At one point in time, virtually every business owner – chiropractors included – has asked the question “How can I improve my income?”   Today’s post will discuss this mega-dilemma of nearly all entrepreneurs.

Before we discuss potential solutions, allow me to throw another question at you:

HOW do you want to increase your income?

For many DC’s, they will add a caveat: “…without working more!”  This is not because chiropractors (or entrepreneurs in general) are lazy.  Most owners could verify that they work harder and, often, longer hours than any employee would tolerate.  In fact, what most business owners are really longing for is a way to work more EFFICIENTLY and EFFECTIVELY.

Is Raising Fees or Increasing New Patients the Answer?

Let’s take a look at two common ways to increase income.  First, you could raise your fees.  This almost immediately produces an income boost. The cost to do so is nothing.  Sounds perfect?  And while increasing fees is one thing I believe is critical to your financial success, it does have limits.  After all, in theory you could double your fees and double your profits. You also may multiply the number of patients who head for the door. With insurance allowables, you also know that strategy doesn’t work across the board.   So, although raising fees may be smart, it is a limited strategy by nature.

Now let’s look at the example of new patients.  Most chiropractors would agree that having more new patients is key to increasing income.  Certainly that is often true. But don’t be too hasty in proclaiming new patients as the premier method of increasing income.  Why?  Two words: acquisition costs. If your new patients come from referrals, the cost to acquire them is nearly zero so this can be a profitable venture.

On the other hand, if the new patient walks in as a result of an ad you placed, you need to now calculate the costs of the ad and the potential income the patient will generate for your practice.  In this way, some new patient acquisition methods can certainly be profitable while others less so or not at all.

So, perhaps a better question to ask is:

What’s the most cost-effective improvement I can make to increase income?

In the October 9, 2009 edition of Medical Economics, healthcare consultant Keith Borglum gives the answer, plain and simple:

“The most cost effective improvement is usually in improving your coding.”

Of course, as a Certified Professional Coder and Professional Medical Auditor myself, I agree and admittedly, I am a bit biased.  But here’s the reasoning behind Mr. Borglum’s proclamation, which is both logical and true to my experience as well:

“An extraordinary number of physicians fail to stay current in their knowledge of coding, resulting in reduced reimbursement or delayed and denied claims.  Many physicians purposefully undercode out of fear of penalties for overcoding or unbundling. Others leave their coding to support staff – an inappropriate approach virtually guaranteed to result in errors …”

Chiropractors are No Different

Although this consultant is speaking in reference to Medical Doctors, in my experience, we chiropractors are really no different.  In chiropractic school, we were taught examination procedures based on creating a working diagnosis so we could accurately assess the patient’s condition and create an appropriate plan of care.  In other respects, our exams were also about protecting ourselves from malpractice resulting from potential hazards that could be mis-diagnosed. But I have yet to meet a chiropractic graduate from any school who was taught how to properly document an exam for purposes of correct coding and billing.

As a result, most fall into one of two camps mentioned above.  Conservative chiropractors tend to undercode or underbill, thus denying themselves reimbursement for procedures they actually performed.  More aggressive chiropractors tend to bill for procedures out of some sense of justification for the time they spend performing a service that may not necessarily match up with coding or documentation requirements.  As a result, they overbill or upcode.

Many clients come to me seeking ways to improve income, but most also have some predetermined methods that they believe they need to use to achieve this and hope that I can somehow teach them a new “trick” or “secret method.”  On the contrary, most clinics I see would benefit not from something new, but by returning to the old.

In other words, they can reliably improve income by making sure they are being paid for what they are already doing. They can increase revenues by maximizing reimbursements and minimizing errors that cause them to leave money on the table.  Proper billing, coding and documentation can help you achieve this – without the added expense of new equipment, extra staff or additional funds in the marketing department.

Proper Coding & Billing Makes Sense (and Dollars)

On top of that, if you consider correct coding from an expense point of view, proper coding not only has the potential to increase your income, but also prevent you from losing income –few strategies can ever achieve both.

If you want to get down to pure return on investment, taking a coding class for $100 or $200 could easily find you at least one item that you could improve.  Even if that resulted in a $25 increase for a service or procedure you performed just a few times a week that could result in a $5000 increase over the course of a year or a 50:1 ROI!

Personally, I have had seminar attendees tell me that one of my strategies was worth $25,000 to their bottom line!  Take that one step further and spend a few hours consulting with a coding expert and you could easily turn your investment into a 5 digit return. One of my favorite examples: 20 minutes into a visiting a client’s office, I found one error that cost them $42,000 in the previous year.  I can’t calculate that ROI as the numbers are astronomical, as is the fact that once corrected, that client will reap the $42K per rewards for years to come.  Similarly, I had a recent phone conversation with another client that revealed a $50,000/year coding error being made for no apparent reason that pure unadulterated ignorance. The client was uncertain whether to be depressed (that he lost that money each year for the past 15 years) or elated (that he could earn it with one small change).

