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Practice Management
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Practice Management
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Written by Dr. Miles Bodzin, D.C.
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Thursday, 25 March 2010 00:00 |
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I was watching some professional baseball players warm-up before a game and it dawned on me. They’re doing the exact same thing I see the local little league players do. They were practicing the basics. I am sure every one of those players knew how to do the basics. But there they were, practicing them anyway.
My question for you is, are you a professional? If you are, are you practicing the basics? Are you mastering the basics?
Why is mastering the basics the single-most important topic? Because it will keep you focused on patient retention. By the end of your first year in practice, if all you did was focus on new patients (which are important) and you put little emphasis on mastering the basics, you will end up with a practice that is symptom based; one that will always need a constant source of new patients. You see, patient retention is the key to profitability. At the end of the day, you need to be profitable to stay in business. What do you think is the #1 reason businesses close? Failure to be profitable.
So let’s review the things you need to master so the new patients you work hard to get, stay with you for years to come.
Basic #1: Always start with the end in mind. You need to develop an attitude of knowing what you are trying to accomplish with everything you do. This is especially true for your office procedures & systems. So, keeping this in mind, let’s review the rest of the basics.
Basic #2: Mastering the Consultation & Exam. Not only do you need to get the clinical data to help the patient, but you need to also find out what to accomplish in the consultation & exam. You need to make sure you let the patient know what you are looking for so you can then report back to them in the clinical report of findings, if you find it. Are you looking for subluxations? Posture? What? Then, in the exam, let them know if what you are observing is indicating evidence of subluxations. "Mary, your posture shows your head is 2 inches forward. This indicates…." Another thing that should occur is an invitation of the patient’s spouse to attend the report of finding. Having the spouse at the report of findings is very important. 
Basic #3: Mastering the Clinical Report of Finding (ROF) & Care Recommendations. The clinical report of findings is probably the most important part of the process to master. The spouse should be there. Let me cut right to the chase. The only thing that needs to be done in the ROF is to give the patient enough information for them to justify hiring you to help them. That’s it. This is not the time to teach them everything about chiropractic. This is not the time to scare them into care. This is the time to act as if you could care less. Not to say you do care less. But you can’t come off sounding like you need them more than they need you. The topic of the clinical ROF is a very large topic that cannot be fully explored here; but make sure you spend the time you need in mastering it.
Part of the ROF will be recommending care. The bottom line with recommending care is - Just do it! Don’t be wishy-washy. Don’t say, "We’ll see you for a while and then I’ll let you know what we need to do." Patients expect you to know approximately how long it will take to get them well. So tell them the truth.
Basic #4: Mastering the Financial Presentation: Once master Basic #3, this becomes super easy. You see, when a patient is armed with the information they need to justify hiring you, presenting finances is not a challenge. By the end of the clinical report, you should be hearing the patient confirm that they want to get started with care. The next natural step is to review the financial plan you offer for them to pay for the services you’re recommending. Once the patient gives you the go ahead to discuss finances, the key here is to have a comprehensive financial plan that covers your entire treatment plan. You need to master creating a good payment plan.
Basic #5: Mastering Re-Evaluations: Doing re-evaluations is important for a variety of reasons. Of course, there’s the significance of monitoring the clinical changes your patient is making. However, that’s only part of their importance. Patients need to know that you know they’re making progress. Using an objective tool to measure their changes is crucial. Have you ever heard, "You go to a chiropractor, you go for the rest of your life," said in a negative way? Where do you think that comes from? It doesn’t come from the docs who show their patients why they need care and then show them the progress their making. It comes from the doc who rarely does re-evals and starts care by saying, "Let’s see you for a while and see how you do." You see, if a patient does not know how they are progressing, they will make their own assumptions. "I guess the doc just wants me to keep coming back." Patients have no problem committing and sticking to long-term programs of care, if they are monitored on a regular basis and shown that progress is occurring.
Basic #6: Transitioning to Wellness Care: The point when a patient has completed their initial corrective care program and is ready to transition to wellness care is one of the most common times a good patient will be lost. Why? Simply because you’re asking them to make a decision if they want to continue with care or not. It’s not that they don’t want to continue with wellness care. It’s that they have to make a purchase decision. They ask themselves, "Do I want to buy again?" This is especially true for offices where they primarily have patients pre-pay for 12-months of care at a time. Using an automated system with monthly payments nearly eliminates patients from dropping out at this time. (Consult state laws to verify pre-paying is an option for you).
Master these basics. Then make sure you practice them throughout your career. There will, no doubt, be times in your career where you just feel like things aren’t going as well as you wanted. Whenever I felt that way, I went back to reviewing and practicing these basics. They’ve never failed to get me back on track and they should do the same for you.
