Practice Management

Practice Management Tips
Practice Management
Written by Mark Sanna, D.C.   
Tuesday, 14 September 2004 21:53

Q: What was it like growing up as a child of a chiropractor?

A:  Growing up, our toys were the equipment in Dad’s home office.  My sister and I would take turns climbing on to the headpiece of the old porcelain-based, high-low table and launching each other through the air by stepping on the spring-loaded foot piece.  There was always a plastic model spine around, which was very useful for frightening the neighborhood children during Halloween and for countless “show and tells” at school.  Since Dad was studying Applied Kinesiology, we learned it to.  We would amaze our little classmates by muscle testing them before and after they opened a package of sugar under their tongues.  My first patient was our family dog, who received so many “adjustments” from me that I think she expected an audible release every time I would pet her!  When asked, as a young child, what I wanted to be when I grew up, I would always answer, “a dog-o-practor!”

Growing up the child of a chiropractor had its challenges too.  I can remember the time when I was in the first grade and some kids called my Dad a “quack” during recess.  I remember being confused at first, and then hurt, that my Dad wasn’t as good as the other kids’ dads.  When I went home that night, my parents reassured me that Dad wasn’t a quack.  It was my first lesson in the discrimination that confronts chiropractors even today!

Q: What are your dreams & aspirations for the chiropractic profession?

A:  My goal is to see chiropractic recognized for its central and unique role in the delivery of healthcare.  My vision is to have all chiropractors experience the freedom that results from financial abundance.  I know that it is only by creating a generation of financially affluent chiropractors, who are motivated to support our profession, will chiropractic win the respect that it deserves.  It takes significant financial resources to affect public policy on a legislative level.  The best lobbyists and legal counsel are extremely expensive.  My goal can only be achieved if chiropractors come together in a spirit of unity to protect our profession.  Our chiropractic licenses are not an entitlement, they are a treasure.  A treasure that was hard fought for by a generation of chiropractic pioneers, some of whom were jailed for their convictions.  Many of us take for granted the ability to freely practice our profession, but we must remember there are still many who wish to deny us this right.  We can never stop fighting for the complete recognition of our value to humanity until the battle is won.  Our patients deserve nothing less from us.

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.

Create Your Future: Use of an Effective Business Expansion Planning Calendar
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Tuesday, 14 September 2004 21:51

Let’s face the facts.  Although the average chiropractor does see an occasional “walk-in” new patient, this is more the exception than the rule.  We, as chiropractors, consider that there is a minimum number of new patients that we need to see each week in order to be satisfied that our practice will continue to grow at the expected rate. The question, is what do we need to do to insure that new patients continue to arrive at our front door?

Every business should have a business expansion plan, as growth of a business normally occurs by acquiring new business.  Whether it is a new customer, new client, or new patient, new business is our lifeblood.  Wouldn’t it be helpful, in the case of a chiropractic practice, if that minimum number of new patients were planned for? The average practice would grow almost immediately. If you knew that there would be ten new patients in your clinic scheduled for next week, and you had your usual amount of “unplanned” new patients, your new patient worries would simply disappear.  By planning your new patient activities in advance, you are essentially guaranteeing yourself that, by doing activities this week, you will have new patients five weeks from now.

The first step in this process of planning for acquiring new patients is simply to make the decision that you are going to take control of this area of the practice.  Then, begin putting together your business expansion-planning calendar, a month-at-a-glance style calendar that goes at least a year into the future. The calendar should be on your desk where it can be looked at every single day. A list of all possible new patient procedures should be made.  This list has endless possibilities, but begins with the most straightforward activities—perhaps those that you do daily or weekly—like asking for referrals from your existing patients.  Pick Monday and Thursday next week for this process and write the activity in the calendar so that it is planned, and you know exactly when you will be doing this.  You will then want to plug this activity into your calendar for the next six months or so.  Do this same procedure with all of the activities you can think of that, realistically, you will accomplish, and insert them into your calendar well into the future.

Perhaps there is a health fair in your community every three months.  Make the necessary connections with the necessary people, and get those events scheduled into your calendar. Next, schedule your outside lectures for the next year. Schedule your staff training for each week. Perhaps once or twice per month, you need to get into your local business community and meet some key people.  Insert in your calendar that you need to do video consultations with your patients once per week.