Before you mistakenly believe that these things only happen in rock-star practices and that I am discovering only the rarest of gems, think again. I am certainly no superman. And my clients are amazingly human as well.

But here’s the thing:  if you are making $10K/year mistakes on some items, missing $15K/year opportunities on others and uncertain how to capitalize on $25K/year possibilities in other areas of your practice, eventually that money begins to add up to big dollars and little sense if you don’t do something about it.

It’s Not ALL About Audits

Finally, I know that in recent years, there has been much written about audits.  And they are a real, scary possibility for all of us.  May I remind you, however, to keep things in proper perspective.  Although it is possible (perhaps even probable) that many chiropractors are doing things incorrectly in terms of their billing, coding, documentation and compliance, that certainly does not mean that everyone will be audited.

On the other hand, however, if you consistently under-code or fail to bill for your services, one thing is guaranteed: you will ALWAYS be paid less than you should for your work.  After all, no one will pay you, if you don’t ask properly.

So, the next time you are seeking ways to increase income in your practice, remember the following:

1. All income increases are not equivalent – consider return on investment
2. Correct billing and coding can help you prevent income loss
   
3. Correct, billing and coding can help you increase income

Action Steps

One of the most basic steps towards improving your coding should include the purchase of the ChiroCode deskbook.  Quite frankly, no office should be without it.  And EVERY office I have seen without one of these books that is making major coding errors that are costing them money and exposing themselves to audits.  Unfortunately, I can think of no exception to this rule.

Secondly, take an active part in improving your billing, coding and documentation knowledge.  This is for both the doctor and the staff.  Read blogs, articles and attend seminars.

If you are tired of being put to sleep and want more interactive instruction on proper coding, billing, documentation and business development,I have some upcoming seminars you may want to attend as long as your brain can stand 12 hours worth of material stuffed into a six hour format.  Disclosure: I drink too much caffeine, talk fast and we cover a lot of ground. If you can hang (and you can), see my SEMINARS page for more info and upcoming dates and locations.

Now is the time to start planning and investing in success for 2012 and beyond!

How Can You Increase Your Chiropractic Income Without Working More?

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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!

12 Things Chiropractors Will Have to Change in 2012 (Part 3)

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5) Be on the A/R Alert. As predicted, the latest statistical surveys on the economics of medicine (including chiropractic) have indicated that small physician and hospital Accounts Receivable are growing and “aging” across the board. Translation: it’s taking longer to get your money and you have more money hanging out there in the void. According to most reports, the obvious cause is the economy; people have less disposable cash and unfortunately, we as health care providers are low on the totem pole of priorities for bills to be paid.  The also obvious consequences that no one likes to mention are (a) impending cash flow crunches and/or (b) the potential inability to collect what’s due.  Either result is bad.  The lesson?  Watch that A/R!  It’s fairly easy for a practice with a decent volume to get in a zone only to suddenly look up and notice that their A/R has formed a small mountain whilst their nose was busily pushing the grindstone.  What’s reasonable for A/R?  It’s tough to give a rule of thumb that would apply to everyone, but the most basic benchmark would be that “healthy” A/R represents approximately 1.5x gross monthly collections and “unhealthy A/R” begins when you go over 2x gross collections.  But these formulas can vary widely depending on your practice and payer type.  Suffice it to say, no matter how the numbers balance out, most folks have a good inkling that their A/R has changed for the worse and/or when their A/R has become dangerous to the cash flow.

6) Take Tighter Reigns on Deadbeats. A natural consequence of focusing on the A/R as described above is the fact that you will begin to notice flakes, not of the dandruff variety, but financial flakes.  You know the type: they hobble in but dart out the front door before you can collect their co-pay.  They remember the fact that you were 2 minutes late for their appointment 6 years ago, but always seem to forget their wallet.  They setup payment arrangements but never manage to inform their bank or checkbook of the same. When times are flush, sloppy offices tend to not notice these folks falling through the cracks until revenue is less vigorous than anticipated or until they get frustrated with the fact that they are essentially working for free.  Either way, the solutions are the same: tighten up your financial policies, begin to outsource the deadbeats to collections “alternatives” (I generally don’t recommend traditional collections agencies) and/or quit being such a softie and giving away your hard-earned work.  See my Chiropractic Collections and Financing Secrets program for more detailed strategies in this regard.

7)  Beware the Rise of the Non-Insured, Insured. It does not matter where you practice or who your major insurance payers are – I consistently hear reports that $5000 and $10,000 deductibles are becoming more commonplace.  For many DC’s this means that this patient, who believes they have insurance coverage, will essentially be considered a “cash” patient or someone without coverage.  Proactive strategies to deal with these patients and communicate to them effectively are necessary because they are not the same as dealing with a patient who understands they have zero insurance.  These people believe they have insurance and are sometimes shocked to find out how poor their coverage is.  I have seen and heard umpteen offices botch this and force these patients to leave by making them feel unwanted or unworthy.  Since this patient will become more common, you should have set strategies that are well-rehearsed for all your team members to handle these patients tactfully, respectfully and successfully.  Surprises are bad for the patient and your staff, who isn’t quite sure how to handle this.  The Collections Secrets program and the Chiropractic Office Protocol Book are good places to start, if you need strategies in this regard.

