In all my recent meetings with government officials, including several trips to Washington, D.C., and participation in numerous reform initiatives, like the regional White House Forum on Health Care Reform, major buzz surrounds the electronic health records portion of the economic stimulus plan. To date, much has been discussed about the American Recovery and Reinvestment Act (ARRA) of 2009 and its impact on healthcare and, with more than $19 billion of the economic stimulus package dedicated to the implementation of electronic health records across the nation, the attention is warranted. Though the rules and standards related to implementation have not been fully established, some key elements have been confirmed that influence decision-making today.

Let me first emphasize that the Electronic Health Record (EHR) package is directed at physicians, and doctors of chiropractic are included because the ARRA of 2009 adopted the definition for physicians for this program from the Social Security code. This is an important note, as not all healthcare professionals will be eligible for incentive payments, but chiropractic physicians are an approved group.

In order to fully understand the incentive payment requirements, you must ask yourself two integral questions to determine eligibility. Do you have a qualified EHR product? And are you using it meaningfully in practice?

To be qualified, the EHR system must have the capacity to handle patient demographics and clinical health information. It must also have clinic management capabilities, as outlined by the entity that certifies qualified EHR’s. Only certified EHR’s will be considered for incentive payments, and the certification body has yet to be named. However, most insiders predict that the Certification Commission for Healthcare Information Technology (CCHIT) will be selected, as it is the only entity currently approved by Medicare for EHR certification.

So, if you have a qualified EHR, are you using it meaningfully? "Meaningful use" is defined by three key measures: (1) Connectivity to health information exchanges (HIE’s) and other EHR’s; (2) Regular reporting of quality measures to the Centers for Medicare Services (CMS), including outcome assessment scores and pain assessments; and (3) e-prescribing capability (Note: because chiropractic physicians do not have prescribing privileges, it is unknown whether this will remain a requirement for DC’s.). The framework that has been introduced suggests that reporting quality measures to CMS will likely be managed by PQRI, the Physicians’ Quality Reporting Initiative, a standardized mechanism that already exists. More rules regarding reporting requirements are expected to come at a later date.

Once you answer "yes" to the above questions, as much as $44,000 is available as a post-adoption incentive for implementing EHR. What’s more, for clinics with multiple physicians, each physician can qualify for an incentive payment, as long as a qualified system is being used and each physician is using it meaningfully, as the terms outline.

To qualify for the full incentive payment of $44,000, your EHR system has to meet the aforementioned qualifications, no later than 2010, to begin earning incentive payments in 2011. If you’ve already adopted a system that meets these guidelines, then you automatically qualify for the incentive payment.

And, while we know that the Department of Health and Human Services and the Center for Medicare Services will be involved, their specific roles are still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds, such as an annual $25,000 in covered services to CMS, are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify.

The chart included with this column outlines the incentive payment schedule in simple terms.

The ideal timeline for implementation

Typically, it takes 90 days to six months to plan, train, and implement the new EHR system. PQRI currently states that you have to report on 80 percent of your patients. Assuming PQRI is a requirement for demonstrating meaningful use, it stands to reason that you would have to use the system for the better part of 2010 to begin receiving your first incentive payment in 2011.

Implement in 2009, use the system in 2010, and begin receiving incentive payments through Medicare in 2011. If you opt not to transition to an electronic health record system, you will be penalized beginning in 2015 through 2018. These penalties will be assessed against your normal reimbursement for services from Medicare.

So far, only 15 to 20 percent of DC’s have moved to EHR. With enormous financial incentives to support the move, there is no longer an excuse to wait. There are just too many good reasons to adopt!

The Lost Sale

Whether a doctor, lawyer, architect, you are in the business world. The business world is a world of selling. There is a powerful technique you can learn called the "I Want to Think It over Close." This is the only way I know to save this kind of lost sale. You know by now that, when the customer says, "I want to think it over," he is really saying, "Goodbye." You know from your own experience that customers do not think it over. They do not sit there carefully studying your brochures and your office fees with a calculator and a pen.

The key to any system is the infomercial. With a good infomercial, patients should be closed by the time they come to your office. If they say, "I want to think it over," it was something you did in your close that lost them.

People Are Often Ready to Buy

Patients who come to your office are ready to buy. I don’t care if they come in for a free examination. NO one fills out a Health History and then waits to see you, not really wanting care.

On the other hand, as many as 80 percent of the people you speak to are probably ready to start care at this point. They just need a little push. They need some help. A buying decision is traumatic for them. They are tense and uneasy, and afraid of making a mistake. They may be right on the verge of saying, "Yes," and they need the professional guidance of an excellent doctor. They will look you in the eye and, when they do, they are saying, "Can I trust this person?" My question to you is, can they?

Patients come to your office looking for trust. You can accomplish this by doing a great consultation and a thorough examination. You affirm this by telling the patient what they need and nothing more. Your Report of Finding should not be a sales-scripted speech like many consultants teach. It should be from your heart and be a review of their problems, objective findings, and necessary treatment. If they trust you, they will abide. But, if you accept the "I want to think it over" at face value and depart, you will probably never get a chance to see them or to treat them again.

