Archive for February, 2010

Upcoming Chiropractic Seminars — Billing, Coding, Documentation MASTERY!

by Tom Necela on February 26th, 2010 in Chiropractic Seminars, seminars

Reading time: 5 – 8 minutes

Chiropractic Billing, Coding & Documentation Mastery

Effective Strategies for Maximizing Reimbursements & Minimizing Audit Risk

Presented by:  Tom Necela, DC, CPC, CPMA & The Strategic Chiropractor

portland postcard2seattle postcard

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Saturday, March 27, 2010 — Portland, OR

Western States Chiropractic College (Hampton Hall)

2900 NE 132nd Avenue

Portland, OR 97230

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Thursday, April 1, 2010 – Seattle, WA

Best Western River’s Edge (Seattle Airport)

15901 W Valley Highway, Tukwila, Washington, 98188

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Due to the special hands-on Documentation/Coding Training Session – SEATING IS LIMITED!

Cut through the confusion and learn how to increase and protect your practice’s bottom line with billing, coding and documentation strategies you always wanted to know, but never knew who to ask!

Here’s just a sampling of what you will learn:

ð        New audit targets for 2010 that can impact your bottom line

ð        Strategies to get paid better for what you do

ð        Avoid mistakes that get your claims denied or delayed

ð        Tips to achieve defensible coding & documentation

ð        Avoid audit traps for Medicare and billing “red flag” that alert the insurance radar

ð        Systems to create internal audits that improve compliance

ð        Discover new code updates and clarifications for 2010

*** Now Featuring***

“Hands-on” case coding including actual examples of documentation do’s and don’t gained from Medicare and other commercial insurance training sessions

Here’s what DC’s are saying about Dr. Tom’s seminars:

“Tom is an expert at what he does and makes it simple for the rest of us!”  Eric Hansen, DC

“I would recommend all DC’s attend one of Tom’s classes. They are necessary, practical and essential for a professional, compliant and meaningful practice. He is one of the rising stars of the profession!”  Melinda Maxwell, DC

Dr. Necela is the most authoritative source of coding, billing, auditing & Medicare issues that I have ever seen.”  James Bowen, JD

“More useful information in 4 hrs than I received in 4 years!”  Jacob Waller, DC

I wish every state would encourage licensees to attend your seminar”  Lori Inkrote, DC

“Four hours went by fast – I could have stayed longer!” Dale Johnston, DC

“His material is packed with information, never the same and full of the latest updates – I’ve attended as many as 3 in one year and always learn something new!” – Amy, CA

About your presenter:

A former Insurance Claims Analyst, Dr. Necela is a Certified Professional Coder and the first chiropractor to become a Certified Professional Medical Auditor.  Dr. Necela uses his unique perspective and expertise to train chiropractors on sound billing, coding and documentation principles that allow them to increase their income, reduce their risk of audits and work smarter (not harder) towards a better business.  For more info, see www.strategicdc.com

Registration Details

Seminar Hours: 9am-3pm (6 CEs)

Lunch is included!

$149 in advance for DC’s / $179 at the door

$198 in advance for DC + 1 Staff / $258 at the door

$149 advance for Staff only (without DC present) / $179 at the door 


REGISTER ONLINE!


(Click Links Below)


FOR MORE INFO

Email: info[at]strategicdc.com

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Correcting Chiropractic Billing Snafus, Altering Records & Advice from Bob

by Tom Necela on February 22nd, 2010 in Audits, Billing, Documentation, EHR / EMR, chiropractic documentation, compliance

Reading time: 8 – 12 minutes

altering records

In the wake of insurance denials, some chiropractors pose an interesting question in their attempt to get paid for what they do.  It is some variation of this:

“If I billed something incorrectly…or the insurance company denied a particular service…or procedure A was bundled with procedure B…can I change my records/billing/coding so I can get paid for this?”

Certainly, my loyal blog readers know that one of the two primary purposes of my writing this column is (1) to help you maximize reimbursements by getting you paid for ALL the work you do.  But this purpose is also coupled with keeping you compliant in your billing, coding and documentation while attempting to achieve my other goal for you, which is (2) to minimize your audit risk.