8.) Let Go Of Your Dead Wood. Face it, the reimbursement from many payers doesn’t appear to be getting spectacularly better anytime soon. Now is the time to seriously analyze which payers are at the bottom of your barrel and let them go.  Why continue to struggle with payers who reimburse pitifully, require mountains of paperwork and make you, your staff and your patients jump through a series of endless hoops to continue or justify care?  The beginning of the year is the best time to analyze this, once you receive your 1099s.  For more info on the exact how to’s, see my article previously published in Dynamic Chiropractic entitled “How to Drop an Insurance Company.”

That’s it for Part 2 – check back in a few days for Part 3 and more things to keep tabs on in 2012!

12 Things Chiropractors Will Have to Change in 2012 (Part 2)

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This year, there will be some major changes that will definitely need to be tracked along with some trends you definitely want to pay attention to.  Here they are…

1) Medicare deductible. We’ll start with an easy one — the new Medicare Part B deductible will be $140.00, starting January 1, 2012.  Yes, if you are paying attention, that is LESS than last year’s deductible!

2) Convert to 5010 Format. For all offices filing payments electronically, you will have to convert to the new 5010 format by Jan 1, 2012.  Hopefully, you heard my endless warnings about converting to 5010 and have prepared your practice well in advance of the 2012 deadline.  If not, get moving! 2012 is here and you do what to be paid, don’t you?!

3) New Medicare ABN Form Required. Yes, it functions exactly like the old ABN and looks nearly identical too.  But that doesn’t change the fact that the folks at Medicare require a new ABN form and give you yet another reason to put them high on your list of irritants.

4)  Take a Serious Look at Your EMR Company. Results are in and the “dream” of stimulus money has actually come true.  The first few government checks arrived in the hands of – believe it or not – chiropractors!  Yes, there are fully certified EMR programs that chiropractors can use. I don’t want to turn the whole EMR picture to focus on stimulus dollars. But…a few points need to be seriously considered in 2012. (a) If you don’t have EMR, now is a good time to shop.  However, don’t even bother shopping for one that is not certified. If they couldn’t be bothered to get certification, what else are they leaving out of the equation?  (b) The next question becomes – if you don’t like your EMR, now may be a good time to switch – and again, move towards one that is certified. At least you have a chance to get your $$ back that you spent on your former rotten apple with the possibility of stimulus dollars.

To keep the post mercifully short, that’s it for Part 1 – check back in a few days for Part 2 and more things to keep tabs on in 2012!

12 Things Chiropractors Will Have to Change in 2012 (Part 1)

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DO YOU HAVE…???

• chiropractic coding questions that never seem to get answered?
• a chiropractic billing mess you can’t solve?
• chiropractic documentation dilemmas and don’t know where to turn?

HELP HAS ARRIVED — GET ANSWERS NOW!

You’re invited to join us for our 4th Annual FREE webinar event: “The Toughest Chiropractic Billing, Coding, Documentation & Compliance Questions EVER!”

You missed the FREE event but you can still get a copy of the webinar on CD — see below for details!

This 90-minute Q&A session with Tom Necela, DC, CPC, CPMA, CCP-P of The Strategic Chiropractor — Certified Professional Coder, Medical Auditor, Compliance Professional and former Insurance Claims Analyst — will address those pesky, confusing or just plain oddball questions you never seem to get properly answered.  Best of all, you don’t have to go anywhere to get them!

HERE’S HOW IT WORKS

1. Register for the FREE WEBINAR!

2. On the registration page, write in your TOUGHEST questions on…

• Chiropractic Billing

• Chiropractic Coding

• Chiropractic Documentation

• Chiropractic Collections

• Chiropractic Compliance

• Getting Paid for the Work You Do!

And receive the ANSWERS you need that will help you:

• Maximize your reimbursements

• Decrease denials

• Shorten Payment delays

• Lower Accounts Receivable

• Reduce your risk of audits

WHY the Toughest Chiropractic Billing, Coding Questions WEBINAR?

We are hosting this seminar as a special “thank you” to all of our blog readers, clients and customers who have made The Strategic Chiropractor the #1 source for teaching chiropractors how to “Work SMARTER, not harder” for increased profits and better compliance.

As a sign of our appreciation we’d like to offer you a FREE seat for this webinar and the chance to have your question answered “live” during the event.

(If you cannot attend or would like a CD copy of the webinar, see below for details.)