These are only a few examples of new patient procedures; however, all too often, the doctor just “hopes for the best” by doing marketing procedures as needed or when he thinks of doing them or, worse yet, when that number of new patients is too low, and the stress levels begin to be too high.  If the activities are pre-planned, and written down, and the calendar gets looked at on a regular basis, the activities will be completed.

Once the calendar is complete, then the ball is essentially in your court.  You must look at the calendar, and do the pre-scheduled activities.  Once one is completed, make a large blue checkmark over that action so that it is clear that you did, in fact, do it. These actions can be adjusted within the calendar in order to make the most effective use of your time.  If you do not complete a scheduled task, and you realize it too late in that day to do it, then simply write in you calendar in red the words “not done.”  Then reschedule that activity as soon as possible and complete it.  As you view your month at-a-glance calendar, after the first few weeks, you will easily be able to tell if your business expansion planning is on track as you note all of the blue checkmarks, or way off the track if it is full of red ink words that say “not done.”

Get started on your calendar process as soon as possible, and watch the difference in your practice as well as the difference in yourself.  Once you have this system in place, and you are comfortable with your daily, weekly and monthly tasks being completed, you will have no trouble scheduling a little free time to relax and enjoy yourself.

Dr. Maurice A. Pisciottano, Executive Director of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, researcher and teacher.  He is well known for his practice management expertise and new patient development programs.  He has devoted the past 14 years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Worldwide, Dr. Pisciottano has trained over 10,000 chiropractors and treated over 650,000 patients with the Pro-Adjuster®.  He regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  Dr. Pisciottano is an honors graduate from the Palmer College of Chiropractic.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Compliance: The Cornerstone of a Healthy Practice
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Tuesday, 14 September 2004 21:48

Today, more than any time in our history, doctors are being watched.  Big Brother is watching!  So many offices are worried about HIPAA. Yes, if you violate HIPAA, you will receive a fine.  However, if you do not follow the rules of the OIG (Office of the Inspector General), you may not only be fined, you may face jail time.

As a consultant who works with integrated practices, it stuns me to see how many offices have integrated by themselves.  They get a legal document from a friend and move forward.  Then they wonder why they are on the cover of Dynamic Chiropractic.  There is no right way to do the wrong thing. Whether you are integrated or not, you must play by the same rules.  These are not separate for MD’s and DC’s; they, like HIPAA, are for all Healthcare.

If you are in practice, know the rules.  If you are integrated, hire an attorney.  While attorneys can help you with the legal documents, most often they are not familiar with billing, coding and compliance.  This is why consultants are so important—not just to provide you with the rules, but to make sure your practice is compliant.  It begins with knowing the rules.  

Code of Conduct

It is the policy of all of my clients’ offices to instruct and understand that all individuals associated with the practice conduct themselves in an ethical manner and in conformance with all federal and state laws and the policies and procedures of the employer. To this end, your office’s Conduct Code and Compliance Program are to be prepared to provide employees, as well as those with whom your office does business and the general public, with a formal statement of commitment to the rules of ethical conduct as spelled out in this Code.

It is imperative that all my clients and personnel comply with the standards contained in the Code, and immediately report any alleged violations thereof to the Compliance Officer.  This is where you begin.  You must designate an employee to hold this title and assist in investigating any allegations of wrongdoing. It is our policy to prevent the occurrence of unethical or unlawful behavior, to halt such behavior as soon as reasonably possible after its discovery, and to discipline personnel who violate the standards contained in the Code and the Compliance Program.

No Code of Conduct can cover all circumstances or anticipate every situation. Therefore, should an employee encounter a situation which is not addressed specifically by this Code, he/she should apply the overall philosophy and concepts of this Code to that particular situation, and observe the ethical standards of honorable people everywhere.


It is the responsibility of your office to obey the law. Personnel are encouraged to report all that they are doing to achieve their goals, to record all transactions accurately in their books and records, and to be honest and forthcoming with auditors. We require that all employees conduct themselves in an honest and ethical manner, including honest bookkeeping, honest budget proposals, and honest economic evaluation of projects in all aspects of an employee’s work.

Conflict of Interest

Your office and all employees must avoid situations in which their personal interests could conflict, or reasonably appear to conflict, with the interests of their employer. A conflict of interest could exist in any opportunity for personal gain, apart from the normal compensation provided through employment or payment for services rendered.

