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Special Feature
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Special Feature
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Written by Dr. Miles Bodzin & Dr. Ray Foxworth
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Tuesday, 23 October 2012 19:02 |
B etween our two companies, Cash Practice and ChiroHealthUSA, we hear from hundreds of doctors a month who think they want to transition to an all cash practice. The reasons are varied, but are most commonly related to frustrations in dealing with insurance companies, hearing about or being involved in a recent audit, dwindling reimbursements and increased demand for pre-cert paperwork or documentation.
 We also find there are many misperceptions about going all cash. Such as, going ALL cash means you are finally free to do what you want in making recommendations to all patients about their care. You can opt-out of every network and disregard terms of the PPO agreements. And, the BIG LIE many have heard is if you are all cash, you are immune to all the rules and regulations from your Board of Examiners, all the way up to CMS and the OIG, when it comes to proper documentation, billing, coding, discounting, state and federal inducement violations and other red tape including HIPAA.
As is usually the case, the truth lies somewhere in the middle. Going all cash or transitioning to a more cash-based practice can be liberating in many ways, but it is not a panacea. If your State Board of Examiners has outlined the minimum standards for documentation, you are still bound by those standards, regardless of who is paying the bill.
If you see patients who may be insured, they will expect to be provided with a proper receipt reflecting your diagnosis with the proper ICD-9 codes, the procedures you performed with proper CPT codes and, if the patient submits the receipt to their insurance carrier for consideration, you may certainly expect to receive a request of records to support medical necessity. And, while you may have been “PAID” by the patient and think you are in the clear 100%, if your record keeping and coding is not up to par, you can probably expect a complaint filed with your board from a patient who may have SWORN they did not intend to send in receipts to the insurance carrier since you are all cash.
Now, as soon as we write this, we are going to hear from someone who says, “My attorney says if I have them sign this form that they won’t file, or that they can’t file a claim when they pay cash, I’m in the clear.” If that is the case, good for you and make sure you have that attorney on retainer because there is NOTHING worse than dealing with a “ticked-off” patient who decides later that they want their insurance company to pay them back and YOUR notes or records are sub-standard. So much for being immune from rules and regulations by going all cash!
Another area where doctors often think going all cash brings them freedom is in making treatment recommendations and offering varied forms of payment plans or pre-paid plans, especially if the patient is paying cash. Once again, while there is some freedom from not being involved in insurance networks, there are other rules and regulations that may come into play.
In several states, Boards of Examiners have promulgated rules about pre-pay plans and require escrow accounts to be utilized.
In several states, Boards of Examiners have promulgated rules about pre-pay plans and require escrow accounts to be utilized. Why? You can bet it is because of patient complaints related to refunds! Also, there are some states that consider collecting in advance for health care services to be the “business of insurance” and you must have an insurance license issued by the state.
Finally on this topic, keep in mind that if you are seeing a patient with insurance, even if YOU are out of network, the patient has certain obligations as a policyholder, such as paying the required deductibles and copayments. Be aware that if you, even as an out of network provider, offer pre-payment plans that include any discounts on the patient’s cost-sharing portions, the insurance company may not be liable for any payment or reimbursement back to the patient.
Diversified Isn’t Just a Chiropractic Technique
We are seeing that more and more doctors want to become less dependent on insurance. And there are some who want to go 100% cash, but they are not the norm. For most doctors, the smart move is to do what your investment banker might suggest, “Diversify”. Meaning, don’t be 100% anything! Have a good mix of insurance, personal injury, workers’ compensation and build up your cash side of the practice. This will bring you the ultimate in practice stability and peace of mind by not having your practice disappear overnight if all your financial eggs are in one basket. For doctors who were ALL PI or workers’ comp and practiced in states where changes to these payment methods were implemented, ask them what it is like the day AFTER the law changes and PI or workers’ comp vanished.
As long as you understand that the transition to a cash-based practice does not make you invisible from regulators or grant you immunity, then we encourage you to consider diversifying your practice to include more cash-based patients and become less dependent on insurance.
Transitioning to Cash-Based Practice has MAJOR Benefits Even When the Patient Has NO Insurance Benefits!
There are three major benefits of placing your patients, particularly cash patients, on long-term care plans. The first benefit is you rarely have patients drop out of care because "the pain went away" or "the insurance ran out". Those are the two most common excuses doctors will state as the reason patients drop out of care. And both are completely neutralized when placing a patient on long-term care plans. So you end up with better treatment compliance.
There are three major benefits of placing your patients, particularly cash patients, on long-term care plans.
The second benefit is a result of the prior benefit. You get better clinical results, get more referrals and become more profitable as a practice. It is pretty obvious that if your patients are staying on your care plans, they will get better and will be more likely to refer friends and family.
