Technology


Prevent Missing in Action Patients from Becoming Lost in Action
Technology
Written by Dr. Paul B. Bindell, D.C.   
Tuesday, 14 September 2004 21:41

Every doctor has patients that miss appointments. There are numerous reasons for this, and it is up to you and your office staff to make sure that those missed appointments do not become lost and forgotten.

In the past, there have been many methods that were used to keep track of missed appointments, but they all required that someone in the office remember to look in a special file, or print a special report. Now there is a better way.

When you use a full-featured office management computer program, your MIA (missing in action) patients remain on your computer screen, until each appointment has been resolved. You and your staff have them as a constant reminder, until each has been rescheduled. No one must remember to look in the special file. No one needs to print a special report. All you have to do is look at your computer and make the recall and reactivation phone calls.

This is only one of many features that should be present in your office management computer program. A full-featured office management program is designed to keep your office efficient and productive. Other features include electronic claims, remembering every insurance claim submitted so you no longer print and file a copy, scanning of documents, and full integration with the your documentation software.

Computer programs designed by a chiropractor give many functional benefits. The right program makes your office as free of paper as is possible. Search out and take advantage of these programs and make your office more efficient with greater productivity than it has had before. The result will be more income and more time that you can spend with family, friends, or in any way that makes you happy!

Dr. Paul Bindell, President of Life Systems, Inc., is a 1975 Palmer graduate, in practice in Rockaway, NJ, since1976.  In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice.  Dr. Bindell can be reached by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Integrated Software
Technology
Written by Dr. Paul B. Bindell, D.C.   
Thursday, 08 July 2004 21:03

Once you have had the pleasure of working with automated SOAP notes, you know the benefits of software that automates patient care.  In all cases, patient notes are only a portion of the paperwork in a chiropractic office.  In addition to SOAP notes, it is now possible.  Each program eliminates the need for paperwork, but the main concern when finding the right software combination is that all the different programs are fully integrated and compatible with each other.  Integration is the crucial element that allows patient information to flow freely between programs allowing for quick and accurate data sharing that saves time, effort, and money.
 
When billing insurance, both the doctor’s notes and the bill for services rendered must correlate.  In fact, Medicare requires that your progress notes document and match your billing, and in any case in which they do not, Medicare can fine you up to $10,000 for each progress note and bill that does not match. The software you utilize should be checking to make sure that your office notes and insurance bills always match.  You should not have to waste time comparing your notes and HCFA forms.  A fully integrated suite of software programs issues a warning notice anytime a dis-crepancy occurs.  With integrated software checking for differences, thousands of dollars are saved by keeping billing and progress notes in unison.

A fully integrated suite of software programs issues a warning notice anytime a discrepancy occurs. With integrated software checking for differences, thousands of dollars are saved by keeping billing and progress notes in unison.Integrated software allows patient information to automatically flow from the doctor to the billing office to the receptionist, eliminating duplication of effort from having to reenter information many times.  Such information includes diagnosis, treatment plan, transactions, and personal information that could take hours to recreate. In integrated software, this crucial data is entered only once and is shared automatically by the programs with no additional human effort whatsoever.  Therefore, you and your staff save an abundance of time and are able to concentrate more on patient care, recalls, and collections.

Integration goes a step further when a Pocket PC, a hand held computer, is involved.  Technology has reached the point where a Pocket PC is connected over a wireless network, and the information is updated on all your computers as soon as you file and save your SOAP note entry.  Immediately, your front desk has the information needed to schedule an appointment and enter the visit charges, your billing office knows what to send to the insurance, and your clinical findings are part of the patient’s permanent record.  This technology gives the doctor complete freedom of movement while treating patients and entering notes.  The Pocket PC allows the doctor to have one hand-held computer that he carries with him, which eliminates the need for a desktop computer in every room.  The doctor is also able to carry the Pocket PC wherever he goes outside the office and, upon return, all the new entries automatically synchronize with the main office computer.  Pocket PC technology revolutionizes your practice on so many levels that it will be discussed in greater detail in future articles in this series.

Integration of the software is achieved using a computer network that is set up within your office.  It is critical that you have software that is compatible with your network.  For wireless connections to work, both your computer and the Pocket PC must have the proper wireless equipment installed.  A “hard wired” network means that you have wires connecting all the desktop computers in your office, and you have a wire connecting your computer to a docking station for the Pocket PC, so it can synchronize with your main computer.  In order for software integration to be complete, it is necessary for all the software programs to come from one company. This avoids conflicts between the programs, databases, and development from different companies.