In other words, I would love to see every chiropractor paid well for all of the work they do (not more than they deserve, but not less) and, of equal importance, possess the proper documentation necessary to KEEP the money they earned.

Answering the question(s) posed then is not a simple “yes” or “no” but an “it depends.” Let’s explore this a little further.

Amendment of Records Can Be a Good Thing

Amendment of a medical record can be a good thing. Reviewing your records to check for accuracy and completeness and taking the time to amend them is common and commendable. We all know that the daily duties and pace of practice often cause us to spend less time taking notes that we may want to or that good documentation may warrant.  Therefore, a practice of reviewing notes before the day’s end, for example, can be a good way to catch any missed items needing documentation as well as prevent incorrectly billed or coded services.

Obviously, the best practice is to complete your records correctly the first time. But if you didn’t, you can make an addition or correction later. You must do so in a legitimate and above-board fashion—timely and not apparently an “alteration.” Different payers may have varying definitions of what constitutes “timely” documentation, but most appear to indicate that the note should be completed during the actual encounter of shortly thereafter.  Most payer descriptions I have seen of this seem to indicate “shortly thereafter” means within 24hours after treatment.

Avoid Alteration of Records

Let’s differentiate between the terms: “Amendment” or “Alteration.”  For our discussion, Amendment refers to the process of reviewing and/or correcting mistakes within a short period of time (as above) for the purposes of correction.  Alteration, on the other hand, does not quite convey the same corrective intent.

For example, if you alter your records once a lawsuit has been filed or an attorney has requested your records, it’s too late and this would not be considered a legitimate “correction” or amendment of the patient’s file.

Unfortunately, this is a common scenario: you receive a request for records, review your documentation, and see that some fact is omitted or some entry is inaccurate. You quite innocently think that you can “improve” the record.

Let me stop you there. Don’t do it.

Every state chiropractic board in the country has heard numerous cases of records alteration and, I am sure, cringes every time they have to review one.

In reality, the insurance company, plaintiff’s attorney, claim review company and who knows who else has likely already obtained a copy of your records in their original form. As the jury is shown both the original record and your “revised” record, you will see your credibility disappear before their eyes – even if the alteration of the record was innocent, helpful or minor.

At the least, any alterations you make in the records significantly after the treatment date can be viewed as self-serving. Taken to the extremes, it can also be regarded as a cover-up or potential fraud.  (See picture at start of blog for what technology can do to squash your attempts to alter records anyway!)

Adding To or Correcting Records

What should you do if you discover an omission? Suppose you review your earlier progress note and discover that you forgot to state that you made an appointment for a patient x-ray? Or what if you reviewed the x-rays and in the process of documenting your findings, inadvertently left a key finding out of your report?

Sometimes, omissions may not have clinical relevance but are needed for accuracy. For example what do you do when you discover that a simple typing error has made your 26 year old patient 62 years old?

In cases like these, adding a note can illustrate the fact that you are a conscientious chiropractor by demonstrating that you are careful enough to review your notes and concerned enough to add the missing information.

To properly amend records, you need to:

  • Put a notation in the margin next to the original entry: “see my note below.”
  • Enter another note at the time you discover the error. Write in the added information. Initial and date it.
  • Draw a single line through the incorrect entry. Make sure that the original entry is still legible.
  • Explain the correction. If possible, explain why the earlier note was incorrect, the reason for the error, and the reason the error was noticed.

On the other hand, erasing, using correction tape or fluid, or obliterating any documentation in the record is unacceptable and would be a big no-no that can land your tail in hot water.

Billing Snafus

Many chiropractors contact me – after the fact – about their claim denials, payment disputes or billing problems which may have occurred as a result of errors or ignorance.  Some of these problems are correctable.

If you legitimately performed a procedure, documented it correctly and simply forgot to bill for the procedure alongside the other services that were rendered during that visit, you may wish to submit a corrected claim and get reimbursed for this.  Provided you do this in a timely manner, the insurance should reprocess the claim and pay for your for the service.

