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Diversify: Portfolios and Financial Classes of Practices Are a lot Alike - The mix practice formula for 2011-2012
Special Feature
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Sunday, 25 September 2011 22:42



very financial manager will tell you that in order to hedge inflation, a volatile stock market and to meet expectations without jeopardizing your principle capital, diversify. Some recommend more stocks, while others more bonds, yet others urge you to invest in government notes.  These are all wise strategies in order to stand the test of time in your long-term strategy-based investment goals.

In practice, the strategy is no different. In the 1980's, I had 50% of my practice covered by the Empire Statewide Plan and I was making a great living. Unfortunately, overnight, without prior warning, every policyholder got a notice that said chiropractic services were available for only "in-network" providers and I wasn't one of them. It turned out that the president of the state organization became the consultant for the insurer and only a few of his handpicked "cronies" were added to the panel, leaving the rest of us "schlubs" to fend for ourselves!

It was a vital lesson in practice and although it was an expensive lesson, it was one that has served me well over the remainder of my career. I learned that you cannot rely on one carrier or financial class for survival in practice. You need to have a mix of patients in your practice. This means you need patients from every arena, managed care, Medicare, workers compensation, personal injury and fee for service (cash) .

With that being said, you have to closely examine the level of reimbursement for each financial class. In today's economy, managed care and Medicare are low payors. Workers compensation, depending upon your state, fluctuates greatly and can fall anywhere in the spectrum. Cash patients are great, but you are at the whim of the economy and then there is personal injury.

Personal injury is by far the last place for a doctor of chiropractic to earn a very good living. If you refer back top to this publication's February, 2011 issue, I chronicle by state the best and worst reimbursement states for personal injury in combination with cost of living factored into the equation. There is one caveat; you have to be the best-of-the-best at what you do in order to survive in each class.

calculatorquoteIf  you want to thrive in sports chiropractic, then you will have a predominantly managed care practice and you need to excel in treating those types of injuries. The same with Medicare; you need to be expert in geriatric chiropractic as that has its own set of nuances. This also holds true with personal injury and Medicare. You need to be expert in trauma and have the requisite credentials behind you with an admissible "formal" curriculum vitae. The legal community will not take you seriously otherwise. Yes, they will take your referrals and yes, they will accept your invitations to dinner, drinks and ballgames. However, unless you are the "real deal" on paper and in practice through clinical excellence, they will never refer to you even if you refer to them. Why would they want to work with you if you are a liability to their cases? Things are tough for lawyers also, economically.

Deciding on the best way to spend your time, energy, and money is to determine your ideal practice mix and create the perfect scenario for success in that financial class. It is my experience and recommendation that there be a minimum of 60% personal injury with 15% cash and for the rest, be prepared to work a whole lot for a whole little. Many DC's nationally have gone from 10% personal injury to 40 % personal injury and have tripled their incomes, reducing the financial stress in their practices. All of these doctors have one thing in common, they all became expert in trauma care and working in the medical-legal arena. You cannot just decide to get more personal injury cases without the requisite training. Lawyers aren't ignorant. You will get 1 or 2 of tier clients to work on and if you don't have the required training, as soon as they talk to you or see your documentation, you should be prepared to be a 1 and done. They will work with you once and never work with you again.

It is sometimes better not to take a personal injury case if that will create a bad reputation. A good reputation is easy to create if you have none; it is quite difficult to overturn a bad one. The solution is to become expert in all things "personal injury" and that has nothing to do with treating your patients. It is about becoming a good diagnostician and expert at triaging cases. This has nothing to do with your practice philosophy because it has little or nothing to do with the care of your patients. The hard truth is that lawyers do not value a case based on your care. They put less value on technique and more on documentation. They live in the world of "what's wrong " and the documentation of that in an admissible format.  That is what you need to become expert in order to succeed in the medical-legal environment in today's economy.