Dr. Miles Bodzin is the Founder & CEO of Cash Practice Inc., a web-based service company providing the Cash Plan Calculator®, Auto-Debit System® and Drip-Education® Email Marketing System. To learn more about how the Cash Practice® Systems can help your practice, visit www.CashPractice.com where you can get our Free Cash Practice® Mini-Course to learn even more. Dr. Bodzin can be reached at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or 1-877-343-8950.
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Practice Management
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Written by Michael Megehee, D.C.
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Thursday, 25 March 2010 00:00 |
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Chiropractic Physicians have an insurmountable competitive advantage over other health care professions to draw substantial new income into their practices. Nowhere else is the opportunity greater; all that is needed is for Chiropractic Physicians to "align" their practices to include driver physicals, alcohol and drug testing for the transportation industry.
The "adjustment" of where $1 Billion is spent annually is imminent, due to the upcoming mandatory training and testing of those that perform the DOT Medical Exam for truck drivers. Until now, any DC, MD, DO, ANP or PA could perform the exam with minimal preparation. That is due to change early this Fall, when the Final Rule is published for the National Registry of Certified Medical Examiners (NRCME).
No physician wants to be forced to take a training course, or even worse, to take a certification test. However, as a profession, this is one time when we should embrace inconvenience. Because few chiropractic offices offer this procedure, nearly all of the annual 4+ million driver exams are provided by the other professions. However, when faced with the new requirements, the number of these providers is expected to drop dramatically. As the trucking industry scrambles to find a new provider, the door swings open for chiropractic and those that prepare now will reap the benefits.
Cost has and will be an important factor in who gets the business. This is where chiropractic’s low overhead serves best. Chiropractic costs for rent, malpractice insurance, and employees are hard to beat. The result is that, when it comes to pricing, chiropractors can out-compete just about everyone, except another chiropractor. The significance of this can not be overstated.
Reimbursement will be a major deterrent for many clinics. Most chiropractors charge between $45 and $100 for a driver exam. This amount is frequently greater than that for chiropractic adjustments and/or therapy. In a medicine oriented office, however, this represents a relatively low reimbursement compared to what services could be billed. This deters medicine based clinics, and attracts the chiropractic physician. An added bonus is that there is no insurance to contend with and no waiting to get paid.
Motor Carriers frown when paying drivers to sit in an office waiting for an exam, or if an appointment is not available for several days or weeks in some clinics. Many self employed drivers are paid by the mile and time off the road is money lost. To add to the urgency, many drivers inadvertently allow their current exams to expire. It’s no surprise they’re looking for a same-day appointment, as they are either off the road, or subject to a substantial fine if caught driving. It’s been an unfortunate fact that many chiropractic offices are underutilized. However, chiropractic offices can often provide same-day appointments. For many drivers and motor carriers, this is "the" determining factor in physician choice.
 Most chiropractic offices also underutilize their staff. Since drug and alcohol testing can and should be performed by your staff, income from these services comes nearly cost free. The clinic gains an ability to generate income, even if the physician is absent. Companies prefer a one-stop shop which also offers the alcohol and drug testing. There is a nationwide shortage of clinics offering the alcohol test for truck drivers. This is a strong selling point to companies that struggle to find clinics with all three services. Once an office is providing the DOT drug and alcohol testing, there’s no reason not to provide drug testing for non-DOT regulated employers. The Non-DOT drug testing market is estimated as being 7X larger than the DOT drug/alcohol market. Opening a satellite clinic in a truck stop, or providing services at the client’s facility are options few clinics have the desire or ability to consider, but they are effective marketing strategies.
FMCSA estimates that 40,000 trained medical examiners will be needed within 2-3 years. As these services are federally mandated, they tend to be independent of the state of the economy. Even those ready for retirement may find this an appropriate avenue to continue at a reduced pace and a reduced physical stress to themselves.
Starting now deters other clinics from competing with you later, increases your visibility when trucking companies are looking for a provider, and firmly establishes your office with the client for years to come.
Training is available from chiropractic colleges, nationwide physician networks and third parties. Although training is not required to perform the driver medical exam, the physician should download and review the exam form and instructions from the FMCSA website. Training is required to perform the DOT drug collection and alcohol test. DOT alcohol testing many times requires purchase of a breath alcohol tester that is approved by the DOT. This is part of the reason why clinics that perform alcohol testing are in such short supply. If the physician will attend a "Train the Trainer" course for alcohol and drug testing, he is able to train his own staff which greatly reduces his costs.
For those looking to build their chiropractic visits, every driver exam, alcohol test and drug collection represents a potential chiropractic patient. What other marketing strategy pays to have a potential patient come to your office? Incorporating these services into a practice will not be for every chiropractor, but every chiropractor should investigate this opportunity to out compete the competition while the door remains open.