We also need to state that if you are recommending long-term care plans, you better be able to deliver on the promises you make. We are not talking about just providing "pain relief" type care for a longer period of time.
Let's be real. If you want to deliver on the promise of wellness, you better be able to demonstrate improvements in the patient's well-being. There are some great tools and resources available for doing just that.
When recommending long-term care plans, obviously there will be a fee for your services. It is crucial that the way you collect the fees for your care plan is setup correctly. We should start by stating what NOT to do. The idea of offering a plan of care where the end goal for all patients is to prepay for the program (i.e. prepay for a year of care) is not recommended. Why? The challenge is, prepaying for anything (outside of chiropractic) is not the norm for people and, as noted before, could be considered the business of insurance in some states.
People are used to "financing" everything these days. Look at how TV commercials promote a car. Do they advertise the price of the car? No, they tell you the lowest monthly lease payment available. They do that because they know that the majority of people make a purchase decision with the "monthly payment" in mind rather than the total price.
So, offering your patients a long-term care plan that offers payment options is what we recommend. By offering options, the patient will pick what works best for them. The options are monthly payments, a larger down payment with smaller monthly payments and a prepayment for the folks that want to choose that option where it is legal. We find that most people choose one of the first two options.
The last thing about collecting the fees for these plans is to consider using an auto-debit program to collect these payments. Our experience has shown that the more often people think about the money you are charging, the more likely they will stop care. We have a policy in place to remove every situation we can that reminds them of the money. So, no statements are mailed. No third-party financing (i.e. Care Credit or similar plans). We securely keep their credit card or bank account information on file in a PCI compliant program and run the payments on the agreed upon date. This is no different than having a routine to submit claims every Tuesday or on the 1st and 15th. With a proper auto-debit system, it can be BETTER than insurance since there is NO waiting for reimbursement or claims rejections!
The bottom line on transitioning to a more cash-based practice is to do it for the right reasons. We encourage all of our clients, even those who choose to go 100% cash, to remember that regardless of the payer type, you should document correctly, code correctly, bill correctly and, if you discount or offer payment plans, make sure you are handling those correctly and start practicing with more peace of mind.
Dr. Bodzin is the Founder and CEO of Cash Practice Inc, a web-based company that provides The 4-Step Process for Reducing Your Dependence on Insurance and New Patients.The Wellness Score, Cash Plan Calculator, Auto-Debit, and Drip-Education Email Systems give the practicing chiopractor tools for implementing the four steps. Dr. Bodzin speaks internationally on running a cash-based practice for Associations, Parker Seminars, Philosophy Groups and for many of the coaching companies. Dr. Bodzin can be reached at 1-877-343-8950,
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or by visiting www.CashPractice.com.
Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. He founded ConservaCareCorp, the first chiropractic network selected by the State of Mississippi to serve over 195K covered lives in the State Health Plan. You can contact Dr. Foxworth at 1-888-719-9990,
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or visit the ChiroHealthUSA website at www.chirohealthusa.com
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Special Feature
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Written by Kathy Mills Chang, MCS-P
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Tuesday, 23 October 2012 18:24 |
M ore often than not, doctors decide about insurance participation based on the horror stories they hear from their friends. It's not unusual for both new and seasoned practitioners to throw up their hands at the prospect of dealing with insurance companies on behalf of their patients. More doctors are also concocting ways to skirt working with Medicare. None of this is necessary. Insurance coverage is a treasured commodity that patients feel compelled to use because of the premiums they pay. A typical practice working within the boundaries of compliance and proper documentation and billing should have no problem working with third-party payers. To cultivate a healthy doctor-carrier relationship, focus on these five areas: 
- Ensure You are Properly Credentialed
- Understand the Expectations and Limitations
- Know the Medical Review Policy
- Bill and Code Correctly
- Firmly Follow Up
Ensure You are Properly Credentialed
Every carrier has rules about who does what to whom and who gets the $5, as they say. There are two kinds of relationships possible with a typical carrier: a participating or a non-participating agreement. This is delineated by the rules associated with the contract signed. Medicare, however, is a different animal: Whether participating or non-participating, you must be registered with Medicare to see any Medicare patients. That means you have applied for provider status and are legally allowed to see Medicare patients. Chiropractors have an extra layer of regulation, in that if a chiropractic manipulative treatment (CMT) code is provided, you must be able to bill it, and without being registered with Medicare, participating or not, you can’t bill without a Medicare number. And yes, we are all aware of the nightmare getting registered with a carrier, and Medicare in particular, can be. Here is a story related by KMC University Medicare Reimbursement Specialist Naomi Chance, CPC about a recent experience she was involved in:
“It was in the summer of 2011 when a young doctor contacted me about the numerous and complicated problems he was having getting his Medicare Enrollment Applications approved. He had completed every single form required, submitted all sorts of documentation, crossed every “T,” and dotted every “I.” Still, the “Medicare Development Letters” kept coming. He documented tens of calls to his MAC carrier to inquire about all the delays. He asked all the right questions, and pleaded for their guidance and direction. Then he would wait and wait and wait. Every single time, no matter what he did, no matter how many times he reapplied, or how many times he called, wrote, faxed and yelled, his Medicare applications continued to be “DENIED … pending development.”