Similarly, if an insurance company has denied your service based on a claim submitted with the wrong code on it (due to a human error, mistake, number dyslexia, etc), re-submit your claim for payment consideration.  In these instances, I find a short letter submitted with the corrected claim to be helpful. (i.e.  Dear Sirs,  I inadvertently billed for 58940 instead of a 98940.  There was no Oopherectomy performed, in part or total, during the course of the patient’s chiropractic visit nor was it my intention to attempt to get paid for one.  The service performed was…)

Some billing problems, however, should not be corrected.

For example, adjusting 3-4 areas of the spine (98941) and performing manual therapy (97140) in one of those same areas won’t fly with payers and will result in a denial.  If you have billed this out and find a rejection letter staring you in the face, you should not downcode your service to a 98940, re-bill it and hope to be paid for your “corrected claim.”

Presuming you did adjust three or four areas in the first place, it would be fraudulent to downcode because you are essentially lying to get paid.  Again, take your lumps and correct the issue.

Likewise, if you bill for a service only to find it denied, you should not re-submit the claim using a different code in an attempt to get paid.  Look in any coding book, page 1 or thereabouts and you will see instructions that read something like “Select the name of the procedure of service that most accurately identifies the service performed.”

Spaghetti billing methods (throw it to the wall, see what gets paid/sticks) are not advisable, inefficient and potentially fraudulent.

Parting Words of Wisdom…From Bob

So what do you do if you have a billing problem that causes you to lose money, but which you cannot correct if you wish to keep your nose clean?

  1. Identify and research the issue so that you can understand the problem.
  2. Seek experienced help.  Billing and coding errors rarely occur in isolation.  Typically, I find multiple errors that are costing my clients thousands of dollars in unrealized income or potential losses.
  3. For future purposes, and on the lighter side, see Bob Newhart’s classic advice on the matter below.  A little on the rough side, but technically accurate!  J

To Your Success!

Tom Necela, DC, CPC, CPMA

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The 25 Meaningful Use Criteria for Chiropractic EMR Systems

by Tom Necela on February 15th, 2010 in Business, Documentation, EHR / EMR, chiropractic EHR, chiropractic EMR, chiropractic business, chiropractic documentation

Reading time: 8 – 14 minutes

chasing-money

Adopting an electronic medical records (EMR) system can net you up to $44,000 in government incentive money. Or can it?

Some of the most frequently asked questions I received in 2009 (which still continues through 2010) is in regards to how to select an EMR system and the stimulus funds that potentially go with EMR implementation.

The problem?

All stimulus incentives hinged on practices adopting “meaningful use” of the EMR systems in question.  The problem? Up until December 2009, “meaningful use” was left undefined!

In other words, you could not get the money unless you were using EMR according to certain set criteria but no one went on record to establish exactly what those criteria were!

Unfortunately, the cloud was not exactly lifted this past December because the proposed rules for “Meaningful Use” are 556 pages long! Worse yet, industry experts don’t expect the final rule to be much different so knowing the proposed rule is essential to meeting meaningful use and getting paid.

So, then, how does one crack the mystery code and define meaningful use?  Lost in those 556 pages are a total of 25 requirements your practice must meet to achieve meaningful use. Don’t worry, I will spare you the trouble of reading the electronic equivalent of War and Peace (which is far more difficult to understand and much less entertaining) and summarize the 25 points below.

But let me cut to the chase.  For those of you who have recently purchased an EMR system or who are considering a purchase, don’t bank on getting those stimulus dollars just yet.

For those of you who are still considering getting an EMR system, let me go on record and state that I think that is a great idea for most practices.  However…don’t purchase one just because you feel the stimulus dollars are going to be rolling in afterward.

Purchase one with the intent of having a system improve your clinical documentation, practice management and overall efficiency.  Most will do that, provided you choose the right system to suit your needs.

Can’t decide which system to choose?