Why Advertise?
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Special Feature
Written by William Salazar   
Sunday, 25 September 2011 22:25

mcdonaldsAs an advertising agency we are always approached with a common question amongst DC Medical practices…”I’ve been in business for so long, why should I advertise?”  We always answer their question with a question…”Have you ever heard of an international fast-food chain that uses Golden Arches as their trademark…and go by the name McDonald’s?” Their response is always a “yes” and it usually comes with a smile, knowing that our next comment will be…”so why do they still advertise?”  The truth is that if McDonald’s never spent a single dollar in advertising, people across the world would still know who they are. However, it has taken the McDonald’s company, since their first television campaigns in 1963, decades to produce such a worldwide recognizable model and yet they STILL ADVERTISE!

So then “Why advertise?”  As a DC practice you have a “product” that can benefit your clients, both existing and potential. What do they know about you?  Does the community your business resides in know anything about your practice? How can your practice make their lives better or promote a healthier lifestyle? Let’s be honest, long-gone are the days of a single practice in a “one store town.” Everywhere we look people are moving in or out of cities, patients pass away, new businesses are still starting up (even in our current economy) and not to mention the future DCs that are graduating every year…in the thousands.  If you don’t think you have competition, then it is fair to say that you have been left behind.

There are many effective media outlets to successfully promote your practice. Planning the right strategy and implementing it effectively will always work. However, the most important factor in any media campaign is to track your marketing dollars. If you are not taking the time to sit down at least once a week and gauge your advertising efforts, then you are throwing your money away. Don’t be afraid to make media changes in the middle of your campaign. Look to see what outlet(s) are creating a better return on your investment and stay there. If one or more media outlets are not producing the results you need, cancel them and move on to an outlet that is better suited for your practice. Every media outlet should give you a two week clause to get out.  This is where utilizing an advertising agency is effective.  An advertising agency which specializes in medical practices will have checks and balances in place and will faithfully keep you abreast of all your marketing dollars, especially advising if any changes need to be made.

Television advertising can be the most effective tool when promoting your practice. A false expectation is that TV advertising is very expensive and unaffordable for many doctors.  A strategic advertising plan can place you in front of thousands of viewers, on the right show for a minimal amount.  As an agency, we’ve seen clients execute an effective TV campaign for as little as $500. Here is the catch…it was an agency who made the media purchase. An agency should always work effectively to get you the best rates possible and disclose them to you.  Nine times out of ten, an agency will have better rates for your practice than you can get on your own.

What about a commercial? Don’t be afraid to lend a helping hand in your creative commercial. It is your practice and you should try to convey it with as much integrity as you can in a 30 second commercial. However, let me be very honest here…NOT every doctor needs to come out in their commercial. Your presence as a professional in person is completely different than your presence on camera or on television.  Do not fall into “it’s my practice and I want to be in the commercial” syndrome…you, on camera, can actually hurt your business if the commercial doesn’t agree with you.  Again, always seek the advice of professionals and allow them to guide you, they should have years of experience in this matter.  Give them the message you want to convey and let them determine how the message will be promoted.

iphoneThe internet is one of the most impactful tools currently used in our business strategy. It has replaced local yellow pages advertising. Yellow page advertising, even if you were on the back cover of one, is no longer effective like once before. Think, when was the last time you used your local yellow pages to search for a restaurant or a local business?  Internet presence is a non-negotiable tool your practice must have, regardless of your years in practice.  The internet can also help you track who is looking at your website, capture their information and send them email campaigns about your practice. This somewhat new technology of capturing someone’s specific internet interest is called Advanced Target Marketing and literally follows the habits of a person on the internet who is looking for a practice like yours. There are also many other ways to utilize internet placement and advertising. Being on the right page, for the right demographic and at the right time of day is crucial. In other words, having a link on a local gas station’s website most likely won’t get very many hits.  When planning an internet campaign always keep in mind the amount of impressions you want to target and if those impressions fall into your target market.

Social networking, Facebook and Twitter to be specific, has come and changed the way we keep in touch with family and friends. It has also developed into a tool that we use every day in how we send messages to each other, communicate what we like or dislike, or refer someone to.   Creating a Facebook page for your practice is free but it isn’t enough to do just that. You must commit yourself or someone in your office to a couple of hours a week to keep your page updated and fresh. Invite friends and patients to like your page and request other business pages as friends.  You aren’t looking to see how many friends you can claim, but instead how to effectively get your practice name out to your community.  Advertising on Facebook has also become an effective way to brand your practice.

