Practice Management

Ten Easy Steps to a Successful Screening
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Saturday, 03 April 2004 16:20

Chiropractors all over the country conduct health screenings.  Some are successful, some are not.  The ones who are not successful typically fail because they do not properly prepare for success.  The following ten steps will help ensure success the next time you conduct a health screening.

Step # 1–Set Yourself Up to Succeed
Think about your community, the demographics of your public and their characteristic activities of interest.  It is important to lay the foundation for a positive event that has positive results for the participants in your community.  Remember to consider the type of screening and where the majority of the people interested in this screening would frequent.

Step # 2–Review Staff Functions
If you are taking any staff to the event, review what their specific functions will be during the screening process.  Staff members can assist by routing people to your screening area, helping with the patient information or scheduling a follow-up appointment for chiropractic care.  Decide what everyone’s role will be prior to the event to eliminate confusion and present a professional organization to your community.

Step # 3–Interest the Public
Plan to have something of interest in the area of your screening.  You want to catch the attention of your public through a specific piece of equipment, television screen, literature display and/or type of screening featured.  Your screening area must be inviting and easily accessible to your audience.

Step # 4–Introduce Your Survey
Have an information survey available to pass out to everyone interested in participating in your screening.  The survey should be short (no longer than one page) and easy to fill out.  All pertinent contact, as well as medical information, should be included.  Do not forget a signature area for consent to conduct the screening.  

Step # 5–Collect Survey
As you collect the survey, you essentially begin your screening process.  Build a bond with the person.  Initiate easy conversation about the location, family, weather, etc.  Let your personality come through to help the person feel comfortable with you.

Step # 6–Introduce Yourself
Once the individual feels at ease with you, introduce yourself.  Do a little commercial regarding your credentials and practice history.  Weave the discussion of your qualifications around to include some specific questions about their survey.  This will smoothly lead you into conducting their evaluation.

Step # 7–Conduct Evaluation
Carefully conduct the evaluation or screening.  Give a thorough explanation of the cervical, thoracic and lumbar areas that you are screening.  Make sure to use instrumentation and/or a procedure that will add credibility to your screening process.

Step # 8–Include Patient Education
Critical to your screening process is educating the individual regarding the results of their screening.  Align the credibility of your screening to their problem through the education process.  Be sure to include how chiropractic care in your practice will help their specific situation.

Step # 9–Set an Appointment
Ask direct questions to determine the individual’s feelings about chiropractic care.  Determine if an office tour or new patient visit is more appropriate for the individual.  Set the appointment and give directions to your office.

Step # 10–Confirmation Call
Two days prior to the individual’s appointment, call to see if an earlier appointment would work better for them.  If so, you can move the appointment up in your calendar.  One day prior to the appointment, call to confirm the appointment.  Be careful not to put yourself (or your staff) in a position to ask a yes-or-no question.  This could lead to a cancellation of the appointment.

Consider doing a health screening in the near future.  Follow these ten easy steps and enjoy a successful screening event.  Increase your new patients and promote a positive awareness of chiropractic care and your practice within your community. 
hiropractors all over the country conduct health screenings.  Some are successful, some are not.  The ones who are not successful typically fail because they do not properly prepare for success.  The following ten steps will help ensure success the next time you conduct a health screening.graduate of  National College of Chiropractic.

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.

Generate a Positive “First Impression”
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Saturday, 28 February 2004 00:00

A first impression is a lasting impression.  An individual will receive their first impression of your practice based upon their interaction with your front desk staff.  Whether an individual calls on the telephone or walks into your practice off the street, your front desk staff delivers to them their first impression of your practice.  A person will make their decision to become a patient or to continue to receive care in your facility, or not, based on how they are treated by your front desk staff. 
Individuals clearly formulate an opinion on how the doctor thinks, works, and acts based on their interactions with the front desk person.  It makes no difference if you have a chiropractic practice or a business that deals with chiropractors.  The front desk is the key to getting and maintaining your customers.  
Since they are a focal point of your practice, it is extremely important that you evaluate your front desk staff from a distant and unbiased standpoint.  Take a look at the individuals running your front desk and evaluate them as if you have never met them before. 
Listen when they answer the telephone.  How do they treat the person on the other end of the line?  Do they sound caring and accommodating?  Or are they short and to the point?  How do they treat other doctors, such as a colleague or friend, when they telephone your office?  Ask people you speak with on the phone, “How did the front desk person treat you when you called in?  Did they seem warm and receptive to your conversation?” 
What is the demeanor of your front desk staff when dealing face-to-face with current or prospective patients?  Are they pleasant when answering questions or scheduling an appointment?  How is their enthusiasm for their job, their level of interest in the patient and their personality when interacting with others? 