Michael Megehee, DC, is a FMCSA designated Subject Matter Expert and President of TeamCME, a nationwide network of physicians that provide services to the trucking industry. Dr. Megehee is a member of the FMCSA Team that developed the NRCME physician training course. For free information on how to get started performing driver medical exams, go to www.TeamCME.com.
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Practice Management
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Written by Dr. Richard E. Busch, III, D.C.
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Thursday, 25 March 2010 00:00 |
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We are all aware there is great division over universal healthcare coverage. The federal healthcare bill that is now in the Senate has, for months, debated spending, coverage, negotiations and—keeping with transparency—publically reported, after the fact, "back room" deals that are secretly happening. What will managed care look like, if—or when—the government takes over? The answer is simple–tax, waste and spend.
Managed care and government subsidized healthcare will quickly overburden the healthcare system, under compensate the healthcare providers, and under provide healthcare. As with any government agency, it will quickly become bloated with bureaucracy and inefficiency. It will be a living hell for the doctors that are involved, and it will become a living hell for the patients that will rely on it. The bill is not to provide easier access to care or improve healthcare delivery. It is painfully obvious that not much of the bill is about patient care, at all.
The rules don’t have to run your business nor run you out of business. The old adage goes that, "Luck is when opportunity meets preparation," and we can truly be prepared, if we get out ahead of it. The best thing is to decide how you can actually transform your practice into a cash practice. There are simple yet, somewhat, difficult decisions to make right now to be certain that our patients and our families do not suffer as a result of this government healthcare takeover.
 I feel very comfortable and very sound running a practice that is virtually 100% cash. I believe the direction, in the future of healthcare, will be the transformation to a cash practice. The only thing that could limit this is, if in some way shape or form, the government is allowed to force every practitioner into their model.
I've heard it said, time and again: insurance is too important to my patients; you can't do cash in my area; or YOU may be able to do cash where you live, but the economy where I live just won't support it. The fact is there are cash practices all over and in every healthcare discipline. These practices are succeeding, growing, and thriving, even in this tough economic time.
It is impossible to predict what actually will be inside the proposed healthcare bill, until it has passed, if it will pass. Do not wait for luck. A doctor would be wise to meet this opportunity with preparation to incorporate the practice of cash as a preemptive solution. Prepare now, as this is a golden opportunity and, sooner than later, others will consider you having luck.
Dr. Richard E. Busch III, developer of the DRS Protocol™, is a nationally recognized Doctor of Chiropractic, author of Surgery not Included, and speaker. In ’96, he founded the Busch Chiropractic Pain Center which is considered one of the largest case fee cash practices in the US. Dr. Busch, president of the Busch All Cash Academy, consults with doctors across the nation in the conversion to cash and the case fee. www.allcashpractice.com or call 1-866-662-2225.
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Practice Management
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Written by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP
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Thursday, 25 March 2010 00:00 |
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I have written before that it took chiropractic 115 years to care for 5-7% of the population. Frankly, that is powerful, considering the obstacles we had to overcome. However, it is not nearly enough and we, as a profession, have to do better. The status quo is not enough.
I have had the honor of meeting many who handcuffed themselves to their adjusting tables and were taken to jail for practicing chiropractic in the 1960’s. I have had the honor of being trained by chiropractors who studied under B.J. Palmer. I have had the honor of being mentored by many who cared for 300-400-500-600 patients in one day. I have had the honor of being taught directly by many of the masters who invented techniques that bear their names. I have lived a privileged chiropractic life.
It is now your turn to honor them and their contribution to changing the world by bringing chiropractic to 5-7% of the population. We cannot do the same things they did 40 years ago; we need to learn from the past and do better today and tomorrow. Thanks to today’s acceptance of chiropractic nationally, we have it much easier than they did; no one has to make the decision of surrendering freedom and going to jail for caring for a patient.
My goal is to get all of chiropractic to do whatever is necessary in order to care for 95% of the population within the next 5 years. The solution is so easy and here is a very simple first step towards that goal: We need, as a profession, to increase our credentials and make them transparent to the public, so the public can make an informed choice. Credentials are not part of the chiropractic culture. Every MD and DO must present their curriculum vitaes when applying for residency. This is a mandatory step and forces the doctors to be their best on paper. We need to do the same and, by doing so, will change the culture of chiropractic and will resolve one issue of how the profession is judged by outsiders. I have reviewed 1000’s of chiropractors’ CV’s and we need help.
I have urged every doctor in the nation to go to www.uschirodirectory.com and use the FREE CV builder in order to help in this process, because every doctor is judged by the courts, hospitals, insurance companies and many governmental agencies based on his CV. Unfortunately, many don’t complete this process. However, the chiropractic colleges can make this happen quickly and efficiently. They have the power to fix this problem and get us one step closer to the 95%. If they require each candidate to have a CV that is in an admissible format in order to enter into an internship, the problem will be resolved instantly.