Once set up with fully integrated software, you will immediately notice a simplified, more efficient routine in your office.  You will rapidly process insurance, schedule appointments, produce narratives, and reduce paperwork.  This increases the time that you and your staff will spend on patient care, recalls, collections and expanding your practice.  As a result, you are likely to have more time to do the fun things in life with your friends and family, and you are likely to have more money to do it with. TAC

Dr. Paul Bindell is a 1975 Palmer graduate, in practice in Rockaway, NJ, since 1976. In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice.  Dr. Bindell can be reached by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
“Digital Analysis” of Plain Film Radiographs - A Superior Tool to Better Educate Patients and Attorneys
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Technology
Written by Aadam Z.Quraishi, M. D.   
Saturday, 28 February 2004 00:00

A benefit of being a doctor is the opportunity to see patients improve while treating them.  Most patients are quite grateful for the constant support and will return for more treatment if their conditions are exacerbated or new problems develop. 

 

 

 

However, receiving payment for services rendered is a different story.  Today’s healthcare practitioners have to be quite savvy in the business aspect of their practice.  How can a doctor enjoy the pleasures of treating patients, limit liabilities, contain costs and maintain a reasonable steady increase in revenue?  One answer today can be found in diagnostic radiology. 

 

 

 

Chiropractic doctors perform systematic and thorough physical examinations using methods, techniques, and instruments standard across all healthcare professions:  X-rays, MRI, PET and CT scans are essential parts of a practice.  However, another imaging service available is Digital Radiographic Mensurations.  It is often referred to as a “computerized enhancement” and “digital analysis” of plain film radiographs. 

 

 

 

Spinal X-raysSpinal X-rays are taken when a comprehensive history and thorough examination have determined probable musculoskeletal involvement.  The results from the analysis of X-rays that have been digitized and analyzed produce an outcome assessment process that helps establish the following:

 

a)     A chiropractic diagnosis for the correction of specific motions’ segment and functional units.

 

b)     A scale to assess the patient’s current conditions, compare serial studies, and determine maximum clinical improvement.

 

c)     Help provide a specific treatment plan with the clinical goal of restoration of the functional biomechanics. 

 

d)     Provide a unique graphical information format of the patient’s biomechanical findings for reference during each treatment session.

 

 

 

These will clearly help the doctor determine the need for treatment, the type of treatment to be administered, and monitor changes during treatment resulting from any re-injury. 

 

 

 

A comprehensive Digital Radiographic Mensuration should include three reports:  Biomechanical, Pathology and Digitized analysis.  Well-referenced Biomechanical reports produced by patented advanced technology are recognized by some of the most notable institutions in the country.  Those including impairment ratings per the latest edition of the American Medical Association’s Guide to the Evaluation of Permanent Impairment help justify medical necessity.  Multiple studies have shown X-rays read by board certified radiologists gather a much greater amount of information and are able to deliver more extensive pathology reports and data analysis.  Digitized analysis reports, especially those with the patient’s actual images imprinted onto photographic paper, provide a superior tool to better educate patients and attorneys.

 

 

 

Patients, by nature, are mostly visual people who understand pictures and graphs.  A patient’s X-ray images, when printed onto photographic paper with mensuration lines and statistical analysis graphs displayed next to normal spine images, illustrate to them their biomechanical differences as well as structural improprieties.  This gives the patient information that will motivate him to continue treatment and comply with further recommendations.  In addition to increased patient retention and compliance, the potential for lawsuits is lowered due to the fact that the patients have been well informed with documented references and research data about the necessity of their treatment protocols. 

 

 

 

One major complaint by doctors’ billing offices is the demand by insurance companies for detailed documentation to justify medical necessity.  The general medical profession and third party payors do not quite understand the vertebral subluxation complex.  By using the documentation from objective detailed reports provided with a comprehensive Digital Radiographic Mensuration and Analysis, insurance companies will not only approve longer treatment but also reimburse with greater compliance.  

 

 

 

Digital analysis of spinal X-ray films is a tremendous diagnostic resource available to help today’s chiropractors restore their patients to health and wellness.  What criteria should you consider when choosing a digitizing company?  Look for a service that provides:

 

  1. Board certified radiologists licensed in the state where patients are treated.

     

  2. Professional Comprehensive Reports

     

  3. Free shipping/handling of films to your clinic

     

  4. A reasonable turnaround time on reports

     

  5. Continuing Education seminars/lecture and materials

     

  6. Certification program for your clinic

     

  7. Availability to discuss cases with radiologists when necessary

     

  8. Newsletters to improve technique and further education

     

  9. Knowledgeable support for you and your staff

     

 

 

It is easy to see how diagnostic radiology and the use of Digital Analysis of spinal X-ray films in your practice can help you provide better patient care, limit liabilities, contain costs and increase revenue.  TAC

