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Practice Management


Luck Is When Opportunity Meets Preparation
Practice Management
Written by Dr. Richard E. Busch, III, D.C.   
Thursday, 25 March 2010 00:00

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.

http://www.theamericanchiropractor.com/images/busch.jpgI 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.

 
95% of the Population Cared for by Chiropractic: The first step is up to you
Practice Management
Written by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP   
Thursday, 25 March 2010 00:00

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.

http://theamericanchiropractor.com/images/markstudin.jpgIn 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.

 
Will Chiropractic Survive under a New Healthcare Plan?
Practice Management
Written by Tom Owen III, and Todd Osborne, D.C.   
Thursday, 25 February 2010 00:00

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.

http://www.theamericanchiropractor.com/images/owen.jpgWill 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.

 
Technology for Accountability: Who’s in charge and who benefits?
Practice Management
Written by Dr. Steven J. Kraus, D.C., D.I.B.C.N., C.C.S.P., F.A.S.A.   
Sunday, 25 October 2009 00:00

If someone offered me $44,000 just for doing what I knew I needed to do anyway, I’d be the first in line. Now, this is precisely what the government is doing. And, in August, they told us who will certify the electronic health records (EHR) software systems making DC’s eligible for incentive payments. Does that grab your attention? It sure grabbed mine.

The HIT Policy Committee has ruled that the current governing body is the Certification Commission Health Information Technology (CCHIT). However, they acknowledge that multiple certification bodies can exist. For now, the CCHIT organization will be creating a special certification related to the American Recovery and Reinvestment Act, particularly the HITECH section of the Act to allow for EHR’s to meet the meaningful use and HIT Policy guidelines for EHR. The CCHIT will qualify EHR systems to assure they meet the standards required to allow DC’s to be eligible to receive up to $44,000 in incentive payments.

The sooner you adopt the right technology, the fewer objectives you’ll have to meet.

Before this August’s announcement, we didn’t have the complete picture of exactly who was going to be certifying the EHR…. Now, we know it’s a three-tiered qualification:

1. Your EHR must be certified by designated entities, one currently approved is CCHIT.

2. You must be using your EHR meaningfully.

3. You are required to report on Medicare-defined quality measures, with some possible examples being pain assessments for quality, region and intensity, as well as outcome measurement assessments.

Doesn’t sound too tough, right? That is, as long as you have the correct EHR system in place to make complying turnkey. Place the burden on your software partner, and make sure they are not only dedicated to the chiropractic profession, but are also committed to keeping your system current. Qualifying factors for "meaningful use" become more compounding in subsequent years, with additional criteria added in 2011, 2013 and 2015. Just because you’re compliant the first year doesn’t mean you’ll continue to qualify. That’s why your software partner needs to be committed to keeping up with all the programmatic criteria, so you don’t have to worry about them. Some consideration for adopting in later years is being contemplated by the HIT Policy committee.

The sooner you adopt the right technology, the fewer objectives you’ll have to meet. If your true EHR is not in place by the end of the first quarter of 2010 (and you’re not employing meaningful use and reporting), you may likely be too late to cash in on 2011’s payments—up to $18,000. Eventually, you’ll be penalized (receiving lesser Medicare reimbursements), if you don’t comply.

But what’s meaningful to you might not be to the next person. In all actuality, it doesn’t really matter what "meaningful" means to you (or the next person)—the government gets to define that. And, if you’re looking for the full $44,000, it’s best to know and employ that definition by making sure your software partner does the same.

However, before you get concerned about the government dictating what is meaningful, you should understand that the HIT Policy Committee developed its "meaningful use" guidelines to benefit three parties: the payers, the practitioners and the patients. This means we’re all working toward the same goal—more accountability that leads to better patient care.

You see, if you’re meaningfully using a true EHR, you’ll realize substantial office efficiencies, producing outcome-based assessments and proven courses of treatment with better clinical decision making right at the point of care. This leads to increased patient compliance and better results…which lead to greater reimbursements—from the government and other third-party payers. Plus, satisfied patients refer new patients. There is simply no downside here.

In order to make this topic easy for you to swallow, I’ve created a top 10 checklist for you to consider when purchasing compliant EHR software. These are just a few of the items that can contribute towards meaningful use. Make sure your system…

1. Captures patient demographics

2. Reports on quality measures, such as pain assessment

3. Provides outcome assessments with pre-loaded questionnaire tools

4. Follows the back pain recognition program guidelines in treating LBP

5. Keeps allergy and medication lists current

6. Can record history and health conditions

7. Sends demographic health information to other providers electronically

8. Electronically reports to patients the findings of their radiology or lab results

9. Offers diagnosis-based handouts/videos—provided to patient and documented in the chart

10. Is interoperable with other diagnostic equipment in your office, such as digital X-ray or inclinometer ROM devices.

All of the above position you well for government incentive payments. The list doesn’t stop there. But don’t just do it for them—adopt the technology to benefit you and your patients. It doesn’t have to cost you a pretty penny.

Reports indicate the average cost for a medical physician to adopt and integrate qualified EHR is between $40,000 and $60,000. The average cost for a chiropractic physician to do the same is $12,000 for the software (plus any hardware you might need). This could be due to a variation in what the respective markets will bear. Take that as you might, but it means you’re positioned for full reimbursement for your software, hardware, training time and conversion to digital.

When you adopt technology that will make your life easier, better the patient experience and outcome, as well as position you for improved third-party reimbursement, you can be confident that you’re being accountable to the EHR federal qualifying criteria, but also to your practice and to your patients. And that’s a win-win-win scenario.

Dr.-Steven-J.-KrausDr. Steven J. Kraus is CEO of Future Health, Inc., a company that partners with chiropractors to deliver a comprehensive clinic management solution, including fully-integrated EHR. Dr. Kraus is a recognized expert in building successful clinics, having developed and sold 18 practices of his own and provided strategic consulting services to more than 400 healthcare businesses. He offers leadership to numerous industry associations and currently serves as the Chairman of the Iowa Board of Chiropractic. Contact Dr. Kraus at This e-mail address is being protected from spambots. You need JavaScript enabled to view it for more information.

 
You Should Give All Your Patients the Same Care Plan
Practice Management
Written by Dr. John Davila, D.C.   
Friday, 25 September 2009 16:56

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.

 The issue is the difference between a "Care Plan" and a "Treatment Plan"

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.

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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.


Dr. John Davila is a 1994 graduate of Palmer College of Chiropractic in Davenport, IA, and practiced in Dr.-John-Davilathe Myrtle Beach, SC, area for 13 years. Since 2000, he has been consulting with insurance companies and doctors in private practice in the areas of coding and documentation. In 2001, he re-wrote the Medicare LCD coverage policy for Palmetto GBA (SC Medicare). His company, Compliant Services & Solutions, Inc., helps doctors of chiropractic to ethically maximize their practices, while avoiding audits and repayments to insurance carriers. You can reach Dr. Davila, toll free, at 1-877-322-6203 or by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or on the web at www.ComplaintUSA.com.

 
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