“Development of what?,” he cried. He did what they asked, but it was never enough. He made corrections to the applications as they instructed him to, yet it was still never right. He was repeatedly given conflicting information by every “expert” he spoke with. One Medicare Analyst would tell him to do something one way, and yet another Analyst would tell him to do it another way. When it seemed like he should just give-up and give-in to Medicare, a friend referred him to us for assistance.
Time was running out fast because Medicare’s timely filing limit is one year. Any claims submitted for dates of service after that one year mark would deny and it was going to cost this young doctor thousands upon thousands of dollars. He felt certain he was never going to be reimbursed for all of that patient care and work! The long story made short is, that once we evaluated everything, it was clear that “action steps” would be necessary to get this young doctor’s Medicare Enrollment Applications approved, and the $125,000 in pending claims processed and paid.
We went to work fast, gathering all of the facts, data and key information, and knew exactly what had to be done. It took a lot of work, but the end result was HUGE for this doctor. Compliance was in and every one of his $125,000 worth of claims was paid.”
The moral of this story was that it nearly took a mountain to be moved to make the carrier responsible for their role in holding up the enrollment of this doctor. But the mountain WAS moved, and the outcome was favorable. Don’t give up!
Understand the Expectations and Limitations
Every carrier will not have a fee schedule that pays what you believe your value to be, or the value of the care you’re delivering. Insurance participation is a very personal decision, made for a variety of reasons. Agreeing to accept a sub-standard fee schedule may work for you because it serves as a marketing arm for your business. Complete understanding of the difference between what the carrier feels is medically necessary, and therefore payable, and what you think they should pay for, helps manage your expectations. Being available as a participant on a plan may open the door to patients who would not otherwise come see you. This open door allows you to explain chiropractic care, the differences between “medically necessary” and “clinically appropriate” care, and who pays for which, AND allows them to know you and make a decision about you becoming their doctor. Having access to this open door may also come with limitations: lower fee schedules, contractual rules and obligations you don’t like, and other penny ante complications of working with third-party payers. That’s why it’s a personal decision. Do the following to mitigate problems later:
- Read the contract before you sign it! Know if you are agreeing to things against your principles or methodology of treatment. Know if these agreements will affect the processes in your practice.
- Acknowledge that insurance was not meant to pay for everything. Give the patient the simple fact at the beginning of care: “Great news Mrs. Jones! Your carrier will contribute toward your financial responsibility in the office! Isn’t that great!” And know this: No matter how much that contribution is, it’s great. If you own it, your patient will too.
- Have systems and payment plans in place to help make care affordable for your patients when it is their turn to pay. Utilize a Discount Medical Plan Organization (DMPO) like ChiroHealthUSA to offer legal, network-based discounts. Help your patient understand the insurance card is not a Visa or MasterCard!
Know the Medical Review Policy
It really is true that when you bill and code correctly, you make it easier for the carrier to pay your bill.
Whether you choose to work with insurance carriers as a participating doctor or not, nearly every service covered by the carrier is likely to have a medical review policy. This policy outlines the expectation of coverage, the types and descriptions of covered diagnoses, and will summarize what the carrier assumes you are doing if you are billing that service or code. For example, a contract with BCBS of Texas states that massage is a covered service. However, if the patient is receiving 97124, Massage Therapy or 97140, Manual Therapy, the doctor may not delegate that to a CA or other provider working under the DC. It is expected that the DC provides the hands-on service. Even though the scope of practice in the state of Texas allows for delegation, the contract signed by the provider supersedes that. What if you are not a participating provider? The rules still apply! They state that the DC must always provide the service to be paid for that muscle work. Be sure you know your medical review policy for any carrier you do business with. These simple steps will help you stay ahead of the game:
- Create a spreadsheet and include a list of every carrier you do business with. Identify whether you are participating or not.
- Pinpoint each major code or code set that you use. Some carriers categorize all physical therapy procedures together, for example, while others list them by individual code.
- Find the medical review policy on each carrier’s website for each code or code set that you use. Note any special rules or particular issues that may apply to the service as you rendered it, such as by delegation. Remedy any outpoints that are identified, and write internal policy to keep from crossing the line.
