e know a charming chiropractor who is ready to start winding down to segue gradually into retirement. Scrcndipitously. his daughter recently graduated from chiropractic college and the plan has always been for her and her husband to take over the family business. But the chiropractor"s w ifc called us in some distress. She and her husband are both keenly aware that while they've been financially successful, they're still stuck in what arc now almost the "dark ages" of chiropractic coding, documentation, and procedures, the '80s and '90s when they first started and grew their practice. They knew that they hadn't kept up with the times, and thought they would have plenty of time to straighten things out before their daughter graduated. Now. time was up. and they were both horrified and embarrassed about what their daughter, who has been trained in more up-to-date processes, documentation, and especially electronic health records (EHR). would find when they let her take a closer look at the books. Their documentation was spotty at best, they were still billing on paper, and the office had long-standing patients who liad been allowed to get away with never actualh paying their copays because they felt like "friends." They'd run such a loose ship for so long that they actualh feel bad about handing over this dinosaur of a practice to the kids. However, as the doctor's w ifc acknowledged, they were so out of touch with the current healthcare rules and climate that they didn't even know what they didn't know. They wanted to turn their ship around and set a smooth-sailing course for the future so tliat the next generation wasn't stepping into chaos, but they had no idea where to begin. Basically, they were crying. "Help!" When we are called to help a practice like this one. we come in loaded forbear. In order to liavc the clearest picture of the exact situation, we conducted a detailed examination of the systems and procedures of the practice in the areas of compliance and reimbursement. We reviewed even system, or lack thereof, in the practice. We also pulled random patient files and audited them. The results were exhaustive and deeply revealing. If you've ever had to transition an older loved one from a typewriter to a computer, from a landline to a smartphone. or from a three-story Victorian to an assistcd-lh ing condo. then you know about the kinds of weird, outdated storage systems, ideas, and habits that come up. People form habits built over decades tliat arc in place for so long that they no longer even question them. That was the case here. too. The coding was hopelessly out of date. Revaluations were virtually nonexistent. There was a crude computer practice-management program in place, but it was essentially nothing more than simple ledgers. They even still used travel cards. Sometimes, travel cards arc hand-me-downs from the chiropractor who founded the practice: the new DC may attach sentimental value to travel cards used by the doctor who inspired him or her to become a DC. (Imagine how this dynamic easily might have played out between father and daughter!) The financials were as big of a mess as the (lack of) documentation. There were no collections systems in place at the front desk, no financial report of findings, and precious little in the way of clinical reports of findings. Horrifyingly, patients just sort of came in whenever they wanted, and every visit was billed to insurance! Case management? Nonexistent. Not surprisingly, the patient balances were out of control, and there were virtually no policies or procedures in place. In some wavs. that didn't even matter, because even if there had been a standard operating procedures (SOP) manual in place, it would have been out of date. They were, quite simply, set in their ways, as most people become after decades of doing things in the manner to which they arc accustomed. The difference here is tliat these sweet old dogs actually wanted to learn some new tricks, so they could pass on something meaningful to their kids instead of a mess. In the case of this particular practice, it was urgent to install documentation systems tliat would stand the test of time. It made sense for the daughter to take lead on documentation and actually train her father in the process. We advised that her husband, in the meantime, take on one area of the office at a time, slowly begin to learn how the processes should ideally work, and then, with our help, write policies and procedures to gradually turn the situation around. Each area of focus got attention and. over time, became organized to the degree that systems could be installed. The staff (including the older chiropractor and his wife) now could be effectively trained, and the SOP manual was created as they proceeded. It was important that major patient policy changes be initially implemented with new patients only, which kept the established patients from feeling as if the boat were being rocked too violently. It also allowed the office to "practice" new systems and fees with new patients who had no established expectations of how things "should" be. Slowly, the practice's founding chiropractor and his wife began to feel more comfortable with the changes. The practice began to function more smoothly and effectively as their daughter and her husband began stepping in to gradually take over key systems and functions. Today, the senior doctor has a viable retirement date, and he and his wife feel good about the legacy they arc leaving for the next generation. Wc"ll leave cleaning out the family home in preparation for the move to a retirement condo to the kids. Kalhy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and. since 1983. has been providing chiropractors with reimbursement ami compliance training, advice and tools to improve the financial performance of their practices. Kathy is known as one of our profession sforemost experts on Medicare andean be reached at (855) TEAMKMCor [email protected]
