cabin pay for added amenities, not added safety. Harvey Mackay, author of How to Swim with the Sharks without Getting Eaten Alive, says, “Provide your customer with everything you promise and then a little more.” All your patients deserve the same quality of care. You must also make certain your commercial insurance contracts don’t prohibit providing extra services by interpreting them as a different level of care. And, of course, Medicare and Medicaid require equal treatment for all patients. If you see many self-pay patients, you have a freer hand to implement a value-added services program with them.

Even if what you do is perfectly legal and in accordance with your contracts, you must consider the perception that you’re offering two levels of care. In a sensitive area like health care, a patient could sue you over that perception. So consider that risk management aspect before proceeding.  Review this with your healthcare consultant or attorney.  Know your state laws; don’t hesitate to contact your state board.

Become a Specialist

Flight attendants draw a curtain between cabins to divert coach passengers’ attention away from what they’re missing. You might accomplish the same by opening a second practice catering to upscale clientele. For example, a Diplomat in orthopedics or acupuncture might develop an “elite athlete” sports medicine practice under a different practice name right next door.

Declining reimbursement has pushed many offices to shorter, limited visits for routine cases. The patient may not even see the physician at each visit. But, by offering an enhanced option like Endermologie for an additional $1500 or more, you can add a new line of treatment to your practice.  Yes, this can be done with massage, rehabilitation, laser treatment, etc. And, if your insurance contracts permit, you might be able to offer longer visits, more access to the doctor and enhanced office visits.

Apply this principle to your own specialty. Figure out how you can provide–or partner with other businesses to provide–services that your typical patient needs or wants. Create an optional program, and charge for it. Learn from other businesses, like the airlines. It costs less than $50 more to fly a passenger first class, but airlines can charge hundreds more for a first-class ticket.

A Huge Opportunity

Surprisingly, Americans spend more out-of-pocket dollars on medical care than Medicare and Medicaid pay combined, according to the Eisenberg study. That amount is growing, from $203 billion in 1995 to approximately $300 billion in 2000. Numerous patients willingly go beyond their health plans, into their own wallets, to get the medical care they want.  Now, add in the world of Anti-Aging, and this number will continue to escalate.  People will pay to feel good, people will pay to look good, people will pay to be healthier and more energetic.  A Wellness office is the office of the future, a one-stop shop for health.  Now is your time.

Given the downward pressure on traditional reimbursement, it makes sense to consider establishing this new revenue stream.  Many of my clients go to the MD/DC approach, however 50% stay just a DC practice.  Now the hot topic is DC/PT, but be careful; the same Stark rules apply.  There is no right way to do the wrong thing.  Don’t cut corners. If you do it, do it right and consult with experts in this arena.  The key is same store growth.  Now is our time. The world is looking for a better model of healthcare.  Chiropractic is not a Philosophy, Art and Science.  Chiropractic is a Science, with an Art and a Philosophy.  The key is chiropractic is a Science, documented by research; we are more than bone movers.  We live in the world of Healthcare, a trillion dollar industry.  Fortunately, our specialty is chiropractic.  We can do a lot under the scope of our license.  Expand your knowledge, work to the extent of your license, follow all state and federal laws, and watch your practice grow. TAC

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.

Creating a High Quality Image
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Thursday, 08 July 2004 21:17

In today’s society, image is everything.  Public perception of a service or product can actually make or break a business.  Lets face it…chiropractic has had a less than positive public perception for over 100 years.  Do you ever contemplate your image?  What does the public perceive when they are introduced to you and to your practice?  What do they notice and remember about your office?  It goes without saying that everyone has a first impression of an individual or a business.  As a profession, we know that we have a good quality service to offer to the public.  Chiropractors are very highly educated doctors with powerful abilities for healing as well as for promoting wellness and healthy lifestyles.  What can you do as an individual to help change the public awareness of chiropractic?  Now that chiropractic is gaining recognition as a viable alternative to medical care, it is more important than ever to emphasize the high quality of care that our profession provides.  In other words, our profession must pull together and put ourselves out there in the public eye as the high quality health care providers that we are!  Our time has come.