Bill and Code Correctly
When scouring the Medical Review policy for the most typical services you render, pay close attention to billing and coding guidelines that are particular to that carrier. Although it doesn’t make sense, some carriers follow their own set of rules that are contrary to national coding principles. Some carriers still inexplicably require the “51” modifier on the Extraspinal Manipulation code, 98943. This coding policy is outdated and incorrect, and efforts are underway to get such things updated. Meanwhile, however, whether you agree with the policy or not, if you don’t use a “51’ modifier when billing 98943, you simply won’t be paid. Other rules are easier to follow. It’s easy to stay abreast of correct coding standards by connecting with the American Chiropractic Association or other coding consulting groups. It really is true that when you bill and code correctly, you make it easier for the carrier to pay your bill. Keep these tips in mind:
- Update your coding manual annually. Note in your compliance manual every year that you have updated your coding knowledge and applied appropriate changes.
- Make proper coding and billing a “family affair”. Educate and support key team members in learning and staying on top of coding and billing rules and changes. Compliance rules dictate that annual training is documented for all billing and coding personnel and that includes the doctor.
- Know that you DON’T know. You were not anointed a coding or billing Queen or King when you received your Chiropractic Diploma. Keep the skids greased between your office and carriers by aligning with trusted advisors who can assist you with keeping your coding and billing on track and compliant.
Firmly Follow Up
Once you’ve ensured that all the insurance relations tips noted above have been completed, and you’ve billed your appropriate services to a carrier for payment, we want your teeth to come out. Rules and regulations apply to carriers as much as they do providers. When a clean and correct claim is presented for payment, it must be adjudicated within a set number of days. This includes payment OR pending OR denial. Know what your state insurance commissioner has to say about carrier responsibilities for claim processing. Once you know this, set up your internal system of follow up to flag unpaid claims at the appropriate time and get on the phone! Forget tracers! That’s so 1983. Pick up the phone or get online and find out why your bill isn’t paid. And be ruthless until you get your answer. You have every right to fight on your patient’s behalf for payment of your claim. Internal accounts receivable systems that are worked, tracked and managed will ensure that you never miss timely filing deadlines and every cent that is yours will be on its way to your bank account, post haste. Try these tips for a smooth process:
- Set aside dedicated follow up time weekly for unpaid claims from the aging report, and for responding to denials and other reactive items that come in the mail. This often neglected area is usually the culprit in erratic cash flow.
- Pearson's Law states: That which is measured improves and that which is measured and reported improves exponentially. Reimbursement department team members should have metrics that are reported weekly and monthly that include number of outbound calls, dollar amounts of resubmitted claims, and other important data that helps the doctor or practice management see the follow up work being done.
- Be merciless in your pursuit of payment. Go to the supervisor’s supervisor’s boss’s manager if you have to. Use the insurance commissioner. Drag in the employer’s HR department or Ombudsman when you have to. Be an advocate for your patient and be sure you collect what you deserve.
Playing in the insurance sandbox is usually a “win” for chiropractic practices. Whether providing access to more patients who would not otherwise come in if they had to pay out of pocket, or providing a way to be paid what’s reasonable and customary for your services, insurance participation can enhance the business of your practice. You may choose to fully participate in all plans, to selectively identify those with whom you want to interact, or to provide a way for patients to pay you and then be reimbursed. Regardless of your decision, if you decide to work with insurance, do it with your whole heart and soul, and it will be a win-win situation for all parties involved.
Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P), and since 1983 she has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy can be reached at (855) TEAM KMC or
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Special Feature
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Written by TAC Staff
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Monday, 03 September 2012 22:17 |
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“Why did you develop an instrument to give a chiropractic adjustment?”
D r. Arlan Fuhr has been asked that question frequently in the 45 years since the Activator Method was first in development. The answer is simple: his body hurt too much.
 Dr. Fuhr was three years into his practice, and had been adjusting a high volume of patients using a thumb thrust generated by bringing the elbows together with quick force. But after long days of using his thumb to make contact, and snapping his elbows together, the wear and tear was taking its toll. In the morning, he would soak his elbows in hot water to loosen up the joint ligaments, and at night he would ice them by kneeling in front of the sink.
Says Dr. Fuhr, “My dog was my sole sympathizer. He would sit and watch me faithfully as I completed this daily ritual.”
Then, on one of those painful evenings, Dr. Fuhr said, “No more.” He decided there had to be a better way to administer the light force speed adjustment that had become central to his practice.
Dr. Fuhr approached his partner and the two set out to find an object or instrument that could provide the same speedy thrust at the end of the day as it did at the beginning.
His first real success came quite by accident.
“I was treating a local dentist and told him about my quest to find something to replace the thrust I was giving with my thumbs and elbows,” remembers Dr. Fuhr. “After his adjustment, he turned to me and said, ‘We may have just what you are looking for.’”