Just sit back there...I'll call you when the doc can see you...

After you have taken an opportunity to evaluate your front desk staff, carefully consider the results of your findings.  Immediately address any areas of concern and then implement a formal training program.  Your front desk person should receive at least one hour of training per week.  Their training should focus on increasing their skills to become better communicators, handle patient objections and concerns to care, and also include sessions on becoming a better listener, paying attention to detail and duplicating what the patient is asking. 
Another important aspect in the training of your front desk staff is knowledge of your personal information.  The front desk person needs to be trained on your specific skills and abilities.  It is vital that they know your complete educational background, including what chiropractic college you attended.  They should be well versed in answering questions regarding chiropractic care and any special techniques you use in your practice.  It is advisable to periodically have one of your friends, colleagues or a family member call in and ask your staff members to describe the type of work you do as a chiropractor.  Your staff should be able to speak intelligently about your background and current chiropractic efficiencies. 
It is also important to set protocol for the front desk staff to follow under specific conditions.  For instance, what is the protocol when another doctor calls in to speak with you?  How should your front desk person handle this situation?  The front desk person should be trained to inquire what the call is regarding.  It is important to note if the call has to do with a current patient, sending a new patient to the clinic, or a similarly specific situation. 
You should have a protocol established so the front desk person is not put in a position of deciding if it would be okay to call the doctor back later.  The front desk person can not evaluate the importance of the call or the impact it may have upon your practice.  By putting a protocol in place, the front desk staff will know when to interrupt or when to take a message, based on their training of the protocol. 
A weekly training covering all areas discussed here will ensure that you continue to offer the very best first impression to the public.  If the information listed here is consistently followed, the level of “good” public relations that is fostered in your community will increase.  A friendly and well-trained front desk person will go far in providing a caring and professional environment that people would like to share.  It will make a “lasting” first impression! 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.   
Saturday, 28 February 2004 00:00

Q:  Which adjunctive services, if offered, have you found to be most beneficial for chiropractic practices?

A:  The language of reimbursement today is the language of function.  In order to fully participate in the mainstream of healthcare, chiropractors must become proficient in objectively assessing and documenting the functional outcomes of their care.  It is extremely difficult, if not impossible, to track functional outcomes in a practice that operates in the “passive care paradigm” of the 1970’s–in which patients come in, lie down, receive an adjustment, hot pack and muscle stimulation, visit after visit, for forty-plus visits.  The most successful chiropractors today include active care/rehabilitation in their treatment protocol. 

The CPTÔ codes with the highest value are the active care codes:  therapeutic exercises, kinetic activities, neuromuscular rehabilitation, and others.  The reason for the high level of reimbursement these services receive is that they produce a higher quality outcome.  Patients who participate in rehabilitative exercise programs have a lower rate of recurrence of their original conditions, and this is recognized by third party payors.  After hiring a personal coach, the most beneficial service a chiropractor can add to their practice is to invest in low tech (tubing, bands, gymnic balls), or high tech (weight stack machines) rehabilitative exercise equipment.


Q:  What mistakes in practice management do most DC’s make?


A:  The single most effective habit you can develop to successfully manage your practice, after hiring a professional coach, is to establish regularly scheduled practice building hours.  While almost every doctor I speak to has established regular hours for patient care, only a very few have established similar hours for practice building. 

If you search long enough, in every chiropractic office you will find a box filled to the brim with seminar notes.  These notes contain ideas, each one a gem, that has never been implemented.  The single most efficient way to close the gap between idea and implementation is to set aside a minimum of two-to-three hours each week devoted entirely to practice building.  This time should take place in your office and should be uninterrupted. 