Historically, this is our most popular event webinar of the year, so you need to act quickly! Last year’s edition (2010), we maxed out our 1000 attendee capacity and some folks got locked out!  All the previous editions of this webinar resulted in hundreds more questions than we could physically answer in a limited time format — so get your registration and your questions in early!

We’re going to try to expand the capacity of the webinar this year but space is limited and ADVANCED REGISTRATION is MANDATORY to submit questions (the earlier you submit them, the better chance they have for being included in the presentation material).

So register below, submit your questions on the registration form and get your front row seat for the ultimate biggest bargain on the subject of chiropractic billing, coding documentation, collections, compliance and more!

Webinar Event Details:

WHEN:      Tuesday, December 13, 2011

TIME:        9am PST / 10am MST / 11am CST / Noon EST

LENGTH: 90 minutes

WHERE:    In the comfort of your home or office!

HOW:         Register below!

You missed it! Get a copy of the webinar on CD now !!

Click below to purchase a copy of the webinar on CD

2011 Toughest Chiropractic Billing, Coding Questions EVER webinar on CD

Your Toughest Chiropractic Billing, Coding, Documentation Questions Answered! (FREE Webinar)

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Before you get too giddy about the prospect of your office not having to undergo conversion to the 5010 Format for Electronic Claims submission – think again.  The recent Medicare announcement of the delay was in response to compliance enforcement and does not affect your requirement to convert to 5010 Format for reimbursement purposes for all payers.

In other words, if you want to be paid, you must still convert to the 5010 transaction format by January 1, 2012.

CMS simply decided that they wouldn’t add insult to injury and take any enforcement actions (i.e issue monetary fines) until March 31, 2012 for entities that have not converted.  How nice of them.

So, doctors, what this really means is this:

If you don’t convert to 5010 in a timely fashion (by January 2012) you not only run the risk of not being paid for your services but if you delay long enough (past March 31, 2012) you also run the risk of your office being subject to additional penalties for non-compliance. (How you will pay those penalties if your office is not making any money is beyond my comprehension and apparently is not a concern of the feds either.)

In Summary:

• CMS did not change the actual implementation date of HIPAA 5010. Providers must still comply with the 5010 transaction standards by January 1, 2012.
• CMS simply decided it will not take any enforcement actions until March 31, 2012.
• If you submit claims electronically, convert to 5010 quickly before you seriously regret it

Two Bright Notes

1)      CMS decided to delay enforcement because it acknowledged the fact that most covered entities would not be ready to comply by January 1, 2012 and that many covered entities are still waiting for software updates.  My email inbox confirms this as well.  Hallelujah! At least someone at Medicare has a foot on this planet!

2)      CMS is still accepting complaints related to compliance between January 1 and March 30, 2012. My final suggestion would be to get on the horn and complain to your clearinghouse if they are not yet ready.  In theory, you can complain to Medicare to.  If you do, thanks on behalf of all of us who cannot tolerate talking to anyone from Medicare for any reason J

Medicare States: Mandatory 5010 Conversion Date for Chiropractors Remains, Fines Delayed

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Undoubtedly you have seen plenty of advertisements and received numerous solicitations from Chiropractic EMR, Billing and Practice Management Software vendors. Their pitches to simplify your life, make your practice more efficient, earn you $44,000 in stimulus funds and do everything this side of massaging your tootsies are hard to escape.

One potential use for software stands out as massive untapped and seldom mentioned resource for your chiropractic business: the ability to extract meaningful data about your patients and practice.

5 Ways You Should Be Using Your Software or EMR

1. Automated Relationship Building. Most practices are in the habit of trying to keep in touch with their patients.  To do this, some send newsletters (via snail mail or email) while others send birthday cards. This should be perhaps the first and most basic use for your software; if you are not doing this yet, start. If you don’t like writing a newsletter, pay a college student to do this or find a pre-printed one. But can also be easily expanded to sending an “anniversary” card or email celebrating when the patient first entered your practice. Or reminding the patient that their insurance benefit year is soon expiring. All of this falls into the relationship building category, which often gets tedious, unless you automate it!

2. Improving Consistency of Care. Many software systems now have features that allow you to send text or email appointment reminders.  This is great but again, it’s the tip of the iceberg.  What about running reports to see when your patient’s last had an exam?  Easily done by running a report for the billing codes you use and can easily let you know it’s time to schedule that patient for a checkup.  Does your practice use x-ray? How about running a report to determine patients whose x-rays are so old they are clinically useless?  Then contact those patients to update their file; chances are if their x-rays are moldy they are either an inactive patient or an active one who slipped through the cracks and can perhaps benefit from some updated films. In this way, your software can help you provide better consistency of care – after all, if you performed an exam initially doesn’t it make sense to perform a follow-up to check progress?  If you took an x-ray to help you determine the problem, how long will that be an accurate tool and when do you need to take another.  You define the parameters but automating this helps you keep your care more consistent.