Dealing with Suppliers and Patients

Conducting business with suppliers and referring providers may pose ethical or even legal problems. The following guidelines are intended to help all personnel to make the proper “ethical” decisions.

1.  “Kickbacks” and Rebates:  Employees (or their families) may not receive personal kickbacks or rebates in exchange for the purchase or sale of goods or services at any time.  “Kickbacks or rebates” can take many forms and are not limited to direct cash payments or credits. In general, if you or your family stands to gain personally through the transaction, it is prohibited. Such practices are not only unethical but are, in many cases, illegal.

2.  Gifts or Gratuities:  Employees may not, under any circumstances, accept gifts of money, nor may they solicit non-monetary gifts, gratuities, or any other personal benefit of any kind from suppliers or patients. Employees may accept unsolicited, non-monetary gifts from a firm or individual doing, or seeking to do, business with you only if the gift is of nominal value, or the gift is primarily of an advertising/promotional nature.

3.  Entertainment:  Personnel may not encourage or solicit entertainment from any individual with whom your office or employees do business. From time to time, employees may offer or accept entertainment, but only if the entertainment is reasonable, occurs infrequently, and does not involve lavish expenditures.


Insurers and patients shall not be charged for more expensive services or equipment than that actually provided. Examples of overcharging include:

· Billing for more complex or sophisticated (and thus more expensive) services or equipment than actually provided (up-coding);

· Billing two insurers, such as Medicare and a private insurer, for the same services or equipment; and

· Waiving a patient’s co-payment without informing the government so that the government believes that your charges are higher than they actually are.

Books and Records

Falsification of Records:  Federal law requires us to ensure that our books and records accurately reflect the true nature of the transactions represented.  It is against our policy for any employee to cause our books and records to be inaccurate.  This is why we like ink, versus pencil.

Examples of false or artificial record entries include the following:

· Making the records appear as though medical services or equipment were provided to a patient when, in fact, no such equipment or service was ever provided to that patient;

· Making the records appear as though one type of medical service or equipment was provided to a patient when, in fact, a different type of medical service or equipment was provided to the patient;

· Making the records appear as though a medical service or equipment was provided to one person when, in fact, it was provided to another;

· Making the records appear as though a medical service or equipment was provided to a patient on a certain date when, in fact, the service or equipment actually was provided on a later date; and

· The creation of any other records that do not reflect the true nature of the transaction.

Any employee who knows, or should know, that he or she is making false or artificial record entries shall be subject to disciplinary action, including possible termination.

Employee Relations

It is the responsibility of your office to provide equal employment opportunities to individuals who are qualified to perform job requirements, regardless of their race, color, sex, religion, national origin or age. There are laws that prohibit discrimination against minorities, sexual harassment, and similar misconduct. Regardless of any legal prohibition, every u employee has a right to work in an environment free of harassment or discrimination based upon sex, race, creed, physical condition or national origin. All employees shall treat each other with courtesy and fairness and have respect for the dignity of others.

Reports of Wrongdoing

Each employee has a duty to report any suspected violation of your office’s Code of Conduct. If any employee reasonably suspects that any employee, subcontractor or agent is involved in any sort of criminal wrongdoing, or has or is violating the guidelines or policies contained in the Code, that employee should immediately report those suspicions directly to the Compliance Officer. In the event that an employee feels that a report has been given inadequate attention by the Compliance Officer, the employee may report to the Clinic Owner or Administrator.

Remember this rule:  REPORTS OF VIOLATIONS BY EMPLOYEES MAY BE MADE WITHOUT FEAR OF RETALIATION.  This is a mandatory component.  If you would like more information, go online to Office of the Inspector General. 

And, finally, remember that compliance is not an option.  Follow your heart, be true to yourself, and be true to your profession.

The world of healthcare and compliance is based on results.

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.  For more information, call (561) 626-3004.

Dr. Eric S. Kaplan NOTE:

Be sure to check the Upcoming Seminar Section for more information on a great chance to DO THE RIGHT THING!  For a limited time, register to win FREE tickets at, courtesy of LPG, our Title Sponsors.