The dentist described a surgical mallet that was used to split wisdom teeth and recommended that Dr. Fuhr take the scalpel out of the shank of the mallet and replace it with something blunt. He said he didn’t use his very often, so he would bring it to Dr. Fuhr the next time he came for an adjustment.
By replacing the scalpel with a brake shoe rivet and using a rubber tip from a doorstop, the first modern-day chiropractic adjusting instrument was born. It wasn’t perfect; the surgical mallet, while effective for short periods of time, was not engineered to sustain the volumes of patients Dr. Fuhr was treating. It was clear that an instrument designed specifically for chiropractors, one that could withstand at least 1,000 thrusts a day, was needed. But it was an important first step. Even now – several generations of Activator Adjusting Instruments later – the momentum of that original development process, and, more importantly, the effort to continuously improve, goes on.
The first Activator Adjusting Instrument received a federal patent in 1976, and this instrument has been used as the predicate device for all future FDA registrations. Earning this patent was considered a pioneering event in chiropractic, providing the basis for the development of later generations of adjusting instruments.
Another influential point in the history of the Activator was the initiation of research to support its efficacy. To start, Dr. Fuhr had no formal research to underline the Activator’s effectiveness, other than clinical experience using the instrument. In the mid-80s, he hired a PhD to evaluate what the instrument actually accomplished. In those days, members of the academic community were reluctant to get involved with chiropractic, but a renegade from UCLA, who had been exiled for challenging his department head, was attracted to the unique opportunity.
As it turned out, although this PhD was naturally bright and a hands-on researcher, his background in immunology didn’t align with what Dr. Fuhr and his team were trying to accomplish. Being a good-natured scholar, he did the best he could but was quick to admit that he was not the best fit. Not willing to derail the project, Dr. Fuhr identified a biomechanical engineer to help with the analysis.
 “That engineer taught me a valuable research lesson: You cannot force an academic to do anything he or she is not naturally interested in to begin with,” Dr. Fuhr remarks. “Fortunately, the engineer was quite compelled by what we had created, and went
on to lead a decade’s worth of research on resonance frequency, specifically how to align the frequency produced by the instrument with the natural frequency of the body.”
In 1994, Dr. Fuhr patented another instrument that had a special weight on the tip that caused it to resonate more closely with the natural frequency of the body. He began to learn about the neurophysiology of the body, and the more he discovered, the more he realized that additional research was needed.
“I really appreciated that, through our research, we were getting tangible answers about how far we moved a bone and what physiological effect the instrument thrust had on the body,” says Dr. Fuhr.
The next improvement to the instrument came when an engineer and Dr. Fuhr noticed some clinicians pushing the instrument too hard into the patient, which, in turn, dampened the instrument’s thrust into the patient. Dr. Fuhr and the engineer developed a pre-load frame on the instrument that made it impossible to place an improper thrust into a patient. This same pre-load assured that each thrust was the same, regardless of the practitioner using the instrument.
Dr. Fuhr likens this reproducibility to companies like Starbucks and McDonald’s. “You can travel to virtually any country and order a cup of coffee or a cheeseburger that will look, taste and smell virtually the same as the one you order at home,” comments Dr. Fuhr. “Of all my accomplishments, my proudest is the fact that any patient receiving an Activator adjustment will receive the same thrust, time after time, in every city in the world.” Because Dr. Fuhr’s instrument development efforts ran parallel with his research, his team commenced investigating instrument adjusting compared to Diversified adjusting. He chose Diversified because of its widespread use and the fact that it was the most heavily researched technique at the time.
“Our research yielded impressive findings, and we have numerous peer-reviewed papers that demonstrate equivalency between the two techniques,” says Dr. Fuhr. “Another interesting trend emerged from our research activities - the appearance of multi-site testing. Projects have ranged from evaluating techniques to relieve low back and neck pain to temporomandibular joint disease.”
In 1986, the National Institutes of Health awarded Dr. Fuhr their Small Business Innovative Research Grant, the first funding ever given by NIH to chiropractic. That was followed by the founding of the National Institute of Chiropractic Research, where for 15 years he helped raise $600,000 for preliminary research on instrument adjusting.
“To demonstrate our progress,” comments Dr. Fuhr, “nearly that much was granted to the profession in last year alone to fund research in instrument adjusting.”
Throughout these decades of research and development, Dr. Fuhr came to understand why his dear friend Dr. Joe Keating was always annoyed by the saying “Chiropractic works.”
“For years, we believed we didn’t need supporting research because we just knew that chiropractic was effective,” opines Dr. Fuhr.
This same pre-load assured that each thrust was the same, regardless of the practitioner using the instrument.
