This is the third article of a three part series.  For the previous two articles in this series, see: 12 Things Chiropractors Have to Change in 2012 (Part 1) and Part 2

9.  Pay Attention to Payer Policy Changes! Insurance companies continue to unleash a fury of payer policy changes to mostly unaware doctors and I don’t see this trend stopping anytime soon. Case in point: in 2011, several Blue Cross entities across the country unilaterally wiped out CPT rules with their “interpretation” of coding for the use of Modifier -52, timed procedures and physical medicine services.  The result?  Hundreds of thousands of dollars (millions?) worth of chiropractic services denied, post-payment demands made and sudden cases of high blood pressure ensued.  In my Chiropractic Billing, Coding & Documentation Seminars, I inform attendees about these latest changes and warn them to pay attention to those emails, newsletters, payer bulletins and EOB’s from insurance companies!  Unfortunately, when a payer changes the rules (their medical or reimbursement policies), you are still obligated to them either contractually (as a contracted provider) or in terms of reimbursement – if you want to be paid.  Ignorance is no excuse.

10. Emphasize (or Build) Your Internet Presence. No, I don’t think that the Internet will solve or replace all your New Patient woes.  If the majority of your NP’s are not direct referrals, you have internal systems that need fixing.  That said, not using the internet as a viable source for new patients is ignoring massive, obvious potential for your practice – no matter where you live.  The phone book is all but dead. Newspapers are dying daily. More and more have discarded these “old” media forms with online replacements.  Your first step in this strategy should be getting a decent, non-static website. Believe it or not, there are still plenty of chiropractors with absolutely no websites! While you may think this is not necessary, do a simple experiment. Google your name and the word chiropractor or the name of your town.  If page 1 of Google reveals every other chiropractor but you, that spells trouble. Even DC’s who do have a web presence can utilize this platform to do better. The vast majority of chiropractic websites appear to have useless, lifeless online equivalents of a business card that never changes.  Websites can be so much more and that’s just the start of your internet marketing. Get a website that features video, a blog, a free giveway product – something that begs your potential patient to interact. This doesn’t even begin to tap into other potential avenues such as mobile marketing, social media marketing, pay per click ads, etc, etc.  What are you waiting for? Get going!

11. Your Revenue Model Will Need to Change. This will be perhaps the most difficult thing for many to accept.  The old revenue model, purely based on volume, is crumbling. Payers are paying less and less for adjustments and limiting care while expenses continue to increase. Simple economics tell you that if the price of your service is decreasing, the frequency of which it is consumed is decreasing and the cost to deliver that service is increasing, you have an impending disaster in the works.  Most chiropractors will need to add significant additional revenue streams (By significant, I mean ones that can generate add least 5 digits. Quite frankly, most offices don’t sell enough topical pain relieving gels, back supports and the like to call this income significant) to help their clinics grow; some will need these streams to survive.  Gone also are the days that you can casually or carelessly bill for adjustments only or even, an adjustment and a modality.  Most DC’s do significantly more than this, but fail to get paid for their work and what they will be paid for these basics will be disappointing.  Don’t misunderstand – I am not advocating we gauge our patients for every minor little service we perform or try and pad the bill to the degree where we are running up $350 visits, every visit.  But we do need to take a focused, systematic approach to making sure that we are paid for the good work we do.  For some, that may be as simple as actually billing for the services that are rendered instead of giving them away free.  Others may need to discover that they have reimbursable services that they are currently performing, but not being paid for.  Finally, some may need strategies to maximize or capture the income they are currently leaving on the table as well as develop additional revenue sources or realize the true potential of what they have currently going on in their businesses.  As a side note, this is the essence of much of what I do for my consulting clients and if this sounds like something you need, you should start by submitting a Practice Analysis Questionnaire.

12. Think About Your Exit Strategy. I am not telling you to get out of chiropractic before certain political legislation goes into effect, but someday this might be something you want to consider.  Statistically speaking, the largest segment of chiropractors are in now in their 50’s.  If you haven’t already thought about how or when you will leave chiropractic, it’s time.  Too many DC’s fail to plan this and are left scrambling at the end.  For most, it’s never too early to start planning.  My Ultimate Chiropractic Exit Strategy program is a good place to start you thinking in this direction and is a far better strategy than the one most DC’s employ: none at all!