 

 

Aadam Z. Quraishi, M. D., specializes in Vascular and Interventional Radiology MRI (Neuro and Musculosketal), MRA Mammography, Breast Localization, Nuclear Medicine CT and Ultrasound.  Dr. Quraishi has board certification in Diagnostic Radiology.  To contact Dr. Quraishi please call 866-4PDI-PDI or you can email him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Diagnostic Tools in Chiropractic
Technology
Written by Suzi Plank   
Sunday, 30 November 2003 00:00

Diagnosis, the basis for determination of treatment, is defined as "the art or act of recognizing the presence of disease from its signs or symptoms". Diagnostic tools help you uncover or establish the characteristics of the disease(s) or condition(s). Chiropractors have a wide range of diagnostic tools available to them today …from the old stand by’s to newer technologies. New procedures, tests and technologies continue to be developed, some complementing diagnostic tools of long standing and some replacing them.

The most advantage is gained in determining the appropriate procedure when you know the type of information to expect. Additional benefits come from the documentation of the findings and application to the treatment plan…the ultimate goal of diagnosis.

X-Ray’s: The plain film radiograph of the spine is still considered the simplest and most common diagnostic tool used by doctors to evaluate skeletal problems. X-rays can gather an astonishing amount of necessary information about the patient. Above and beyond ruling out pathologies and possible fractures, X-rays can be used to show mensuration lines that can be used to determine and document specific structural impairments. X-ray’s are the basis for documentation of structural and spinal abnormalities.

MRI: Developed in the 1980’s, Magnetic Resonance Imaging (MRI) produces images of the anatomy without the use of radiation, as in X-ray and CT scanning. An MRI scan, with its enhanced image resolution, can be an extremely accurate method of disease detection throughout the body and is most particularly useful when considering problems associated with the vertebrae or intervertebral discs of the spine. An additional benefit is that an MRI is a non-invasive procedure, and there are no known side- or after-effects.

Typical MRI results of the spine can provide information such as spinal alignment, disc height and hydration, configuration of vertebral bodies, the appearance of intervertebral discs—normal, bulging, herniated, dehydrated or degenerated, the size and appearance of the spinal canal—compression of cord or nerve root, and other abnormalities or inflammation. An MRI cannot distinguish between painful and non-painful anatomical problems in the spine. The patient’s physical exam and symptoms must be correlated with the MRI findings to arrive at a clinical diagnosis.

CT Scan: Computerized (Axial) Tomography, often referred to as "CAT" scans, has been described as a fancy X-ray that can take cross-section (axial) images of the body. They are extremely useful for assessing fractures, because of the bony detail provided. Nerve roots, however, are not clearly shown and smaller disc herniations can be missed. The highly invasive combination procedure of a CT scan combined with a myelogram is a very sensitive test for nerve impingement. A CT scan is a diagnostic alternative for patients who are not candidates for an MRI because of the presence of a pacemaker, metal slivers in eye, aneurysm clip in brain, etc.

Musculoskeletal Ultrasound: Musculoskeletal ultrasound scans of the spine and extremities can provide differentiation of soft tissue, including ligaments, tendons, nerve root area, facet area, costovertebral junction and muscle spasms, for evaluation and documentation. Extremities, such as shoulders, knees, ankles, hips, wrists and elbows, can be imaged and reviewed. Ultrasound allows for real-time scanning of moving and static soft-tissue structures, an important consideration in injuries such as rotator cuff. One limitation is that ultrasound does not pass through bone, so some soft tissue areas cannot be imaged. It is excellent, however, for imaging soft tissue and documenting trauma to tendons, tendonitis, tears, inflammation and ruptures, ligament strains and tears; injury or rupture of muscles, bursitis, capsulitis, neuromas, fibromas and cysts. Musculoskeletal ultrasound is a very "patient friendly" procedure, and there are no known side- or after-effects to its use.

Videofluoroscopy (VF): The American Chiropractic College of Radiology has stated that videofluoroscopy is a useful imaging modality for the demonstration of spinal intersegmental joint dysfunction. VF can display the abnormal motion of the cervical spine, showing the point in motion the hypermobility or aberrant motion occurs. VF is valuable in detecting instability in flexion and extension not otherwise visualized or detected on plain films. VF can be used to document hypermobility, hypomobility, aberrant motion, instability, aberrant coupling, paradoxical motion and evaluation of spinal arthrodesis. Videofluoroscopy is an X-ray procedure and, as such, is contraindicated during pregnancy. Some other contraindications are when motion would be detrimental to the patient; restrictive muscle spasm, dislocations, recent fractures and severe neurological deficit.