Clinicians hung their hats on that statement, but academics and others in healthcare wanted proof of concept. Even today’s students require credible evidence that something works, and they are asking important questions like, “What technique works best for what condition?” Dr. Fuhr was so impassioned by what he discovered through those first clinical trials that he committed to establishing a research base for the Activator Method and the Activator Adjusting Instrument throughout his career. Today, more than 100 peer-reviewed papers have been published on instrument adjusting and specifically the Activator Method and associated adjusting instruments. This head-start on research is what has allowed instrument adjusting to become integrated into the curriculum in chiropractic colleges and has given Activator its position as the world’s most used instrument adjusting technique. It has also differentiated the Activator Adjusting Instrument in all its iterations as the only instrument on the market supported by clinical trials.
Dr. Fuhr admits the journey has been rocky at times, rewarding at others. “The most important thing is that chiropractic has staked its claim in the spine care world, and I believe the research and development of the Activator has played an influential role in establishing that position.”
At a recent dinner, a colleague told Dr. Fuhr that the general scientific community and especially the medical community is becoming publicly interested in manipulation.
Says Dr. Fuhr, “My dream has always been to have a substantive body of research to support instrument adjusting, empowering spinal manipulation to become the treatment of choice, and to create the perfect instrument to deliver that manipulation. All my dreams are coming true.”
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Special Feature
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Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.
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Monday, 03 September 2012 21:50 |
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M cDonald's is possibly the most successful small business worldwide and that success was built on products that are possibly not the healthiest in the industry. In health care, we do not have the option to not be the best because lives are at stake and a suspecting public is often more selective in choosing doctors.
 To understand McDonald's success and learn from it, there is only one marketing concept that you need to "own," and with it you will achieve great success, albeit with one proviso. That concept is quite simple, "Do not double the people you know, double the people that know you." The idea is so profoundly simple that all it takes is either a lot of your time and no money with a door-to-door campaign to introduce yourself to your community or a little time and lots of money with an advertising campaign. Both work because this is a numbers game. Eventually, someone with a spinal-related problem will need a chiropractor and if you happen to be "in their face" at the right time, your phone will ring. However, when you meet people one on one, the return is higher.
Another concept is "RRR." Repeat and review with regularity, a concept introduced to me by my previous mentor Larry Markson 30 years ago and the credo I have followed in all of my marketing endeavors since. When you visit the people in your community, whether businesspeople, clergy or members of social organizations, follow up with a thank you note and place some business cards in the envelope. Find a reason to re-visit the establishment so they remember you. It is a time-intensive program, but one that costs no more than a postage stamp. The Cost: almost $0
If you are advertising, be prepared to do so frequently. One marketing researcher claimed that the public needs to see the same ad 13 times before they actually "see it." That costs LOTS!!!!
The proviso that sets us apart from McDonald's is clinical excellence. I have advised chiropractic offices, medical offices, chiropractic colleges, medical schools, local hospitals, teaching hospitals and medical supply companies on marketing their services to the public. The theme for each was universal and critical to the success of the programs: clinical excellence. Are you a model of clinical excellence? Are you part of a group that is centered on your clinical excellence? I walked into a cardiologist's office a few years back and the walls were covered with diplomas and certificates for every provider. The goal was to promote the clinical excellence of each provider. A brilliant marketing strategy, as every patient was reading the walls and, according to the office manager, this was one of the main reasons for many of their referrals. The Cost: $0
Your curriculum vitae (CV) is another marketing tool and perhaps both the best and most overlooked. Whether you are in practice for 1 year or 30, you have great credentials that constantly grow with each post-doctoral course you take. If you practice personal injury, sports injury, occupational injuries, geriatrics, pediatrics, etc., your CE courses should revolve around those specialties and must be reflected in an admissible and professional CV, not a resumé intended for non-professionals. To access a free CV builder, with free Internet marketing, go to www.USChiroDirectory.com. Once you build your CV online and secure your listing, at no cost if you so choose, then the search engines (Google, Yahoo, Bing, etc.) will automatically find you and list you. That is where to start. The Cost: $0
I walked into a cardiologist's office a few years back and the walls were covered with diplomas and certificates for every provider.
Take your CV to the next level in marketing. Gather all of your patients’ e-mail addresses and send them a link to your CV on the US Chiropractic Directory. They WILL forward that to many of their friends and family. Beware, many experts in medical marketing are now stating that personal Web sites are decreasing in their ability to attract new patients. Directories are now more powerful because there are too many Web sites and too many choices for patients to see. The public is now looking at a concise area to find what they need and directories such as the Yellow Pages online or industry-specific directories are now their #1 choice. There are currently chiropractic directories that offer free listings, as previously mentioned. The Cost: $0
The University of California at Irvine, Department of Urology, under the direct orders of the department's chairman, Jaimie Landman, MD, has mandated every new patient in the department get a phone call after his/her first visit in order to see how they are doing. That person's primary care and/or referring doctor is then sent a report on his/her condition. This is a simple process and the results have been an increase in referrals and patient compliance.