3. Promoting Service Lines. Do you offer massage?  Sell nutritional products? Offer rehab or exercise instruction? Decompression?  Are you frustrated that more of your patients do not take advantage of these services or products? Chances are, you mention them to new patients but what about your existing patients who have been coming to you forever?  Some of them may not even know you offer the service.  Or perhaps they briefly saw a sign go up when you added it, but didn’t take advantage of it at that time.  Why not run a report on all those who are NOT using those services and customize a marketing or promotional letter to them to take advantage of these opportunities or at least speak to you to see if it would benefit them.

4. Re-Activation Cross-Promoting. What if we combine all the above concepts and attempt to re-activate old patients in a different manner?  The birthday card may work for some, the reminder postcard that it’s been a while may work for others, but what if you cross-promote some of your other services in an attempt to re-activate patients?  Perhaps at this time, they don’t feel the need to get an adjustment as they are doing relatively well.  But a massage may sound like a nice treat – whether they need it or not!  Or maybe they have been wondering about what children’s vitamins are best and they see that you mention your new product line and stop in to buy some.  In this way, you are expanding the number of possibilities that the patient will re-enter your practice outside of just your chiropractic services.

5. Allocating Marketing Dollars. Many DC’s are frustrated by declining insurance reimbursements and working harder for the same or less money. Most of us also don’t have an unlimited budget to use for marketing purposes.  Use your software to help you solve both problems and work smarter, not harder!  Run reports to find out who your biggest payers are, where your referrals come from, who pays the least in a dollars per visit average and which marketing efforts produced the best or worst ROI.  Tracking this data will help you better prioritize your marketing dollars towards what works and help you eliminate or give less time, attention and money to what doesn’t.

As I mentioned previously, I see few vendors promoting their software in this manner when most of them probably are quite capable of doing so.  Instead of letting patients (and income) slip in and out of your practice, use your software to help keep you accountable to giving the best care, to maximize revenues from the patients you do have (instead of constantly seeking new patients who will eventually fall through the cracks anyway) and to automate the process as much as possible.

Using Your EMR or Billing Software to Stimulate Chiropractic Practice Growth

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I had some interesting responses to my last post where my main point was that most chiropractic practices need systems to propel them forward to the next level and to overcome the obstacle of being “stuck” in practice.

Most readers admitted to being guilty as charged for their lack of systems.  Several wondered if I had a good system for detecting psycho employees (If I did, that invention would land me the Nobel Peace Prize for single best resource to lower world blood pressure. But alas, no I don’t.)

One humorous DC teased and asked if my Chiropractic Office Protocol Book contained a “bathroom break” protocol apparently for his toilet-happy CA (Answer: NO.  Tell her to ease up on the Magnesium).

All kidding aside, several readers did voice concern that they believed that they had made honest efforts at implementing systems and still no results.  Without being able to analyze their systems in detail, there are two common reason that even the best systems, procedures and protocols can still fail.

So, that’s what I’d like to discuss today with you: how to avoid system failure.

Failure 101 Part A: No Consistency From The Boss

The first and perhaps most common reason for system failure is lack of consistency.  Typically, this points back to the doctor who is either (a) the chief offender and rule breaker or (b) a lousy enforcer of the rules.

For example: many docs will begrudgingly admit that they are incredibly spotty at performing re-exams. Upon closer inspection, I usually find that the doctor setup a time frame initially that the re-exam was to occur but when that point came, he or she blew it off.  Staff tried to remind the doctor, but the exam was blown off anyway.  After multiple instances of the same thing occurring, the staff eventually quit reminding the doc.  They quit attempting to even schedule patients for re-exams to avoid looking dumb when they mention it to the patient but the doc fails to perform one.

End result: The doctor / chief offender has derailed the re-examination procedure with his lack of consistency. In time, re-exams fizzle away (along with the necessary patient care, compliance and potential income).

Failure 101 Part B: No Consistency or Enforcement

There is a subset of lack of consistency and that is a lack of enforcement; both result in failure.

For example, sometimes the offender is not the doctor but the staff.  Perhaps, the staff are required to verify insurance benefits before the patient arrives or give a reminder call to all new patients.  Whatever the task, the staff don’t perform.  But instead of the staff receiving a reminder, warning, discipline or spanking (not recommended, but certainly would communicate the point), the doctor just shrugs it off.  Or the doctor waits until the practice numbers start to fade and then baboom!  The doctor goes nuts and begins his reign of terror and strict enforcement of all rules.

End Result: The sheepish doctor who enforces nothing obviously gets nowhere near the results he would like.  And the explosive doctor creates a staff that secretly hate him or fear the next outburst or both.  But he also doesn’t get the results he wants except perhaps during brief tirades.

Anyway you slice it, the consistent application of your procedures, policies and protocols is necessary for success and progress to the next level.  You, your practice and your staff would be much better off doing a few things well (that you can manage consistently) than trying to set overly ambitious “rules,” requirements or goals that you can’t really manage and monitor.