Quick Response codes (QR) are specific bar codes that are readable by smartphones. QR codes are now the hot thing in media. These easy-to-generate boxes can be placed on just about any type of printed media where people can scan them with their smart phones and be sent directly to your website. A QR code is a low-cost addition to a campaign, and it's a great way to get potential clients to interact directly with your practice/website. Here is a side note on smartphones: U.S. smartphone penetration is expected to hit 50 percent by the end of this year, according to Nielsen. There are currently 73.3 million smartphone users, according to eMarketer.  A recent survey by the marketing firm MGH found that 72 percent of smartphone users said they would likely recall an ad with a QR code. Seventy percent said they planned to use a QR code again or for the first time. 

Utilizing a media agency will help to communicate your practice to the public and help you with all of your marketing plans. They will also take the time to understand your practice and who your customers are, their age and gender and where to successfully reach them. Most agencies already have marketing pieces in place, including media buying, TV commercials and print ads…the tools you will need to create a successful marketing campaign.  Let them do all the work as they have the specific expertise. Look for one that specializes in medical practices and watch your business grow.


William Salazar is the founder and CEO of the Vallejo Media Agency, a full-service, bi-lingual agency that specializes in medical practices.  The agency focuses on building successful campaigns while educating its clients on current media outlets. For more information go to www.vallejoagency.com; or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

The Amazing Chiropractor Series: Interview with Dr. Chris Carraway
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Special Feature
Written by TAC Staff   
Sunday, 25 September 2011 19:28


r. Carraway graduated from Life Chiropractic College in 1985 and recently celebrated his 25th year of practice along with his wife of 30 years, Diana, by his side as his office manager.

After ten years of practice he began the coursework towards becoming a Chiropractic Neurologist.  After successfully completing the New York Chiropractic College Chiropractic Neurology program, he sat for the neurology board examination in 1999 and became a Diplomat of the International Board of Chiropractic Neurology.  A few years later Dr. Carraway was awarded a Fellowship from the International Academy of Chiropractic Neurology.

He has had the pleasure of serving as a treating physician in several studies comparing the cost and effectiveness of chiropractic treatment compared to medical treatment for low back pain in adults, most notably, with Duke University Medical School.  He is a charter member of the National Institute of Chiropractic Research.

In 2007 he took note of the wide range of work being done with low level laser therapy and the mountain of positive peer reviewed research available.  After several positive personal experiences with laser therapy, he began using laser therapy in his daily practice.  The results were impressive and he began to write case studies and articles on laser therapy and chiropractic.  Presently Dr. Carraway serves on the Medical Advisory Board of Multi Radiance Medical.  He also serves as a Senior Clinical Consultant for Multi Radiance Medical and is currently working to help author a laser therapy college curriculum to be used by chiropractic colleges around the nation.

In addition to being a Certified Laser Specialist, Dr. Carraway is a Continuing Ed. Certified Laser Therapy Instructor.

He is a regular lecturer on internet webinars, discussing a variety of laser therapy related topics and has fully integrated laser therapy into his practice.  Dr. Carraway is the director of Advanced Laser Integrations, which is dedicated to helping other practitioners transition laser therapy into their practices.


TAC: What inspired you to become a chiropractor? Do you have a specific story?

CARRAWAY: I suffered from severe headaches as a child and found relief through chiropractic adjustments.  By the age of eleven I had made my career choice and decided that I too wanted to be a Doctor of Chiropractic and help others as I had been helped.


TAC: What type of patients do you generally treat or attract? What are the top five conditions you most often treat in your office?

CARRAWAY: My practice focuses on various chiropractic/neurology related issues as well as the general types of patients typically seen in a DCs office.   For the last few years, with the addition of laser therapy, I have begun to help hundreds of patients with chronic degenerative joint disease(s), as well as using laser therapy to speed the patient’s recovery from musculoskeletal conditions and complicated neurological issues.