What makes this so relevant is that Dr. Landman is a world-class urologist ( http://www.urology.uci.edu/dept_faculty_landman.shtml) known for pioneering successful "non-chemotherapy cures" for many types of kidney cancer, and he has traveled the world researching and teaching and is one of the most sought after educators globally in his field. Nevertheless, he has created a system within his department to make each patient and his/her primary care and/or referring doctor feel good about the care being received. The end result is increased compliance and referrals. It doesn't matter the specialty, marketing for professionals is universal. The Cost: $0
Marketing requires a strong infrastructure that will stand the test of time and is built on a verifiable foundation of clinical excellence through strong credentials backed up by the knowledge those credentials represent. Build your knowledge based upon the type of practice you choose to create. Update your credentials through meaningful CE courses. Build your CV for the world to see. Once that has been accomplished, keep doubling the people who know you. That is the key to successful marketing and often the cost can be $0.
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Special Feature
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Written by Sylvia Marten, MBA
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Monday, 03 September 2012 20:03 |
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How to Maximize Your Exposure on the Internet to Acquire Patients
R emember the game Battleship? Imagine if you knew the squares where your opponents’ ships were placed. You obviously would have a huge advantage over your competitor. Now imagine if you knew how potential patients were using the internet to find a chiropractor. If you knew which online channels patients use most and how, you’d know where to invest your time and marketing dollars. This would give you a huge advantage over your competition. You would have an even bigger advantage if you knew how to maximize your participation in these online channels.
In a recent visitor survey on Spine-health.com, chiropractic patients who recently visited a chiropractor were asked which methods they utilized to find and/or evaluate their chiropractor.
55% of the respondents said they used online resources to find and/or evaluate their chiropractor – including those respondents that had been referred. Of those, 100% used at least one online resource, 44% used at least two online resources, and 15% used three or more online resources. With such a large percentage of patients using multiple online resources to find a good chiropractor, it is now essential that chiropractors understand and decide how they will participate in these popular and growing online channels.
Learn more below about one of the seven key online resources prospective patients use, how they use it, and how you can participate - some of the findings may surprise you. 
Online Channel #1: Google and other Search Engines (35% of online responses)
Search engines offer three main ways to drive traffic to your practice website: 1) organic search results, 2) local search results, and 3) search engine advertising.
If patients find you in organic search results, this means they found your practice website or another one of your online properties in a search engine’s natural (non-paid) search results.
High rankings here are highly desirable because these results tend to be the most trusted, but high rankings can be difficult and costly to achieve. Local search results, such as Google Places, is a non-paid sub-directory that allows local businesses to get listed just ahead of organic search results, which offers opportunity for exposure and potential traffic to your practice website.
Paid search engine advertising allows you to pay for placement at the very top or to the right of search results. This method gives you control over ad placement, and for which search terms
and user geographies your ads will appear.
How prospective chiropractic patients use this online channel: Using a search engine is often the first place people turn to begin the process of looking for a chiropractor. They can find what chiropractors are in their area, or find specific chiropractors by name, and they will get instant access to additional information so they can make a final decision. Many chiropractic prospects use specialty + geography searches (e.g., chiropractor [CITY] [STATE]) or treatment + geography searches, so you’ll want to show up for these searches relevant to you and your location. It is important to have a presence on the first few pages (and ideally on the first page) of the search engine results pages since these are the results that get the lion’s share of the clicks.
See below for tips and suggestions to help your search engine presence and advertising results.
Search Engine Strategy #1: Organic Search Results (non-local, non-paid)
Organic search results are the natural search results that show below the top paid search ads, if present, and below the local search results, if present. For example, when you search Google for “chiropractor Woodlands, TX” you may first see search ads, then Google Places listings, and then organic search results. High organic search results are highly desirable as they are more trusted than ads and investments to achieve them have the longest lifespan (when you stop paying for ads, ads no longer appear, while organic results can last for years). It can often be difficult to rank your website highly for the highly competitive terms, and results in the top three pages of results may require sizeable investments of time and dollars.
Here are some tips to help you optimize your website so you have a better chance of ranking highly in organic search for search terms relevant to your practice.
Tips:
- Optimize your title tag. It appears at the top header in web browsers (e.g., Internet Explorer, Firefox, etc.) and helps your website rank for the key terms prospects will be searching for to find a chiropractor, such as “chiropractor Deerfield, IL”. The title tag represents what users can expect when visiting a web page. It looks like this in the HTML code of your page: <TITLE>This is my title tag of my page</TITLE>. If the main goal of your homepage is to emphasize who you are, what you do and where you are located, your title tag may look like this: <TITLE>Dr. John Smith, Chiropractor, Any town, IL 60018</TITLE>. Remember, the content on your pages should mirror what is stated in your title tag, otherwise it miscommunicates your message and will not be user friendly (or search engine friendly). Do not use the same title tag on every page of your website. Every title tag on every page should be unique.