Failure 101 Part C: Total System Failure

And sometimes, everything falls apart.  You have systems no consistently applied and with no enforcement running in both directions, literally passing the buck back and forth from staff to doctor.

Worse, while you think such a mess is only visible to those on the inside, think again.  Witness the NY Times article of January 7, 2011 advising patients who want to score discounts on care to talk to the doctor. In other words, bypass the front desk who may (on a good day) actually be subject to clinic policies.  Instead, the good doctor consulted for the article advises patients to go to the softie: that’s you and me, brother and sister.

What the article recounts, in gory detail, is how patients can try to negotiate any and all fees, navigating successfully to hit you in the wallet where you are weakest: your systems and your consistency.

Don’t get me wrong. I am not saying you cannot be generous or should not strive to provide affordable care for your patients. But it should not be akin to “let’s make a deal” or subject to the negotiating prowess of your patients.  When this happens, all systems have failed you.

Failure #201 Part A: Poor Design

In Secrets of the $1250 Per Hour Practice, I talk about designing and aligning your practice for profit and passion.  Without that critical step, even the best-engineered systems will fail.  In other words, sometimes it’s possible to set up brilliant systems and procedures that are attempting to work within a flawed business model.  In those cases, systems won’t save you.

Case in point:  a few months ago the briefly famous Wall Street Burger Shoppe, home of the $175 burger, went bankrupt.  Yes, you read that right – a $175 burger!  Debuting in 2008 amidst during a high point in the recession, the WSBS made a big splash and earned a mountain of publicity for gaining the top spot for most expensive burger.  But it’s 15 minutes of fame fizzled in 2011 when owners filed for Chapter 7 citing they “couldn’t make a go of it” in reference to the 112 seat burger joint.

The reason for failure?  Probably not a lack systems, considering that the owner had previously launched 4 other notable restaurants, worked under two prominent New York chefs and has been consulting in the restaurant industry for years.  I’m sure the failure was not due to internal procedures that couldn’t get the burgers onto the tables.

Coincendentally, FastCompany magazine actually featured an article on the burger in their July 2011 issue (the same month the WSBS filed bankruptcy) and therein lies the seeds of failure.  Owner/chef Kevin O’Connell tells FastCompany:

“It started out as a joke…” and was “Created purely in an attempt to one-up the $150 double-truffle patty served at Daniel Boulud’s DB Bistro Moderne”

At the other end of the spectrum, witness the vast number of clinics all offering free exams, free x-rays or free whatevers.  Are all of these clinics bursting at the seams with business?  Doubt it.

Failure 201 Part B: Really Poor Design

In fact, these days FREE is so boring.  Thanks to Groupon-madness, Living Social and other purveyors of internet bargains, chiropractors and other businesses now have instant access to trying to outdo each other in gratuitous insanity.  In such fiercely competitive circles that are frequented by chiropractors, dentists and even plastic surgeons, the prices are getting lower and lower without the smallest thought towards profitability or even the type of patient that would be attracted to a plastic surgeon offering a breast enhancement that normally costs $5000 for a mere $79.  (Nor is there much a thought being given to the doctor that would provide the service at such rates).

My favorite big winner/loser Groupon award goes to the nutcase DC who offered: 1 free exam, 2 free xrays, (2) 1 hour massages and 2 free adjustments – all for a $29 Groupon!

In a way, these are system failures of a whole-different ilk.   When are we going to learn that competing at the bottom barrel of price does not work for our business model?  You are not selling commodities but a service.  And when you deem your service to be virtually worthless via your price, don’t come crying to me that you can’t understand why your practice is in the toilet.

Life Lesson and How to Avoid System Failures

Gimmicks don’t work.  And revenge is probably not a good business strategy either. (Daniel Bouloud was O’Connell’s former employer). And please, please don’t get in the gutter and slug it out with your neighbors on who can offer a bigger bargain.  Leave them alone.  Soon enough, their practice will wash down the drain.  But if you get in there to fight, you may go down as well.

So, as an extremely long answer to those who emailed regarding the possibility of a practice failing even with solid systems in place, the answer is yes: it is possible.  Usually due to the fact that your systems are inconsistent or poorly designed.  Or if you’re very unfortunate, both.

If you’re struggling or your practice is just not where you want it to be, take a good look inside.  You may just find one of these scenarios happening to you.  And until you fix it, your practice is in danger.

How to Avoid Chiropractic “System Failures”

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Let’s talk plans, protocols, systems and solutions to “un-stuck-ify” your chiropractic practice. In other words, how do you get to that mythical “next level” that is just past the point of where you repeatedly bang your head on the same problems that seem to perennially evade decent solutions and defy concrete systems?

Do You Have Systems?  Good Ones?

Admittedly, we all need systems if our businesses are to succeed.  Most chiropractors believe they already have such items present in their practice but “McDonald’s we ain’t.” A quick look in most practices will reveal that  IF systems are present, many are poorly designed, inconsistently applied and most creak like old floorboards when the slightest pressure tests their merit.