Be Agreeable

This is how you use it. When the potential patient says, "I want to think it over," you appear to accept it gracefully. You smile agreeably, and begin pulling down the X-rays and putting your materials and their file away. As you do, you make conversation with these words: "Mr. Prospect, that’s a good idea. This is an important decision and you shouldn’t rush into it." These words will cause the prospect to mentally relax. He sees that you are on your way. His resistance will drop as soon as you stop presenting and trying to sell.

Ask the Question

You then ask, in a curious tone of voice, "Mr. Prospect, obviously you have a good reason for wanting to think it over. May I ask what it is; is it the money?"

Remain perfectly silent, watching his/her face. Smile gently. Take a deep breath and let it out slowly. This is a critical moment.

Wait Patiently

Again, you have nothing to lose. If you leave, you have lost this person as a patient, possibly forever. The worst thing that he/she can say is that he/she has no particular reason but that they still want to think it over. However, in many cases, they will reply by saying one of two things. They will say, "Yes, I’m concerned about the cost." Or, they will say, "No, it’s not the money."

Diagnose the Answer

If he/she says, "Yes, it’s the money," you immediately go into a series of questions designed to deal with patients about cost or price.

You ask things like, "How do you mean, exactly?" "Why do you say that?" "Why do you feel that way?" "What if I can make it more affordable to you?" "Is this your only concern, or is there something else?"

If he/she says that, "No, it’s not the money," you reply by asking, "May I ask what it is?"

Sometimes you must diagnose the patient’s answer to find the reason. Usually, the problem is money. Remember, if they came from your infomercial, they were presold. You unsold them.

Silence Is Golden

Again, you remain perfectly silent while you wait for their answer. In many cases, they will think about it for a few seconds, even a minute or longer, and then they will give you their final concern or objection. They will finally tell you what is really on their mind. They will tell you the real reason why they are hesitating about going ahead.

If you can now satisfy them on this final condition, you can go on to conclude the sale. You can say, "Mr. Prospect, what if we could do this...?" Or, "I think there is a perfect answer to that question."

Now is your time to guide the patient. Remember, they have opened to you. To tell someone you have a money problem or, "My husband won’t allow this expense;" or whatever they have told you is not easy. You have begun trust. Be grateful; be sincere.

Here are two things you can do immediately to put these ideas into action. First, you do not have to memorize the words and phrases of your closing technique and practice it as you would for a play or movie. I do not agree with a four day report. Patients want honest sincere answers. Be the Doctor; tell them of their kinesiopathology, histopathology and what is needed to resolve their problem. Role-play this technique with someone else, if you can. The key is to be sincere. Have an outline, a map, and follow it.

Second, use this technique as soon as possible, the very next time you hear those words, "Let me think it over." You can save sales that might be lost forever.

Be an Optimist at All Times

The key to any close is to offer hope to the patient. If they do not believe you can help them, they will leave. Everyone wants to be physically healthy. You want to be mentally healthy, as well. The true measure of "mental fitness" is how optimistic you are about yourself and your practice. Learn how to control your thinking in very specific ways so that you feel terrific about yourself, your practice, and your situation, no matter what happens. This attitude will build your practice.

Control Your Reactions and Responses

There are three basic differences in the reactions of optimists and pessimists. The first difference is that the optimist sees a setback as temporary, while the pessimist sees it as permanent. I love to borrow money from a pessimist; he never expects to be paid back.

The optimist sees an unfortunate event, such as a patient that does not get well or a new patient that does not show up, as a temporary event—something that is limited in time and that has no real impact on the future. The pessimist, on the other hand, sees negative events as permanent, as part of life and destiny. New patients are either optimists or pessimists as well. The optimists are an easy close; the pessimist will be pessimistic. You have to help them overcome their own mental barriers. Do not drop to their level. They will migrate to your attitude, so take the time necessary.

Setbacks Are Temporary Events

For example, if something you were counting on failed to materialize and you interpreted it to yourself as being an unfortunate event, but something that happens in the course of life and business, you would be reacting like an optimist. The pessimist, on the other hand, sees disappointments as being pervasive. That is, to him, they are indications of a problem or shortcoming that pervades every area of life.

Don’t Take Failure Personally

The third difference between optimists and pessimists is that optimists see events as external, while pessimists interpret events as personal. When things go wrong, the optimist will tend to see the setback as resulting from external factors over which one has little control. Don’t let one negative patient dictate your protocol.

If the optimist is cut off in traffic, for example, instead of getting angry or upset, he will simply downgrade the importance of the event by saying something like, "Oh, well, I guess that person is just having a bad day."

The pessimist, on the other hand, has a tendency to take everything personally. If the pessimist is cut off in traffic, he will react as though the other driver has deliberately acted to upset and frustrate him.

Be personal to your patients, but don’t take things personally.

Don’t Be Nearsighted

Look upon the inevitable setbacks that you face as being temporary, specific and external. View the negative situation as a single event that is not connected to other potential events and that is caused largely by external factors over which you can have little control. Simply refuse to see the event as being in any way permanent, pervasive or indicative of personal incompetence or inability. As a doctor, you have the ability to touch people’s lives—that is a gift that is priceless. Money will come, but only through sincere service.

Resolve to think like an optimist, no matter what happens to you or your practice. You may not be able to control events, but you can control the way you react to them.

React well. Have a great month; see you at the TOP!

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. Co developer and President of Discforce the next Generation on Spinal decompression. For more information, call 1-561-626-3004