Chiropractors have two businesses.  The first business is the patient care business and the second business is the practice building business.  Most doctors attempt to build their practices and polish their procedures in between and around patient care.  Develop the habit of dedicating regularly scheduled time to building your practice.  This habit will allow you to focus your energy and attention on practice growth and will keep you from diverting your attention away from your patients during the time you should be focusing on them.



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.

How Much Staff Do You Need?
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Saturday, 28 February 2004 00:00

As a Consultant, I have had the opportunity to visit clinics throughout the United States.  This is one area of my consulting that is unique.  As the owner operator of 5 clinics that saw in excess of 1200 patient visits per week, it is interesting to see how many clinic’s staff their practices.  Some clinics are overstaffed and some understaffed.  The key is to know which you are.

Clinics of the 2000’s can learn a lesson or two from clinics of the 1970’s.  Most clinics today are overstaffed.  A clinics staff overhead should equal 12% or up to 18% of entire overhead with billing and collections.  The office should run at 50% and never more then 60%.  This is not what I see out there today.  Many doctors hire employees with no set formula in mind.  Doctors like saying, “I have eight employees.”  It is not how many employees you have but how they are utilized and how profitable you are.  Staffing should be equated by number of patient visits as well as collections.  This is also the reason so many clinics have financial troubles.  The first thing I teach my doctors is to understand overhead, how to mange a clinic and how to make it profitable. (See chart)

Use the following guidelines:

          • 0-100 Patient visits per week = 1 full time CA, possibly one part-time after 50 visits.

Front Desk CA

Doctor handles treatment, exams, X-rays, and therapy


          • 110-175 Patient visits per week = 2 CA’s, maybe an additional part-time may be added at 150, to assist with patients or billing.

Front Desk CA

Therapy CA (also traffic control)

Doctor handles treatment, exams, and X-rays

          • At the 150 level an associate doctor may be considered.  He or she will then take on the responsibility of doing the following:
            1. Exams
            2. Taking X-rays
            3. Marking X-rays
            4. Preparing report booklet
            5. Managing therapy or rehabilitation
            6. Diagnostics
            7. Outside marketing


It is only after mastering the above that he or she will be allowed to treat patients. Having an associate can often give you more time to treat and bond with your patients, thus increasing your volume.


          • 175-250 Patient visits per week = 3 CA’s

Front Desk CA

Therapy CA (backs up front desk)

Billing Control CA (backs up both above CA’s)

Associate doctor handles treatment, exams, X-rays



          • 275-350 Patient visits per week = 4 CA’s

2 Front Desk CA’s

Therapy CA

Billing Control/Office Manager CA (backs up all above CA’s)

One of the front desk CA’s at this level assists with billing and collection.


When you get to this level, often one front desk CA answers the phone and does intake.  The second usually sets up patient visits does insurance verification and collects money.  This employee sees the patient as they exit and handles any insurance problems.


          • 350 + Patient visits per week = 5 CA’s

2 Front Desk CA’s

2 Billing CA’s

1 Therapy CA



You can use this knowledge as a motivator for yourself and your staff.  Just knowing that a small increase in patient visits per week will put you at a level that warrants an additional staff member should inspire you to make the push necessary to exceed and maintain that level.  You must maintain this level, though, for four weeks before hiring the additional person.  Let your staff know that increased business can lead to increased staffing.  Many doctors add employees because the staff says they are overwhelmed; that they need help.  The real question is, do they really?  An empirical formula on staff control will lead your staff to more production.  They will know what they must maintain, and what the office must produce to bring on help.

Once the new staff member has been added, you now have a vacuum to fill once more!  Successful people never rest.

Successful doctors throughout the United States have used the recommendations above effectively for years.  Today it is usually insurance that puts a strain on the office.  Many offices utilize billing companies.  Remember, a billing company is nothing more than an outsourced employee.  You must manage them as you would any employee and judge them by their effectiveness.  Before hiring a billing company, ask for doctor recommendations, then call them.  Make sure they do electronic billing and assist in follow up.  A good billing company should provide you with weekly reports.

Some clinics may offer services, which require additional staffing, such as diagnostic testing, rehab services, or massage therapy.  A massage therapist does not equate into the calculations, as they can produce revenue.  It is also their responsibility to assist with therapy and diagnostics when not massaging.  Often they are paid hourly (never by percentage) and are treated as Independent Contractors.