TAC: Which techniques do you use and why?

CARRAWAY: I use the Activator Methods Chiropractic Technique exclusively.  I have not found it necessary to incorporate any other adjusting techniques into my practice.  I also use low level laser therapy extensively, with 90% of my patients receiving laser therapy as part of their care.


TAC: What type(s) of diagnostic testing procedures do you use and why?

CARRAWAY: I use standard radiography techniques and studies and prefer to refer out for specialized diagnostics.


TAC: We understand that you are treating all kinds of different diseases with the laser. Could you tell us a little bit more about your experiences?

CARRAWAY: There is a wide variety of maladies which readily respond to laser therapy.

Ranging from Bells palsy, sciatica, carpal tunnel syndrome, migraines, cervicogenic headaches, TMD, peripheral neuropathies, fibromyalgia, brachial neuralgias, rotator cuff injuries, most all sporting type injuries, shingles,  along with an endless list of musculoskeletal conditions.  Laser therapy is excellent for pain abatement and; let’s face it; pain is what drives most of the patients to our offices.  Pain is a great motivator.


TAC: Tell us two or three of your most amazing patient success stories.

CARRAWAY: Four times this year I have been able to use laser therapy to completely abate a patient’s pain from shingles (herpes zoster) with one five minute laser treatment.  In each case, the pain was gone within one hour after a 5 minute session.  Furthermore, the classic rash and blisters began to dry and heal within a matter of days, not weeks.

Laser therapy is excellent for pain abatement and; let’s face it; pain is what drives most of the patients to our offices.  Pain is a great motivator.

I had a patient who had suffered from glossopharyngeal neuralgia, a disabling condition affecting her face, ear, throat, tongue, etc.  She had been plagued with this condition for 10 years.  I was able to adjust her and use laser therapy to resolve her glossopharyngeal neuralgia in under three treatments.   She has been pain free for 2.5 years now.

Another patient had lost all sensation in her lower legs bilaterally from her knees to her toes as the result of a botched spinal tap.  She could not tell the difference between carpet and hardwood floor.  She could not feel her socks or shoes, nor hot or cold water in her tub.  This had been an issue for 6 years.  I did not hold out any hope that she would respond to laser therapy, but she did and in a matter of just a few treatments she regained all normal sensory function in her lower legs.  I was just as surprised as she was with her response.

I have been able to keep some patients from knee replacement surgery by treating them with laser, and have put a smile on many patients’ faces who suffer from plantar fasciitis.


TAC: What has really impacted your growth as a chiropractor and that of your practice?

CARRAWAY: I practice 4 ½ days a week and stay pretty busy as a general rule.  I have built my practice on my specialization in the Activator Technique, my additional neurology background and most recently my laser therapy pursuits.  I see an ever-growing laser therapy practice in my future.  I hope to practice well in to my 90’s if the government does not completely suck the joy out of practicing.



TAC: What marketing strategies do you use to attract new patients?  And to keep current patients?

CARRAWAY: My marketing strategy is very simple.  Give the best care I can and follow through in detail with each patient.  My patients seem to recognize this and readily refer others.  95% of my new patients are referred from other patients or medical doctors who appreciate what I do and how I follow through with their referred patients.  We do some minimal advertising including yellow pages and newspaper ads, but very little else.

As far as keeping patients, I have a growing base of patients who wish to protect the progress they have achieved with chiropractic care, laser therapy or both and come for regular monthly maintenance care.


TAC: With your practice being Medicare, insurance and cash based multidisciplinary, cash-based, can you tell our readers your advice about setting up and maintaining such a practice in today’s healthcare system?

CARRAWAY: Advice: The population is aging and we need to become more focused on geriatric conditions and proper care.  People are living longer and wanting to have a better quality of life.  This is not going to be brought about with pharmaceuticals.  They want to golf, sail, play tennis, and play with their grandchildren forever.  We cannot give them "forever", but we can add life to the years that they do have.  I think that there is a great void to be filled here and we are just the profession to do it.



TAC: What single piece of advice would you give a new chiropractor just starting out?

