25+ Years of Innovation
INDUSTRY INSIDER
An Interview with eclipse PRACTICE MANAGEMENT SOFTWARE Creators Karen Walters, DC, and Mike Norworth
The American Chiropractor
Mike Norworth and Dr. Karen Walters are a husband and wife team M’ho have worked together for the past 25+ years. Their software is used by thousands of Chiropractors nationwide. In 2014, Mike and Karen were honored by the Board of Trustees of The American College of Chiropractors and inducted as Fellows at a ceremony in Seneca Falls, NY. These honorary degrees recognize their decades-long contributions to the chiropractic profession via a wide-ranging series of software innovations along with their ongoing roles in an educational and advisory capacity to chiropractors across the United States.
Dr. Walters is a 1982 graduate of New York Chiropractic College and has operated a successful, multidisciplinary clinic for decades. She has taught within the NJ College & University system and currently serves as an Adjunct Professor at Syracuse University. WithaB.S. in Biology & Chemistry, M.A. in Computer Science, Mike Norworth is the chief architect of ECLIPSE® and President ofMPN Software Systems, Inc.
In an interview with THE AMERICAN CHIROPRACTOR (TAC), Dr. Karen Walters (KW) and Mike Norworth (MN) discuss audits, software, and documentation over their 25 + year careers in the chiropractic software industry.
TAC: How & why did ECLIPSE come to exist in the first place?
Dr. KW: My practice was growing so rapidly that I was losing track of patients... and sometimes they’d simply fall through the cracks. I found that the sooner I contacted them, the better chance I had of getting them to continue care. I began investigating software, hoping to find a product that would automate this process for me — and asked Mike for evaluation help. In hindsight, it seems serendipitous that he was in the CUNY graduate program for Computer Science. I called colleagues & professors to get recommendations. And told each company I wanted a report to help me h ack patients that came in last week, but hadn’t been in this week, or last month but not this month. None had the capability for this report I considered essential. All refused to add it. Finally, Mike — simply to alleviate my frustration — offered to create a system that handled what I wanted. That report helped my practice grow to a point where I was seeing 100+ patients daily.
TAC: ECLIPSE has been in use nationally for over 25 years. Why does the software cost so much less than it did all those years ago?
Dr. KW: When we first introduced ECLIPSE, it was half the price of competitive systems. As we grew, we took advantage of ‘economies of scale’ to lower prices and reward chiropractors as they helped *us* grow. Some companies charge 2x-4x the cost of ECLIPSE and then advertise how much they’re giving back to the profession by donating a token sum. As a chiropractor, I believe it’s important to pass any savings we can directly to our customers.
TAC: Chiropractors’ approach to adjusting and taking care of patients is extremely varied. Can your software’s Encounter (S.O.A.P) be customized to take this into consideration?
Dr. KW: Anyone who has reviewed chiropractic documentation, as I have, can attest to the incredible diversity of styles when it comes to clinical documentation. We recognize that every D.C. has learned to document visits differently based on school attended, clinical experience, etc. Though the Encounter is quite thorough, a doctor can easily add custom information in a few seconds or hide information they prefer not to document.
TAC: Do you feel that it is necessary for a chiropractor to use certified software to be able to succeed today?
MN: That depends entirely on what percentage of your practice is Medicare-based. Very few ECLIPSE users took advantage of our certification in 2011 despite all the hype. Then, in 2012, 60% of ECLIPSE users from 2011 dropped out of the program! Thousands of practices that use ECLIPSE didn’t seem to consider the trade-offs (e.g., staff time, audits, etc.) worthwhile. Regardless, new CMS programs like MIPS and APMs intentionally make certified software advantageous for offices that bill Medicare to avoid future penalties. Thus, we’re re-certifying ECLIPSE in early 2017 to ensure that clients can choose to opt in or out of such programs.
TAC: As a physician with decades of computer and prac-
tice management experience, what impacts chiropractic practices right now when it comes to using technology?