Staff Management

When professionals initially start their professions, they focus on being chiropractors, optometrists, dentists, etc.  But, as their practices grow, they find they must also become managers.  Some feel involvement in management makes them less of a health-care provider.

All careers eventually lead to management and management means managing people.  Skill, hard work, dedication, and technical competence alone won’t get you to the top.  Over-reliance on technical skills and neglect of the people skills leads to the leveling-off effect.  Continued advancement requires people skills.

There are no tricks to being a manager just an awareness to respond to the human needs of your staff.  Basically, you cannot change people.  You cannot put in people what they do not already possess.

Management of people is like placing a string on your desk.  Try pushing the string, notice how it binds up.  Now pull the string and see how it takes your lead and follows you.  Pulling people is tiring, but pushing people is exhausting and fruitless.

Rules to Remember

The following are rules to remember when you work with people:

  1. All people are motivated.
  2. People do things for their own reasons, not yours.
  3. You cannot motivate people.  You can inspire them, thus, they will motivate themselves.  Don’t FIRE employees, FIRE THEM UP.
  4. You can create factors that will be motivational in their environment.
  5. People won’t change for you, but they may change with you.

Good office procedure and clinical competence will help you sustain a certain level of success, but it’s your ability to manage people that will get you into the major leagues. TAC

Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation's largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

Cheeseburger, Cheeseburger, Cheeseburger
Practice Management
Written by Chris Peetros   
Sunday, 30 November 2003 00:00

A friend of mine, a chiropractor, was listening to the tail end of a talk I was giving in Florida, and after the talk, asked me to explain this cheeseburger thing to him.  I told Mike, (that’s his name) that the cheeseburger phenomenon is something we coined to explain the product problems that we encounter which causes us to redesign our existing product line.  “Explain,” he said. 

Well it’s like this:  You have fifteen chiropractors on the same block and all of them do basically the same thing.  How most of them try to differentiate themselves is by word speak, technique, marketing, hurt and rescue, and other various strategies.  It’s like when you go in the bathroom and see the poster, “As the twig is bent so grows the tree.”  We call that a symptom of product problems. 

“Product problems?” Mike replied. 

“Yep, product problems,” I said.  “Take that cheeseburger analogy thing, replace the fifteen chiropractic offices with cheeseburger stands.  The owners of the cheeseburger stands try to differentiate themselves by rearranging the items between the buns.  The first guy sticks the meat on the bun first, then the cheese, then the tomato, lettuce, onion and ketchup.  The second guy has a better idea.  He puts the cheese on the bun first, then the meat, next the lettuce, ketchup then onion.  Of course, the third fourth and fifth guys do their own arrangement and all feel like they are unique compared to the other fourteen cheeseburger stands. 

“You know, just rearranging the items on a display doesn’t make a new product.  If it was a new product, the cheeseburger stands would be able to charge much different prices and, like the chiropractic office, it seems to me the prices all are about equal.  Equal price, equal value.  Imagine that.  No real way of differentiation.  In our business, we call this a product problem, and, when it emulates the cheeseburger example, it’s time to look at our product and figure out how to really differentiate from the competition and re-engineer what we offer the customer.

“You call them  patients; we call them customers,” I said to Mike. 

Here’s another analogy.  The patient or customer who walks down the street has a wallet with two twenty-dollar bills in his or her pocket.  The money doesn’t care where it gets spent, but the owner of the money evaluates all their spending options.  Pizza Hut, the department store, overdue bills, a gift for someone special, or the chiropractor, and so on—all are options available to spend the money on.  How all of those products stack up is what we call purchase hierarchy.  Which one of those items or combination of them wins out is based on the value the customer places on them.  This is where the tricky part comes in.  How much value the customer places on it is based on their satisfaction index.  We gauge the satisfaction index by the response the customer has to our product without a “sales pitch”.  The duct tape test.

“The duct tape test?” Mike asked.

“Look at it like we do, Mike,” I said.  “If you place a piece of duct tape across the salesperson’s mouth, (this can be a doctor, CA, etc.) and if the product is not accepted by the customer without the pitch, or the customer cannot be convinced to come back and purchase more product without a pitch, you have to start looking at your product and asking why the customer doesn’t perceive value.”