- The more links you can get to your website the better chance you have to rank higher in the search engines. A great way to get links is to write extremely interesting and informative content. If patients or other chiropractors find your content, they may share it with others and link to it from their website or social media channel. NOTE: Do not pay for links as part of your search engine optimization (SEO) strategy. Paid links can often have an adverse effect on rankings in the long run.
- Search engines look favorably on sites that link out to credible, related sites. Linking to Spine-health.com, for example, not only gives your users access to relevant and informative content, but can also boost your optimization efforts. You can link to the homepage, or just to the pages/sections that make the most sense to educate your patients, e.g. the Health Videos section or Chiropractic sections of www.spinehealth.com/treatment/chiropractic. If you carefully screen the sites you link to, and only link to those that you think will truly benefit your patients, then you accomplish the dual goals of providing a valuable benefit to your patients and also presenting an authoritative resource that search engines will value.
Search Engine Strategy #2: Local Search Results (non-paid)
Showing up in the “local” search results is another way to drive prospects to your practice. These results appear above the normal organic results (outlined in #1 above), which can help drive traffic to your website and phone calls to your office. A local page can act as a basic web presence for your contact information until you get your practice website up and running, and if you currently have a site you can add your web address to your local page. However, even if you have a local listing, your listing may not always show in the first set of local results that the search engine chooses to show.
Tips:
- Search the major search engines (Google, Bing and Yahoo) to see if your practice shows up in the “local” results. You should be able to find it by searching for “[Your Practice Name] [City, State]”. Often, businesses are loaded into these directories from an outside source so most likely you will find your practice. If you do show up, make sure your information is correct. There is a link in your listing to request changes since oftentimes the information may be out of date or incorrect.
- If you do not have a pre-loaded “local” listing, make sure you submit your practice online. It’s quick, easy and free: Google Places, Yahoo Local, Bing Local.
- A tip about optimizing your local listing: when setting up or editing the existing title of your local page, add the main keywords you would like to rank for. In most cases we suggest you put the term “chiropractor” and “[YOUR CITY]” in your page title. Most others will just put the name of their business, such as “123 Chiropractic”. Using the above suggestion, an optimized title would be “123 Chiropractic – Chiropractor in [YOUR CITY]”.
Search Engine Strategy #3: Search Engine Advertising (paid)
Search engine advertising displays your ad in the sponsored ad results section of major search engines for the keywords of your choice. This allows you to target specific keywords and geographies you deem most relevant to your practice. These ad campaigns are usually charged to the advertiser on a pay per click (PPC) basis, where you only pay if someone clicks on your ad. With most PPC providers, you can set daily spending thresholds so you can control the budget of your campaigns.
A few downsides: One, Google allows users to manage their ad preferences, so members of your intended audience can now block specific ads or opt out of personalized ads – so your pool of prospective patients may be less than you would expect. Two, these types of campaigns can get costly. Depending on your specific market, the rate of competition from your fellow chiropractors and other websites may make typical per click rates fairly expensive.
IMPORTANT NOTE: It’s not advisable to start a PPC campaign unless you can dedicate the time (or hire someone to do this) necessary to manage your campaigns on a daily/weekly basis. If you are busy focusing on patients and do not have the resources available, it is probably a better use of your time to focus on the other essential tips contained in this article. If you are more advanced in online marketing and have the willingness to invest the time to learn it and manage it, it may be a profitable use of your marketing dollars.
Tips:
- Utilize the geo targeting feature so you can only display ads to users within a defined area around your practice. This guarantees your advertising dollars are not wasted by targeting prospects out of your “sweet spot.” Google has recently introduced Adwords Express for Local Business, so if you do not have the time or resources to manage a full-blown Adwords campaign this may be an option for your practice.
- Set up multiple ad versions. Most advertising programs, such as Google Adwords, will rotate your different ads so it can see what works best. Over time it learns and displays the most effective ads so you get the maximum amount of click traffic.
- Try more than one PPC network to see if one works better or if you can get good traffic from multiple sources. There are many, including Google Adwords, Yahoo Search and Bing/Microsoft.
- Do not overbid (try to get placement for the 1st ad spot) or put large daily maximums for your campaigns. This is a common mistake that can eat up your monthly ad budget in one day. Start conservatively until you understand what types of results you can expect. If you have a good idea of ROI, you can increase your bids accordingly to maximize profitability.
- Do not expect large amounts of traffic. If you are setting up your campaigns correctly you should be receiving extremely targeted traffic, but not necessarily large volumes. This targeted traffic will be much more valuable.
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