CARRAWAY: Brace for impact.  When I started practice 25 years ago, about once a year some new rule or requirement would crop up that we would have to change some office function to comply with.  Now these rule changes and compliance changes are coming like machine gun fire and staying up to date is a real chore.  I am constantly finding some new requirement or regulation we have to address.  Sticking your head in the sand is a sure way to lose your rear-end.  The colleges are not keeping up with all the changes.   They are happening too fast and no one source has all the answers.  It is a daily challenge.


TAC: What general advice would you give an established chiropractor whose practice might be struggling?

CARRAWAY: If what you are doing is not working, get busy reinventing yourself.  The number one complaint that sends patients to a doctor is the common cold.  What is number two?  LOW BACK PAIN!!!  And it is a close number two.  Nobody, in any other profession, is as well-equipped as we are as chiropractors to successfully treat back pain.  Recently three different medical sources published that chiropractic care was not only effective treatment for back pain, both acute and chronic, but was cost effective and demonstrated few relapses.  I know nutrition is important and that white sugar and flour is bad for you, foot orthotics can help and so can hair analysis, etc.  I do not want to step on anyone’s toes here.  But the big piece of the pie that is available to you is back pain.  Embrace chiropractic for all it is worth and focus on the second most common physical complaint to adults, low back pain.  The need is great and the care that we offer is second to none.  Science backs this up again and again.


TAC: Where do you see the future of chiropractic headed?

CARRAWAY: The face of healthcare is changing and changing rapidly.  I hear rumblings that healthcare is going to be outcome based in the future.  This can be great for us as DCs.  Start waving the scientific research flag high and proudly.  It  could be a boom for us.  Big pharma and the AMA are not going to suddenly lay down.  I fear more of the same old political end fighting and backdoor dealings that we have seen for years are going to continue to be stumbling blocks.  I  see more and more evidence that third parties are trying micromanage patient care by limiting visits and cutting benefits.  I would hope that we are going to experience a smooth transition into what healthcare is becoming.  But I am wary of every step that is taken.


TAC: Any final words for our readers?

CARRAWAY: In closing, work hard and love what you do.  I must add a thought from a talk given by Max Lucado.  He was once faced with two very exciting things to do: a weekend signing books, or giving a speech to a huge group; actually, three things to do, including spending time with his family.  He weighed out the pros and cons.  Then the thought struck him.  Who of all these people would be crying the hardest most at my funeral?  The answer was then clear.  He knew where he wanted to spend his time…with his loved ones.  So, while you are making your professional way in this world, do not forget the ones who are with you day in and day out, your family.


You may contact Dr. Chris Carraway at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

IME Abuse: A Plan for an End
Special Feature
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Tuesday, 23 August 2011 22:57



n independent medical examination (IME) is performed by a doctor that has not previously been involved in the treatment of a given patient. Historically, they become involved in the case because of a request by an insurance company and are provided by an independent company retained by the insurance carrier. This allows for a level of insulation between the carrier and the IME doctor, as the carrier can now claim they did not perform any evaluations.

In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it's always about the money!

IME abuse has gone mostly unchecked, because both the patient and the treating doctor have allowed it to for too many unacceptable reasons. Regardless of the past, the time to correct the problem is now and the following is one person's opinion.

When your patient has an IME, suggest that he/she bring a friend who goes into the examination room during the examination. Filming is fine, but a witness will ensure a less hostile environment and, in my experience, will never be denied access upon your request. After the IME, either you, as assignee of benefits, or the patient must request a copy of the IME report. Upon receipt of the IME report, sit with the patient and review everything the IME doctor documented having done.

Explain how a Foraminal Compression test or a Lasegue's test is performed and ask, "Did the doctor perform this test?" Should the doctor have documented doing so, but not performed the test, a VERY common occurrence, the IME doctor lied. In legal terms, the IME perjured him/herself and needs to be brought to justice. You have to remember that the only reason the doctor did this was to make money with complete disregard for the welfare of your patient.