If completely truthful, many DC’s will admit to being “stuck” at a certain level (volume, income, new patients, collections – whatever). Analyzed closely, they would also admit that their systems seem to “break down” at certain arbitrary, upper limits.  Viewed as a mathematical exercise, this can be seen as attempting calculus with an algebra skill set.  Einstein applied the same logic to physics (and life) with the often quoted mantra that “Problems cannot be solved by the same level of thinking that created them.” In other words, “you can’t get there from here.”

Most chiropractors who have experienced frustration time and again by getting to that “stuck” point would be smart enough to realize that your tools may not be strong enough for the job, but few actually go out and get new tools.  Most just keep using them until the whole boat breaks – which isn’t much of a plan and won’t really solve the problem.

When Systems Break Down…

So, yes, systems, protocols and plans are part of your solution. But they either must add to your current systems in place or significantly change the ones that aren’t working.  Case in point brilliantly illustrated by a recent visit to the dentist:

I go to leave with my cavity stricken child and the friendly receptionist asks “When would you like to come back?” Most dutiful patients would give her a nice answer but I can’t resist, so the painful conversation goes like this:

Receptionist:                                     When would you like to come back?

Father of cavity child (me):          No offense to you, but never.

Receptionist:                                     Did your visit not go well?

Father of cavity child:                     No.

Receptionist:                                     Did we do something wrong?

Father of cavity child:                     No.

Receptionist:                                     Oh good.  Well, it looks like Dr. X wants to see {insert cavity boy/girl’s name here} again to fill that cavity.

Father of cavity child:                     Yes.

Receptionist:                                     So did you want to set an appointment for that?

Father of cavity child:                     No.

Receptionist:                                     OK.  Well you have the right to choose but we certainly don’t recommend that.

Father of cavity child:                     Yes.

Receptionist:                                     So should we set an appointment to have that cavity filled?

Father of cavity child:                     I guess so.

Receptionist:                                     What time would be good for you?

Father of cavity child:                     What day?

This conversation went on another few rounds until finally an appointment was made.

You get the idea, but don’t laugh. Similar things happen in your practice every day.  Poorly trained staff at the front desk can undermine your best efforts – new patient or otherwise.  At the least, they are wasting valuable time (yours, your patients and theirs).  On the other end of the spectrum, they are letting appointments, new patients and ultimately, money, slip away through poor training or systems.

I’ve seen similar poor training botch financials, re-route patients to other doctors and cause the doctor’s blood pressure to repeatedly soar to unhealthy levels.  What seems like common sense unfortunately isn’t very common: develop protocols for everything that you can possibly systematize and standardize to reduce the chances of things not going well.  Many claim to understand this concept; few implement it to a significant degree.

Why Systems are Vital to Chiropractic Success

There are several good reasons systems and chiropractic protocols are so necessary:

1. Without them you run a haphazard, stress-filled roller-coaster of an office
2. Without them, you never rise above the level of your present organizational skills or ability
3. If you don’t have a solid “Plan A” in place, how can Plan B save the day?

No office is immune to blips and blunders. But the only thing that prevents total chaos when things go awry (and they will), is “Plan B.”  So yes, you should have detailed systems that both tell you what to do under normal circumstances (Plan A) and what to do when things go sour (Plan B).

EVERYONE Has System Failures…Sometimes

If you get this concept, you can begin to spot weaknesses in major conglomerates and apply the same techniques to your own practice.  Case in point: the infamous “Gmail lockdown.”

I am extremely cranky due to the fact that I am in the second week in a row of an unexplainable Gmail lockdown that has randomly prevented me from sending/receiving email more than a dozen times over the past couple weeks. Each time I go to sign into my account, I am taken to the same nonsense page that hands me a half-dozen generic reasons why I am prevented from accessing my account.  That’s frustrating enough. Worse, I cannot identify why my account specifically has been targeted.  To add insult to injury, there is no explanation, nor anywhere to go to take my beef.  No “contact us” button, no phone # so I can speak to a sympathetic voice in India, nothing.  According to Mr. Gmail, I must sit and wait until the smoke clears anywhere from 1-24 hours.  Then, when I finally re-access my account, I get hit again with the same penalty.  This continues with no apparent end in sight.

Besides my personal beef, what’s the point for you, Doctors of Chiropractic? Many of you have the same nonsense going on in your practice.

Protocols to Avoid the Practice Roller-Coaster

Randomly applied rules with no real no systems, no explanations – just a big haphazard mess.  In my Chiropractic Office Protocol Book, I included 79 protocols so common, so necessary that they probably should be part of every office.  But even if you only need or use 59, 39 – heck, even 19, it would be a step in the right direction for many offices.  I’m not saying I’ve got all the answers in my book (or in my head) but I am saying that I have witnessed way too many “sloppy” procedures and protocols that are the cheese for your whines.