Now I had Mike right where I wanted him.  “Do you have one of those As-the-Twig-Is-Bent-So-Grows-the-Tree posters?” I asked. 

“Yeah,” he said. 
(Don’t tell me, it’s in the bathroom!)

Dr. Mike was pretty quiet by this time, but I asked if he did things like nutrition, electrotherapy, ultrasound, traction and other treatments in addition to his adjustments. 

He said, “Yes.”

Now for the real tough questions.  I asked, “How many minutes do you apply electrotherapy on the patient during a session. 

He replied, “About 12 minutes.” 

I replied, “Oh the electric aspirin.”  I explained to him that there are dozens of treatment options other than the “electric aspirin” that will really send the customer—I mean, patient—home really feeling great.  How about traction? 

Do you do real traction or just rollers. 
“Just rollers” he replied. 

“Just  babysitting the patient,” said I.

“When you do ultrasound, do you treat only three times the ERA of the crystal or do you paint the wall?” I asked.
This is when Dr. Mike stopped answering my questions. 

“Well, Mike,” I said,  “the good news is you’re a perfect candidate for product repair.  Just imagine, if we fix your product offering in all aspects, the patient satisfaction index will go up and your practice will truly be different than the others in the neighborhood.  In fact, the better your product gets, the more of those tacky posters you’ll be able to remove.” 

“Great,” he said.   “They really make the place look pretty unprofessional.”

My advice to Dr. Mike was the same advice I give to all of the chiropractors I meet in my travels worldwide through my work.  It hasn’t changed for twenty years.  When you fix the product, the sales come.  When you do the same thing over and over and expect different results, you have a problem. 

Think about this example.  If we sent twelve employees from the local McDonald’s to an Anthony Robbins seminar for a weekend, do the cheeseburgers taste different on Monday morning?  Are the Happy Meals any better than they were on Friday?  The fact is enthusiasm is a wonderful catalyst, but you need a new product together with the catalyst to really get all the benefits.  Imagine, if we took those same twelve employees and, in addition to the “head repair” they get with Tony Robbins, we gave them an entirely new improved product.  Instead of just “supersizing” every order, they were turning on all the customers to the “new product line”.

So here was my prescription to Dr. Mike:
When you offer adjunctive therapies in your office, they are only as good as the research behind them.  After that, you need to purchase all of your “non chiropractic” additions from reputable companies and knowledgeable distributors.  The lack of training you get from the salesperson hurts your practice and product more than you will ever know.  Only buy from a company that supports the product with in-office training for you and your staff, and backs it up with clinical data from accepted publications, not anecdotal information.  Remember, the only one that loses is you, because the product you offer the public is not as great as it could be.  Demanding excellence from the people you buy your therapies from will help improve the product you deliver to the patient.  Most importantly, if the claims sound too good to be true, they are.

Second was the most important advice to Dr. Mike.  It was the advice about the risk to his license.  I explained to Dr. Mike that taking the information the salesperson gives them on billing codes was like lending his license out for someone else to use.  It is crazy to take the billing advice the salesperson or manufacturer gives you at face value. 
Improper billing of CPT codes is insurance fraud.  Billing codes for therapies that do not have the effect the codes imply is also fraud.  When a salesperson gives you billing advice, remember to always call your billing consultant to make certain you aren’t creating a situation in which, under an audit, you will have to pay back thousands of dollars you probably spent a long time ago.  Let’s face it, “Whose license is it anyway?”  Do you think that salesperson has as much at risk as you do?

Well, Dr. Mike was mumbling something about, “I don’t even eat cheeseburgers, I’m a vegetarian,” while he walked away. 

But I think he learned a valuable lesson about product and the value the customer places on it. 
As he walked further down the hall, I said, “You know, Doc, your patients will appreciate all the changes you make because, when you fix the cause, the symptoms go away.”

Chris Peetros has spent the past 20 years developing products for the chiropractic profession. Currently, he is the National Sales Manager/Specialty Products Division and Chiropractic Products Division Manager for the Chattanooga Group in Hixson, Tennessee. Chris has spent the past 10 years developing the Ergostyle Adjusting Table product line and his most recent project, the Triton DTS Spinal Decompression System. Chris can be contacted through the Chattanooga Group, Inc. He can be reached at 800-592-7329.


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