Given that you should take stimulus dollars out of the equation, there are certainly other factors to consider in choosing the right system for you.  Before you make a $10,000 mistake, perhaps you should consider investing less than 1% of that figure into my “How to Choose a Chiropractic EMR System audio program.”

This 1.5 hour program (on 3 Audio CD’s) walks you through the thought process of how to make an intelligent decision on purchasing the right system for your practice.  I won’t come out and tell you to buy X, Y or Z but teach you how to shop and the tough questions you should be asking to make sure that you are getting the right system.

Frustrated with Your Own System?

It’s not too late to start over and think strategically about what will be a better fit for you and your practice.  I see far too many chiropractors who have expensive EMR systems collecting dust because they abandoned ship out of frustration and went back to paper.

There was a reason you chose to get EMR, you should find a system that you can actually use – they ARE out there!  Again, before you run out and buy another program, consider a small investment in strategy, some collective wisdom and a system to make a good purchase – my “How to Choose a Chiropractic EMR System” audio program accomplishes all of these.

And now, as promised, here are the 25 “Meaningful Use” Criteria for eligible providers. (These criteria were taken from the proposed rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program.)

The List: 25 Meaningful Use Criteria

1- Objective: Use computer physician order entry (CPOE)
Measure: CPOE is used for at least 80 percent of all orders

2 -Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

3 – Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data

4 – Objective: Generate and transmit permissible prescriptions electronically (eRx)
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology

5- Objective: Maintain active medication list
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data

6- Objective: Maintain active medication allergy list
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data

7 – Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

8 – Objective: Record and chart changes in vital signs
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20

9 – Objective: Record smoking status for patients 13-years-old or older
Measure: At least 80 percent of all unique patients 13-years-old or older seen by the EP “smoking status” recorded

10 – Objective: Incorporate clinical lab-test results into EHR as structured data
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data

11 – Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach
Measure: Generate at least one report listing patients of the EP with a specific condition

12 – Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

13 – Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

14 – Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3

15 – Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

16 – Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP

17 – Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours

18 – Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

19 – Objective: Provide clinical summaries to patients for each office visit
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits

20 – Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information

21 – Objective: Perform medication reconciliation at relevant encounters and each transition of care
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care

22 – Objective: Provide summary care record for each transition of care and referral
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals

23 – Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries

24 – Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically)

25 – Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary

The Sum Total

Again, not all these criteria seem terribly relevant to chiropractic and quite frankly, I would love to see how some EMR providers can define these in such a way that they can guarantee stimulus dollars.

My recommendations:

  1. If you already are using EMR, approach your provider with this list and see how their system can complete the measures to obtain each objective so that you at least have a chance at getting some stimulus funding.
  2. If you do not yet have an EMR system, use these criteria as part of your questions to each system that you are considering for purchase, particularly if they are claiming to get you some stimulus funding.  Also, consider purchasing “How to Choose a Chiropractic EMR System” Audio series to further assist you in making a wise choice of systems that will fit your needs.
  3. If you are unsatisfied with your current system, consider shopping for another and following the instructions in #2 – but do not purchase your new system just because you think you are going to get the HITECH dollars!

Best wishes for continued success!

Tom Necela, DC

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Mandatory HIPAA Update Required by 2/17/2010 for Chiropractors!

by Tom Necela on February 9th, 2010 in Audits, HIPAA, compliance

Reading time: 5 – 8 minutes

Copyright 2007 RealityRN.com

The good news is that the new HIPAA requirements aren’t quite as bad as the above cartoon, the bad news is that they are going to require some paperwork on your part. And we know how much all of us chiropractors love paperwork!  Here’s the skinny:

Covered entities and Business Associates (BA) are required to amend existing BA contracts or negotiate new contracts. Contracts executed prior to the HITECH Act do not comply with the interim breach notification rule or the new BA-related statutory requirements.  The breach notification requirements for BAs became effective September 23, 2009, and many of the other BA-related requirements become effective February 17, 2010.

Are Chiropractors Covered Entities?