New patients schedule and are seen on the same day; some adjusted, some not.  Some get a report of findings, some don’t.  Some get taught exercises, some maybe have to beg for what they can do at home. Financials are a mess – some of you have payment plans, a clear sense of structure. Some “wing it” from the back or have the front desk go over patient benefits on the fly at the front amidst a bevy of other things going on.  Recalls happen whenever.  Marketing, whenever.  Patient education, whenever. Consistency of care, whenever.

It’s all random but one thing that most chiropractors universally dislike: random results!  All of you hate the roller coaster of one month great followed by the next one in the toilet.  No one likes the unpredictability of income because the payroll is very predictable.

Don’t Forget the End…

Unfortunately, one day you either wake up and make a vow to get this handled in your office or you ride the sloppy wave until you pay the price in the end.  Because if you haven’t planned, systematized and strategized how to maximize your office during the peak income producing years of your practice, chances are you will leave your retirement in the air as well.  In The Ultimate Chiropractic Exit Strategy and in my seminars, I will rant and rave that dying or shutting down are both very poor exit strategies.  And yet, they are some of the most frequently used.

Questions to Help  “Un-Stuck-ify” Your Practice

So, what’s a good chiropractor to do?  Get to work!  Prepare your practice now – either for profit or retirement or both.  Based on my visits to offices all across the country, here are a few questions you can ask yourself and your staff, as they are the bolts that need tightening in most practices:

• How can we better answering the phone?
• How can we handle new patient processing better?
• How can we better prepare our day so we minimize time wasting?
• How can we maximize daily production
• What are three situations that commonly go wrong and how can we fix them?
• How can we schedule more business, rather than more new patients?
• What area do I (we) need to develop more consistency?
• What do I need to develop a plan for my transition / retirement?

Un-Stuck-ify Your Chiropractic Practice: Rising to the “Next Level”

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The fourth quarter has just begun and before you know it, the challenges of keeping a full schedule around Thanksgiving and Christmas holidays will be here. Instead of looking toward the end of the year and a potentially sluggish schedule with dread, be proactive and make this the best end of your year ever.  Today, I will talk about one of the easiest ways to drag in “unclaimed money” that can help you boost 4th Quarter profits, boost referrals AND endear you to your patients simultaneously. Interested? Read on!

Obviously, for many of our chiropractic patients, the economy has taken its toll. Even patients who routinely come in for maintenance care in the past may have put off their regularly scheduled visits or other chiropractic care that they perceived wasn’t absolutely necessary.

Say what you will about the economic forecast, your patients are still very focused on spending needs rather than spending wants. That puts you in an excellent position to remind these patients, who may have put off needed chiropractic care, that in just a couple of months they will lose any unused insurance benefits for 2011.

In other words, they may as well flush all those hard-earn premium dollars down the toilet!

It’s no secret that insurance companies make millions billions on patients who do not realize that their plans provide chiropractic coverage up to a certain dollar amount or visit limit annually. But insurance companies certainly aren’t going to remind patients about this, and most patients are too busy to sift through their policies to determine what might remain on them.

The first of October is already here and this is the ideal time to begin contacting patients about benefits that will expire at the end of the year. It gives both the patients and your practice plenty of time to get the appointment scheduled and any necessary follow-up treatment taken care of before the busy holiday rush kicks in.

Being the smarter than the average bear chiropractor that you are (after all, you are reading my article!), seize this opportunity to send patients a letter notifying them of their unused benefits!

Write one of your own or use my “Unclaimed Chiropractic Benefits Letter” (complete with three special P.S.’s  and a bonus “how to” guide designed to stimulate even more ancillary business and maximum return for your efforts). Then, have your staff do the rest!  Too cheap to mail it?  Hopefully, you have your patients’ emails and, if you do, this is a great time to put them to use!

Let’s face it.  Your patients are busy too and if you do not remind them of what seems like the obvious, these benefits may just slip away.  Better still, your lovely communication (in whatever form it takes) may also serve as a reminder for patients who haven’t been in for a while to drop in for a check up. Have other services that may also be covered by insurance in your office such as massage or acupuncture? This reminder can certainly serve to give a boost to those services as well!

Here are a three solid ways to really supercharge your efforts:

• Follow up with additional emails, text messages and/or voice broadcasting to alert the patient that the practice is sending information about their chiropractic insurance coverage and to please watch their mailbox, inbox or voicemail for details.
• Post signs around the office for added effect (but I wouldn’t recommend this as your primary effort).
• Encourage patients to refer their friends (who may also be in jeopardy of losing their benefits)

No matter how you slice it, patients will appreciate your efforts on their behalf to help them get the most of their hard-earned money and take better care of themselves in the process. Send your Unclaimed Chiropractic Benefits Letter and take steps to make this your best 4th Quarter ever!

Boost Your 4th Quarter Chiropractic Revenues NOW!

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