Inform your patient of his/her right to render a complaint against the doctor's license and direct him/her to the website of your state professional conduct board. On that site is a complaint form against the doctor's license. I have previously informed the patient that if he/she chooses to render a complaint, he/she should also state that a witness was in the room, so that it is not the doctor's word against his/hers. (Note: This wasn't done against the treating doctor, so you have no complaint.) In my experience, almost 100% of patients chose to render a complaint.

Upon receipt of the complaint, the state is obligated to investigate and create a file on the offending doctor. Simultaneously, if your patient has a personal injury or workers compensation case and he/she has legal representation, the patient should send a copy of the complaint to his/her lawyer. This is critical in leveling the playing field in his/her third party case  so that the lawyer can present to the carrier and, eventually, the jury to cast doubt on the integrity of the fraudulent IME examination and examiner.

The carriers will not be pleased and, should they receive enough complaints against a doctor, they will eventually fire that independent IME company or request that doctor not be used any further. It's always about the money and the best way to ensure removing bad doctors is to hurt their employers financially; losing in court will be a big financial loss.

Another tactic IME doctors utilize is not commenting on testing performed. In every instance, the carrier has copies of all tests performed and, commonly, those tests are not referred to in the report. Part of the time, the IME doctor has a copy of the report or the actual test results and, the balance of the time, the carrier has not forwarded the report to the IME doctor because they realize it will significantly influence the results of the examination. In absence of having all of the results, a doctor cannot accurately report on a condition of a patient and, in many states, licensure boards would consider that misconduct. To do it purposely for personal gain should be criminal. The way to show intent is for numerous complaints to be filed against the same doctor or carrier showing a pattern of abuse.

Another improper tactic is to retrospectively have an IME performed well after care has ended (6-12 months) with the conclusion that the previous care wasn't necessary. Although I would probably lose my license for treating without a timely history and physical, as I would need a clinical basis for my diagnosis, prognosis and treatment plan, so does any doctor rendering an opinion. Crystal balls were banned from medicine a century ago and only "charlatans" can look far into the past to determine the necessity for care. This is an opinion well after the care was rendered and the patient has healed or the wound has been repaired in the interim. A doctor can render an opinion for the "right now" and even for the recent past (a few weeks ago) to determine if either more care is necessary or if the recent care was necessary, as the current clinical picture is applicable. However, to render an opinion 4, 8 or 12 months into the future is grossly irresponsible and cannot be accurate in the musculoskeletal arena.

I am of the belief that many of these complaints will go without disciplinary action. However, they will begin to create a profile on the offending IME doctor and put the carriers and courts on notice about the integrity of the report, the independent IME contractor and the IME doctor. There are many ways to counteract fraudulent IME examination, but the only way to put an end to it is to remove the funding source for continued abuse. A very real parallel is that, if we removed the funding source for terrorism, we wouldn't have any.

Meaningful Use: The benefits of HIT
Special Feature
Written by Matt Richard   
Tuesday, 23 August 2011 22:36



f you’re a chiropractor, chances are you’ve heard mention of Medicare’s Electronic Health Records incentive program. The wealth of information about Meaningful Use (MU) can be overwhelming: state associations, advertisements, solicitations, webinars––you name it. And the new lingo for EHR standardization is becoming something we all deal with daily: quality measures, numerators, denominators, certifications, decision support, electronic prescription, patient reminders, exclusions, etc. There’s a lot going on out there, and with new regulatory requirements comes demand for expert services. This new field of expertise is called Health Information Technology (HIT), and its goal is not just to help navigate the paper pile, but to send it the way of the Dodo bird through computerized automation.

In the coming years HIT services will inevitably supplement your current IT infrastructure. IT focuses on hardware and software configuration, things like passwords and security, routers and networking. An HIT professional, on the other hand, provides consulting for office workflow, meaningful use requirements, staff training and software interoperability; HIT takes IT to the clinical level.

In addition to the EHR incentive program, the Office of the National Coordinator (ONC) has started HIT training programs across the country. From what we've seen already, the diversity of the technical expertise among the first wave of HIT professionals is impressive. I've talked to graduates from these programs that have backgrounds in database administration, technical sales, IT consulting, medical billing, and programming. To a person they’ve gone through months of in-depth meaningful use and HIT training, which speaks to the level of importance being placed on HIT development moving forward.