You cannot just be a good chiropractor and automatically have a successful practice….  The public desires a high quality health care provider.  In this age of technology, people have the ability to choose their health care providers and, as a rule, they want the doctors who are the most current and progressive in their approaches to patient care.  People tend to be ruthless in the pursuit of finding “the best” doctors.  How do they find the “best doctors?”  The answer is not just by word of mouth, but also through personal recommendations.  Today, people are doing their own research via the Internet, which means they are using technology to help them to decide which healthcare provider to use.

How exactly does a chiropractor acquire and utilize a quality image both personally and for the practice?  Projecting a high quality image can start with simply evaluating your personal appearance.  It can be as simple as wearing quality clothing that fits well, and making sure your shoes are shined.  Is your “look” as professional as you think it is?  Also, is your staff dressed and groomed professionally?  Are they practicing their smiles on a minute-to-minute basis?  Your staff is an asset to your practice.  Whether they are assisting with patient care or handling the bookkeeping, they are always projecting an image.  Make sure it is the image you desire your patients to perceive.

The next thing to look at is the quality of your office surroundings.  Is your landscaping neat?  Does your front door work properly?  Is the waiting room inviting and clean?  Is your equipment up to date and working properly?  It can be very helpful for the owner of a chiropractic practice to walk through his or her own front door at least weekly, to just have a look at the place through the eyes of a patient.  Each office should have a monthly checklist that is inserted into the office calendar.  An “image audit” may just catch some shortcoming that you or your staff would have otherwise missed.

Are you using up to date printed material?  Are your intake forms poorly reproduced photocopies?  Is your HIPAA notification readable?  Are your brochures current?  The expense of printing and graphic design is not insignificant; however remember, image is everything, and each and everything you give to or say to a patient reflects upon the perception of you as the doctor.  The public wants high quality, colorful, easy to understand information given to them.  How will you effectively deliver this?

One way to deliver the message of chiropractic in a high quality manner is with the new chiropractic magazines, such as Chiropractic Wellness and Fitness Magazine or Pro-Solutions for Healthy Living.  These quality magazines allow your patients to receive a wealth of positive information in a format that will reflect positively upon you and the entire profession.  These magazines are full of colorful photographs and articles that will educate and enlighten the readers, as well as encourage the readers (your patients) to share the information with others (potential new patients.)

The entire profession of chiropractic is currently undergoing a major transformation.  The public perception of chiropractic has never been more positive and, therefore, it is critical that each and every chiropractor does his or her part in order to continue the momentum.  As technological advancements continue, as research continues, as results continue, so does the enhancement of the profession.  As the image of chiropractic improves, so, then, does the number of people who seek our care.  Don’t be a spectator….  JOIN THE GAME! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Practice Management Tips
Practice Management
Written by Mark Sanna, D.C.   
Tuesday, 08 June 2004 20:06

Q:  What do you predict for the future growth of chiropractic practices?

  Approximately 30% of medical physicians remain in private practice, and the day of the solo chiropractic practice is gone as well.  The chiropractor of the future will be a member of a group practice.  With student debt running at over $100,000, the financial resources required to open a new practice from scratch are beyond the means of most new practitioners.  The trend of the group practice–a senior physician with associate team members–is a win/win for both parties. 

The new practitioner benefits from the confidence, experience, and patient base of the seasoned doctor.  The senior physician benefits from the up-to-date knowledge, energy and enthusiasm of the younger doctor, who is a candidate for future partnership.  In addition, the group practice provides “safety in numbers”.  Overhead costs can be shared, vacation coverage is assured, and often “two heads are better than one” when it comes to strategic planning and decision-making.  The group chiropractic practice is the chiropractic practice of the future, so be sure to choose a consultant who is familiar with how to recruit, train, motivate and compensate your associates.

Q:  What is your opinion of multidisciplinary practices?