Consultation & Physical Exam: The most important diagnostic tool available in your practice is you. Diagnostic tests and procedures can provide targeted information about anatomical regions, physiological systems and more. Your training, and the examination and diagnostic skills you employ enable you, as a chiropractor, to take the best advantage of the data produced by these other tools. Your expertise is required to correlate the assembled findings and determine the best course of treatment for your patient.


Ms. Plank has an extensive background in medical and facilities management.  Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory.  During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology.  She is currently the Vice President of Corporate Services for Practice Perfect.  Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Marketing, Retention, and Patient Base
Technology
Written by Derek Greenwood   
Sunday, 30 November 2003 00:00

What are the common points in the strategies employed by growing successful practices?

In the first few weeks of this year, a series of surveys caught my eye. The new statistics coincided from one survey to another on the topmost issues on chiropractor’s minds...Patient Retention and New Patient Recruitment. No big surprise there, yet it hangs around like a chronic sore back, refusing to go away. Patient turnover is at an all time high and competition for new patients is a fierce, ever-escalating contest. Recruiting new patients can be a costly, drawn out affair, filled with frustration and uncertain results.

Aside from throwing advertising and gimmick money at the problem, which only lowers your ROI (Return on Investment), there are simple, motivating factors that any practice can find with a little introspection. Further looks into the cause and effect of the situation will provide some information to work with. Every clinic and every patient is different, and what may be your Achilles heel may not be the same for another practice across town.

We know from experience that the best and cheapest form of advertising is word-of-mouth. The trick is nurturing a strong patient base that believes your vision of health. If you don’t already have one, your first step is to launch a customer service campaign to earn their hearts and loyalty. Once again, you need to know what will positively work for your practice and your patients.

What would make a person not return...or start going to someone else? Why would they not say anything? Why would they want to put themselves in the hands of a stranger? What went wrong?

A little research into past patients will uncover the most common reasons for patient exodus. There’s always a reason.

Let’s take a look at some of the more prevalent remarks from ex-patients.

  • Moved to another city or state. 
  • No progress in my recovery.
  • Therapy too painful. 
  • Was not a covered expense.
  • Too expensive.
  • Had no way to get there anymore. 
  • Didn’t listen to what I said.
  • They wanted me to buy stuff I didn’t want.
  • Clinic didn’t seem to care.
  • They changed my doctor
  • Never gave me a new appointment.
  • People only wanted my money. 
  • Their people weren’t very nice.
  • Never called to see how I was doing.

If any of these sounds familiar, you have plenty of company. Unfortunately, this happens even to the best. The good news is that you can reduce it to an acceptable level. The great majority of the above kinks are created by inadequate communication. The solutions can only follow after we find out what the problems are.

Highly underutilized in practices, surveys can provide a gold mine of information which is actionable and inexpensive. Not only will these surveys help you with your current clientele, they may unearth strong phrases to use in your advertising. Once you’ve gotten strong agreement on recurring answers from patients or public, you can begin to take action.

Being human, we may falter in our resolve to change things around and discontinue programs, features or services that should have stayed in place. Fortunately your practice software, if it is one of the good ones, can help you stay on track. It can make absolutely sure that you never send anyone out of the office without their next appointment. It can remind you of that one patient that always forgets her appointment, or Mrs. Johnson’s birthday, or that she prefers Dr. Bill. Software can help you track the effectiveness of your promotional activities and provide statistics to gauge response. In short, most of what you need to correct a decline or accelerate growth is within your reach today.

Depending on what your survey turns up in the form of needed changes (survey your patients twice a year minimum), you can implement a five- to-ten point service campaign that preserves your current roster of clients, while you concentrate on marketing/advertising to bring in new patients. What could the five or ten points to your campaign include? It will all come out in the survey…more communication, temperature of the rooms, ask if hurts, a birthday card, reminders, shorter waits, free pick-up at the home, mints…almost anything.

Even the best-thought-out promotional strategy, including letters, cards, phone calls, service awards for staff, package discounts, newsletters, ads, radio/TV, articles, seminars, earned free services and a host of internet and web applications, will be for naught, if they do not connect with the emotional triggers that patients or the public may have. Find out!

As for the growth of your patient base, chances are that, if your patients are happy with you, they’ll bring all their friends with them. And how can you use this to market to the broader public? Let them tell you. Surveys, once again, are the cornerstones of the future. Surveys, planning, a warm, caring staff and the correct software will keep your practice growing, profitable and full!

Derek Greenwood is Chairman of EON Systems, Inc., manufacturers of TPS 2000, a software program for practice management.  For additional information, please call (800) 955-6448.

 
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