The ONC has identified six areas that HIT professionals will be able to serve MU practitioners: Clinician/Practitioner Consultant, Implementation Manager, Implementation Support Specialist, Practice Workflow & Information Management Redesign Specialist, Technical/Software Support Staff, and Trainer. These are the basic roles required to successfully implement an EHR. Large hospitals may assign each HIT role to a team of individuals and a smaller clinic will likely enlist the services of someone that can take on most or all of these tasks.

Successful EHR implementation is complimented by HIT services. I’d even go so far as saying that getting software fully certified for meaningful use is easy part. The real ingenuity comes with designing a training program that HIT professionals can use to assist each clinic in showing MU. If you plan on demonstrating the meaningful use of an EHR you’ll receive HIT services from professionals who will translate meaningful use requirements and help your practice implement MU. Meaningful use brings many new requirements to your practice, but with the proper training and guidance, you and your staff will be able to understand and demonstrate MU with ease.

What is full certification?

The biggest buzzword around the Medicare incentive program is “Full Certification.” When considering an EHR experts are advising consumers to only entertain “fully certified” systems. Medicare offers two types of certification for EHR: Full, and Modular. Certification of an EHR is done in sections referred to as “modules.” The testing procedure for each module is well documented and the order of certification of each module has a precise workflow and expected result. The testing procedure happens like a giant, multi-layered checklist. To receive full certification qualified EHR software must demonstrate, measure, report, and pass 100% of the modules that make up meaningful use. If an EHR is missing a certification for just one module then that EHR only will only receive modular certification. Fully certified systems have a significant advantage because they have demonstrated every module for MU and will have documented procedures to accomplish each one.

The process of getting our EHR fully certified was straightforward. Our test proctor started with the very first module, we walked him through the process, and moved onto the next module. We went through every module, one-by-one, and demonstrated meaningful use of our EHR for every applicable measure. Thankfully for them, Eligible Providers (EPs) will not have to be as thorough as we were. EPs will have a number of exclusions they can make and measures that they can selectively demonstrate. We’ve created instructions for how each module is demonstrated and measured to make it easier on our user base. Successfully completing the certification allowed us to design an HIT training program that meets or exceeds any and all testing requirements.

What makes “meaningful use” meaningful?

Creating a reliable method of medical information exchange is one primary goal of meaningful use. Other goals are the “pay for performance” model that Medicare has been pursuing for years, and providing decision support and educational materials at the point-of-care with reliability and consistency. Ultimately, meaningful use is a broad set of rules that helps gather, analyze, and share medical information, and it establishes guidelines for future flexibility of electronic health records.

When we outlined the meaningful use requirements for Chart Talk, we were able to classify every measure into three basic categories: Patient Information, Interoperability, and Quality Measures. MU measures that fall into the same group share common features such as required percentage reporting, file type and structure, alerting capability, and other factors. Your HIT providers will be able to clearly define each of these measures and how your clinic will apply or exclude them when demonstrating meaningful use.

From the distance the task can look as insurmountable as the High Sierras, but don’t stop now, ‘cause there’s gold in them there hills. Keep from getting your back to a wall with the assistance that’s available to you. The new HIT programs are beginning to put trained professionals into the work place, your local regional extension center (REC) is set up to help EPs implement MU, and your EHR vendor should have HIT services available. Use whatever resources you have at your disposal; with the right HIT partner, teamwork in your clinic, a willingness to modify some of your workflow, and a 49er attitude, you will be able to demonstrate meaningful use and keep your clinic running smoothly.


Matthew Richard is Vice President of Mighty Oak Technology, Inc. Matt championed the “50 Days ‘Til Friday” initiative, a plan that saw Chart Talk receive full meaningful use certification in 50 days. Matt received his BS in Physics from Southern Oregon University and now lives in Minneapolis, MN.



» Six areas for MU professionals


» CMS FAQ 17

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