Dr. KW: Cell phones make a good analog, because they’ve become ubiquitous — like software to run your practice. Most of us can’t imagine getting along without cell phones. Yet, road fatalities went up by 10% last year. And traffic experts agree that cell phones and other hand-held devices are likely to blame for the increase. So, technology often comes with unanticipated side effects.
First, technology can be seductive. For instance, using a card swipe to check-in patients may seem attractive; but the question needs to be asked: Is it smart? My sign-in sheets have saved me from audits because I had a physical signature from the patient for the day(s) in question. A swipe system is like a hotel’s front desk. Anyone can issue a new card to access your room. Does this technology protect you if you’re accused of fraud? We had partners at a top national law firm investigate this for us. They concluded that it would be difficult to defend the doctor on this basis. And a low-tech sign-in sheet would help avoid the need for an attorney in the first place!
Next, your technology should conform to & speed up your business operations. For instance, a unique feature in ECLIPSE let’s everyone in our office see what others are doing instantly in real time. So, for example, if I add services in a treatment room to the same patient chart that’s in view at the front desk, staff see the changes immediately. They simply appear — even if the chart’s already in view on their screen. And when staff members place patients in treatment rooms, I see that on my tablet as it happens. That single feature makes everyone in my office more efficient in myriad ways as we interact during the day.
Finally, technology can lead you willingly down a less desirable path. Over the past decade, vendors finally perfected 1990’s era SOAP narrative formats that the government has since attempted to declare extinct and DHHS has targeted with a multi-faceted set of new audit standards. Chiropractors — especially those who aren’t recent graduates — gravitate to these outdated concepts & marvel at how much verbiage they can generate with virtually no work, rather than focus on updated methods to create documentation.
TAC: Can you describe a present day challenge for chiropractors? Perhaps an existing challenge that has changed over the years?
Dr. KW: Audits (e.g., CERT, HIPAA) have become the ’norm’ and are occurring with much greater frequency than in years past. If you haven’t been audited yet, you likely know someone who has. It adds to the stress of documenting a visit, which can now take longer than adjusting a patient! DHHS OIG is targeting — in a nuts & bolts way — some of the specific shortcuts most doctors use without concern on a daily basis to create SOAP. And it doesn’t matter if these shortcuts are built-in features of their software. DHHS uses phrases such as ’cut & paste mentality’ to paint targeted behaviors with a broad brush. One result is that older paragraph based SOAP narrative formats are * always* at risk. That’s why we designed our clinical documentation to help chiropractors stay within DHHS guidelines — while still allowing busy doctors to document a visit in seconds. The ECLIPSE Encounter reflects decades of clinical research along with the fact that we’ve solicited regular feedback horn chiropractors who actually handle documentation reviews part-time and/or full time.
TAC: Do you help chiropractors defend themselves during audits?
MN: We certainly have helped clients with audits, appeals, and criminal investigations, and have been consulted by law enforcement, insurance company medical directors and state chiropractic boards. We also do our best to help clients get
“So, for example, if I add services in a treatment room to the same patient chart that’s in view at the front desk, staff see the changes immediately. They simply appear — even if the chart’s already in view on their screen. 5 5
paid when they’re not sure why claims are being rejected (e.g., improperly documented CMT codes). We advocate for D.C.’s when law enforcement contacts us — often after records have been confiscated under warrant. And I’ve provided testimony as a computer forensics specialist following accusations of falsified patient records. We’ve never charged for our expertise and have shared our experiences with various DHHS OIG & FBI cases in our blog in an educational capacity. We’ve also helped clients escape overzealous auditors who make requests outside the scope of the law, most recently in MU audits.
TAC: Our sincere thanks to Mike Norworth and Dr. Karen Walters at ECLIPSE®. You may contact them by visiting their website at www.INeedECLIPSE.com. |£SSI
