A few months ago, I was reviewing a few charts that belonged to a chiropractor under an OIG Fraud investigation, when I stumbled upon the typical problems that plague all chiropractors and their documentation when a third party has requested a review. Flipping through the pages, I realized that the chart’s treatment plan didn’t create an end goal for the patient that could be measured. Oh yes, you could see the ever present 3 to 2 to 1 to cover the requirement for frequency and duration. In addition, the file contained the written goals of "reduce pain and subluxation," but there was nothing anywhere in the file that listed a measurable goal that would create an end point to care that would be paid for by the insurance carrier.

Then it dawned on me that every patient’s plan of care in the office should be treated based on your patient care philosophy. The doctor’s awareness of their personal style of care, their types of goals for patients and the type of treatment rendered allows for a greater understanding of what and how much will be covered by the insurance carrier by contract. Having this understanding allows the doctor to be able to communicate to the patient what to expect the out of pocket expenses will be, when the patient crosses over from active care to wellness care.

I know for a fact that every doctor who reads the title and the article to this point will say out loud that every case is different and that there is no way you can put everyone into the same care plan. But, I say, that is not true and you should treat every one of your patients with the same care plan.

The issue is the difference between a "Care Plan" and a "Treatment Plan" and this is where most doctors don’t understand how it can leave your past collections exposed to recoupment from the insurance company. Knowing the difference between these two similar documentation components can make a world of difference to the patient, the practice and the carrier.

In a care plan, the doctor will create a road map to what the doctor thinks the patient may need over a period of time to get the result intended. This is no different from laying out full course for the patient to get to a level of "ideal functional wellness" based on the doctor’s style of treatment and philosophy. In contrast, the treatment plan is the legend at the bottom of the map that measures how fast and how far you have gone on your trip. This is where the mistake is made during the documentation process. The doctor stops at this point and does not complete the process to crossover from laying out a care plan to creating a treatment plan. Now, it may be true that you, as the doctor, may want the patient to obtain reduced pain and decreased subluxation as a result of your treatment, but the minimum documentation requirements will mandate the creation of a functional baseline that can create an outcome to prove what you did was necessary. But, remember, the differentiation between a treatment plan and a care plan is that the care plan is created to gauge the patient’s response to measureable goals and other pain related goals are considered subjective or can’t be measured.

This type of distinction is evident in Cigna’s, Aetna’s and Medicare’s guidelines, as it pertains to a measurable functional improvement of the patient’s condition. In fact, over the past 6-12 months, while working to defend chiropractors, we have seen both private insurance and Medicare carriers get tougher on the lack of a treatment plan and totally discount the fact that a care plan was listed. Due to a lack of a treatment plan during a review, the carriers will typically deny care given from the first date of treatment as "not medically necessary," because the required documentation was not correctly created. Making this change will take your documentation farther than you have ever been before, to be able to create medical necessity.

I always say it is better to keep a patient for lifetime than it is to keep getting new ones. This is one of the techniques I have used for nearly fifteen years, to build a practice full of 300+visit patients. After all, if you are really seeing people for lifetime wellness care, you should have tons of people with hundreds of visits over the course of many years.

When you went to chiropractic school, how long was it before you REALLY understood chiropractic? When I ask docs this question, I typically hear some number of years as the answer: "It wasn't until I graduated and practiced a few years before I really understood chiropractic."

If it took you years to understand chiropractic, how in the world do you expect your patients to understand chiropractic in such a short time? Do you really think they get it by hearing you tell the chiropractic story or reading a brochure or coming to a new patient orientation?

Although all these methods are tried and true for generating new patients, they don’t change a person’s long-term behavior. Ultimately, the reason you educate a patient is so they will change their behavior for the better and that involves using chiropractic instead of dangerous drugs and medical care.

Look at how every other big company teaches people about their product: McDonald’s, Coca Cola, the Drug Companies, etc. What do they all have in common? They deliver a short, to the point message over and over and over again.

People learn something new by hearing the SAME MESSAGE over and over. People don’t change their behavior by seeing one big advertisement. People are creatures of habit and a message has to be delivered many times before they get it.

The philosophy behind the patient education I teach can be summarized by a term I coined, Drip-Education. How are plants best watered in the most efficient and cost-effective way? Drip-Irrigation. How are patients best educated in the most efficient and cost-effective way? Drip-Education!

Step 1:

Define the SIMPLE benefit message you want your patients to know. I say simple, because they don’t need to know chiropractic like you need to know. They just have to know it benefits them. For example, "You get adjusted to stay healthy." Or, "Getting adjusted keeps your immune system strong."

If the patient understands that, when you get adjusted, you will have a stronger immune system, would you need any further information as to why you should get adjusted? In today’s world of super bugs and infectious disease, do you need to know any more? People just know, strong immune system equals good health. What do people think when you say "nerve system"? Health? Or do they think pain, numbness, paralysis? I’m not saying to ignore the nerve system; I’m just saying it does not convey a simple message. Stay healthier with adjustments. See what happens if you start sharing the "immunity" concept with your patients.

Do you drive a car? Do you really care how all the mechanics work? Will you not drive the car unless you know how all the components work? If you like the car, will you tell your friends about how it works or just that you like the car? People choose a particular car for reasons, such as prestige, make, safety, etc; however, they still use the car to get from point A to point B.

What’s my point? In your messages, don’t get too caught up in the "how." Give them a big "why" and lots of "benefits to taking action."

As a general rule, people do not care about how chiropractic works. People choose chiropractic, because it makes them healthier (and feel better).

Now that you have a simple message to share, you’ve got to get the message out.  

Step 2:

Have a predetermined plan for getting that message to your established patients as often as possible and in as many ways as possible.

Examples:

1. Give out a weekly handout. The handout could simply be a photocopy of an article attesting to the benefits of chiropractic. "Ear infections treated by chiropractic!"

2. Send your patients an email based newsletter at least once a month. This is a no-brainer and is FREE to do. Just be sure you have their permission.

3. Send your patients a snail-mail newsletter. Keep it simple and hire a company to print and mail them for you.

4. Explain to a patient who comes in with a cold or flu how they will "feel worse" after the adjustment. That the adjustment stimulates their immune system and that a lot of people feel worse as a result, but then get better faster.

5. Explain to the mother of a child you just adjusted how that child may spike a fever, or fill their diaper on the way home, or get really energetic or sleepy afterwards. In other words, tell the patient what they should expect to occur with regard to a "healing experience." Healing can sometimes be very uncomfortable.