  The multidisciplinary practice is on the cutting-edge of the battleground of integrating chiropractic into the mainstream of healthcare.  There is a clear scope of practice between allopathic and chiropractic healthcare, and multidisciplinary practices provide patients with the best of both disciplines.  The most successful multidisciplinary practices maintain a musculoskeletal focus and refer primary care, when needed, outside the practice. 

A true multidisciplinary practice provides patients with a team approach to healthcare.  The chiropractor provides the practice with the delivery of chiropractic care, the medical physician provides upgraded diagnostic capabilities, and the physical therapist provides active care rehabilitation.  It is important to note that the paradigm of multidisciplinary practice is one fraught with many pitfalls, and those physicians who are contemplating it should do so only at the advice of a consultant and legal counsel who are well versed in the model.  There are many laws, regulations, and guidelines that must be adhered to in chiropractic practice, and in multidisciplinary practice these are multiplied many fold. 

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. TAC

Important Answers to “Report of Findings” Questions
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Tuesday, 08 June 2004 19:55

New patients typically come in to your office with many unanswered questions. They are somewhat apprehensive and are just looking for solutions to their problems.  Most will have a very limited, if any, understanding of chiropractic care.  They have entered a new world and are not quite sure what they will find, but they are open-minded enough to give it a try.

They have walked through your door and now you have the opportunity to educate each one regarding chiropractic care and, specifically, what you have to offer them.  In the course of conducting your Report of Findings, several questions will arise.  How you choose to answer these questions may make the difference between retaining your patient or losing your patient.

1. How long is it going to take?
Before patients even begin to receive treatment, they want to know when they will be finished!  Of course, it is impossible to accurately answer this question prior to conducting an analysis, putting the person on a treatment plan and monitoring their rate of response.

An individual’s rate of response is how quickly they respond to the treatment being administered.  While the rate of response can usually be determined after 3-4 visits, it is specific to the individual and their personal condition.  (Use your past experience to help.)

You need to explain this information so your patient understands what is necessary prior to your giving them an end date for their treatment.  Providing information in this manner lays the foundation on which additional education can be shared.  Your patient should have a relatively accurate prediction from you regarding their case within the first few days.

2. How often do I have to come?
Be honest regarding your expectations of them as a patient.  Consistent treatment is the key to their health and wellness.  If they need an intensive treatment schedule of three times a week, tell them.  Ask them if they are going to be able to commit to such a schedule for the benefit of their health.  Never give ranges such as 2-3 times per week.  If you do this, your patient will only hear the lower number and this will hinder their care plan.

They need to understand what it is going to take for them to reach corrective care through chiropractic.  Now is an ideal time to discuss the difference between relief care and corrective care.  Remember, an educated patient is a compliant patient who will also refer you more patients.
3. Does it hurt?
The answer to this question is directly tied to the technique you utilize in your practice.  Your chiropractic philosophy and methods of treating patients need to be explained to your patient.  Clearly define and describe your technique(s) and any physical discomforts that may accompany your treatment.

With the advancement of technology in the chiropractic field, many doctors can easily respond that there is no pain or discomfort with their treatment.  Educate your patient on any computerized instrumentation, testing procedures or rehabilitation equipment that may be a part of their treatment plan. Provide a consistent explanation to all your patients detailing any technology or methodology that you use. 

4. What is it going to cost?
Since you are not sure how long their entire treatment is going to take, you will not know the exact cost of their treatment.  However, you cannot avoid answering this question.  Confusion over finances will prevent continuation of care.  Giving an individual an understanding of the cost will allow you to continue care and further educate your patient.

As a practicing chiropractor, you are in a position to give a range of cost based on other patients with similar conditions and treatment plans.  Explain this to your patient.  Take the time to discuss any insurance issues and clearly define their financial responsibilities for their treatment. 

Answering these four major questions with your patient will lead to a smooth and productive relationship right from the start.  They understand what to expect from you and chiropractic, and know what you expect from them as a patient.  Education and understanding lead to healthy chiropractic patients on maintenance care! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.


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