Doctors need to take more meaningful continuing education courses to build their knowledge base and credentials. Our licensure boards have mandated CE for a reason. Use it and continually build your credentials on your CV. If used properly, it is also an incredible practice builder. Our licensure boards also need to render double credits for DC’s teaching CE. This will encourage more doctors to strive towards creating better courses for the profession. This is a policy that has been adopted by many State Bar Associations for offering continuing legal education credits for lawyers. We need to do the same.
 In order to achieve that 95%, we also must focus on evidenced based research and peer reviewed papers. That is how the scientific world functions. The problem with chiropractic is that it works too well. It works so well that patients don’t need a paper to show them. However, the public is influenced by organized medicine and we must be able to compete in the scientific world, so that organized medicine recognizes what we do and moves the masses into chiropractic. Medicine bases its referrals on evidenced based research and we need much more of it to succeed in shifting the public. This has to do with the machine that moves governmental and private research money.
That is the reason that I, personally, work with the American Academy of Medical Legal Professionals (www.aamlp.org). They have just created the JAAMLP, a peer reviewed journal of the Academy, to have a forum to publish evidenced based results for the scientific community to learn what we already know: Chiropractic works and should be the public’s first choice for subluxation related problems and to attain high level wellness. There are other peer review journals in chiropractic and every one of us needs to read, support and contribute to their success because their success is chiropractic’s success.
Over the next few months, I will be sharing with you what each of us can do individually and as a profession to make that dream a reality.
The movement is called 95 in 5.
Dr. Mark Studin is the President of CMCS Management which offers the Lawyers Marketing Program, Family/MD Marketing Program and Compliance Auditing services. He can be contacted at www.TeachChiros.com or call 1-631-786-4253.
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Practice Management
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Written by Tom Owen III, and Todd Osborne, D.C.
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Thursday, 25 February 2010 00:00 |
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Healthcare is a hot topic right now. With the possibility of a government sponsored insurance plan looming on the horizon, these upcoming months are going to be a very interesting time for healthcare in America, especially as it relates to chiropractic.
Many chiropractors feel that, if a public healthcare option becomes reality, chiropractors must be included. They want equality. They want acceptance. Let me remind those who feel this way, we were included in Medicare, and most would agree, that has been a total disaster. Malcolm Forbes, publisher of Forbes magazine once said, "Failure is a success, if we learn from it." Why would the chiropractic profession want to be included in a system that has never worked for us? Even the American Medical Association, an umbrella group for 180 medical societies, opposes a public insurance plan and does not want to be included. (New York Times, June 10, 2009.) Do we think chiropractors will fare better than medical doctors in this new plan? Physicians will be forced to comply and will not be able to opt out of it. If chiropractors get "equality" and are included in this, someone who doesn’t value chiropractic will determine what chiropractic is worth and the amount chiropractors will be compensated. We see thousands of chiropractors each year that are included on private insurance plans and they’re barely surviving. Is that the direction we want the entire profession to go?
The trend in chiropractic has been getting further and further away from the fundamental truths of chiropractic in the quest for acceptance in the mainstream medical field. Inclusion is not our answer. To be accepted isn’t always positive, especially when it takes one away from fundamental truths. Remember, only dead fish swim with the stream.
 Will chiropractic survive under a new healthcare plan? Absolutely. Chiropractic will survive as long as chiropractors continue doing chiropractic. How do I know this? Chiropractic was already established as a science, art and philosophy long before insurance compensated chiropractors. Chiropractic benefits began in the mid-60’s, with only a handful of states participating. It wasn’t until the late 70’s, early 80’s when insurance companies began covering chiropractic services. (Source: Chiropractic in the United States: Training Practice, and Research. Chapter VI: Insurance Coverage of Chiropractic Services. Gail A. Jensen, PhD; Robert D. Mootz, DC; Paul G. Shekelle, MD, PhD; Daniel C. Cherkin, PhD.) Chiropractic has been around since 1895 and was alive and well long before the 70’s and 80’s when insurance companies began compensating chiropractors. As my dad, Dr. Thomas Owen says, "We did just fine before you came, and we’ll do just fine after you leave."
Let’s not make the mistake of thinking that the only way chiropractic will survive is being included in a government sponsored healthcare plan. As long as chiropractors remain close to the fundamental truths of chiropractic, they will not only survive, they will thrive.
Tom Owen, III, President of AMC, lectures extensively from coast-to-coast to thousands of chiropractors and students annually. He is the author of Chiropractic from a Business Man’s Perspective, and has spent the last 25 years in the day-to-day trenches of the chiropractic profession. He lives by his quote that "In the end, all that is left are the lives we’ve touched and to what extent they were changed."
Dr. Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Please visit www.amcfamily.com or call 1-423-826-0044 for more information.
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