Maximize Your Practice's Potential
Practice Management
Written by Daniel Dahan, D.C.   
Thursday, 08 July 2004 21:27

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas will be dealt with beginning with this issue and continuing in subsequent issues of The American Chiropractor.  By following the steps given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

Front Office Reception

Front Office / ReceptionThis is by far the most important department in your office.  Indeed, all your patients must first call to set up an appointment for times of service.  Hence, the initial contact is entirely determined by the content of the call.

Since introduction to patient infor-mation as well as all primary questions are typically presented to the front desk receptionist, the individual responsible for handling the call should be organized and dedicated, pleasant, knowledgeable in all aspects of the practice, always smiling, polite, courteous, soft spoken but with an assertive voice, and have a great command of language (the one spoken by most patients).

He or she should be able to give directions to the clinic from major crossroads, be fully aware of your hours of business, and have access to an extensive list of services available at the clinic, prices, as well as general insurance plan requirements, co-patient deductibles, and should also have a basic understanding of modalities and procedures used.  This team member should know whom to go to with issues when they arise, and possess the ability to make multiple appointments.

As a side note, in the 1,000-plus centers that we manage, we typically find that, when a doctor’s family member (spouse, sibling, offspring) runs the front office, there are fewer complaints, excellent collections and hardly any cancellations.

In conclusion, the front office staff member is to be very well trained in continuous coaching to patients so that your office reaches its ultimate goal, which is treating as many patients as possible in the best environment with exceptional care. TAC

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit

The Financial Stability of Family Practice
Practice Management
Written by Dr. Eric Plasker, D.C.   
Thursday, 08 July 2004 21:23

Chiropractic Family Practice is extremely profitable. Rather than working harder and harder for their money, chasing insurance companies only to be denied payment, losing patients because their insurance doesn’t cover the care anymore, and dealing with the incredibly stressful, high overhead that comes with other types of practices, thousands of chiropractors are becoming the family wellness providers for their communities.

The foundation of family practice that makes it work is scientifically and wellness based. We all know that a healthy spine is necessary for people to be healthy. We’ve all seen the patient with severe spinal deterioration who did not have pain until their body couldn’t handle the pressure anymore.

According to the medical journal Spine, “Nerve root compression can exist without pain.”  E.J. Wall reported in the Journal of Bone and Joint Surgery that stretching a nerve as little as six degrees can decrease the strength of the nerve impulse by as much as 70%.


Promote Family Spine Health & Care

Every member of the family should have his/her spine examined during every stage of growth and development, regardless of whether there are symptoms.

Spinal injuries that are left uncorrected can:

· alter spine and nerve development,
· lead to immediate and long term health problems that cause pain, or
· disguise themselves as other types of sicknesses and health problems.

For all these reasons, patients should bring in their family members for chiropractic examination within the first two weeks of beginning care.

Left uncorrected, spinal injuries can alter spine and nerve development and lead to immediate and long term health problems that cause pain, or disguise u themselves as other types of sicknesses and health problems.

For all these reasons, every member of the family should have his/her spine examined during every stage of growth and development, regardless of whether there are symptoms present or not. People should have their spines checked regularly, even after their initial care is complete and all their symptoms are gone. Patients should bring in their family members for chiropractic examination within the first two weeks of beginning care.

The economic impact of this strategy will be both immediate and long term. The immediate impact is that you will double, triple and even quadruple the number of new patients you get every month, because you turn every new patient into a new family. With congruent patient education in place, you will become the family doctor for these families and they will pay you for their immediate care and long-term care.

I have seen chiropractors who are new in practice build a half-million-dollar practice within three years practicing this way from day one. I have also seen practice veterans of ten, twenty and even thirty years, add this wellness base to their current practices, increasing their profit, and taking the stress out of their lives.

Promote Family Spine Health & CareAt the end of next year, rather than wondering where all of your new patients have disappeared to, wouldn’t it be nice to see that you are building your practice with the stability of lifetime chiropractic families. Most chiropractors are sitting on a goldmine and they don’t even know it. It’s time to capitalize and mine the gold by turning every new patient into a chiropractic family for life.

Whether you want a family practice exclusively, or you want to add this solid financial base to your practice, master the economics of family practice and make your practice dreams come true. TAC

Dr. Eric Plasker is the founder and CEO of The Family Practice, where chiropractors are uniting to lead family health care. The Family Practice provides all the tools, resources, practice management and personal coaching necessary to help chiropractors build first-class family practices. He can be reached at 866-532-3327, Ext. 118, or online at


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