The first question most chiropractors will ask is: “Am I a covered entity?”  Put simply, if you conduct transactions in electronic form, you are a covered entity.  Examples include billing electronically (or through a clearinghouse), using any electronic storage media, etc.  Most chiropractors are likely considered covered entities. If you are in doubt, see Medicare’s Covered Entity Chart to help you determine this.

What is a Business Associate?

In chiropractic, we tend to define an associate as the DC who is an employee and who helps us care for our patients. The HIPAA definition, however, is much broader than that.  In fact, the HIPAA Business Associate refers to non-employees with whom you do business and who use or have potential access to Protected Health Information (PHI).  Common examples of BAs may include: electronic clearinghouses, billing companies, transcriptionists, accountants, etc.  For more information and official definitions on Business Associates, go to the Department of Health & Human Services Business Associate page.

Why New Contracts?

As you may know, there was a changing of the guard last year and the Office Of Civil Rights now administers HIPAA per the HITECH Act of 2009.  Also, included in that provision was mandatory HIPAA audits.

One simple way an organization can see how much monitoring needs to be done is to throw out a new change and see how well we comply.  In other words, new contract + monitoring = lots of money generated in fines for the new organization.

Forgive my cynicism, I am sure that there may be other motives.  However, in the meantime, you need an updated BA contract by February 17, 2010…or else.

In case you are not motivated by the “or else” threat, here are some details:

What’s Changed in the new HIPAA Business Associate Agreement?

•          Establishes criminal and civil penalties for non-compliance

•          Now applies privacy & security rules DIRECTLY to BAs

•          Establishes mandatory breach reporting for CEs and BAs

The Hit to Your Wallet

If the threat of jail time is not enough for you (hey, I guess some people might appreciate the alone time), here are some threats to your bank account you might not like:

Penalties will be determined by nature and extent of both the violation and the harm resulting from the violation, so they could be substantial.  Civil monetary penalties have tiered increases to progressively punish offenders.

Tier 1:  Unintentional or inadvertent violation – At least $100 for each violation, but no more than $25,000

Tier 2: Reasonable cause, but no willful neglect – At least $1,000 for each violation, but no more than $100,000

Tier 3: Willful neglect, but violation is corrected – At least $10,000 for each violation, but no more than $250,000

Tier 4: Willful neglect, violation not corrected – At least $50,000 for each violation, but no more than $1,500,000

What is required?

  • Make a list of your current business associates and vendors
  • Identifying entities with which your practice shares PHI because these BA’s are subject to the same privacy and security rules as Covered Entities
  • Drafting new legal agreements for BAs to comply with the HITECH Act
  • Updating HIPAA privacy & security policies and procedures (including the creation or modification of existing Breach Notification Policies). See Dept of HHS Breach Notification Policies page for more info.

The Bottom Line

You will kick yourself for getting fined for this new rule.  Save the time in emailing me your angry thoughts, I probably agree with you and you’re screaming at the messenger anyway, which is not terribly productive.

Here are your options:

Have your attorney draft a Business Associate Agreement for you.  Search the internet for an agreement that is up-to-date (be sure that the agreement mentions the HITECH Act of 2009!  Most that I have seen online are outdated and refer to the HIPAA rules of 2006) and relative to what we do as chiropractors (I have seen ones that are 23 pages long!).

For those who’d like to save time and searching, you can obtain a copy of my Sample Business Associate Agreement that I use with my clients, updated for the recent HITECH Act changes.  Simply, open the Word Document, change the names and any relevant info to your clinic and you are on your way!  For those who would like to have an attorney review your document, this will save you time and money from having them draft one from scratch.

Anyway you slice it, be sure to act on this promptly as the deadline is approaching!

Best,

Tom Necela, DC

Legal Disclaimer: Every reasonable effort has been made to ensure the accuracy of the information and recommendations provided in respect to the Business Associate Agreement. However, due to the nature of changing payer requirements and state regulations, you may wish to seek advice from a local health care attorney to ensure that the use of the Business Associate Agreement is compliant with your state laws.

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Overworked Chiropractors, Under-Producing Chiropractic Practices

by Tom Necela on February 2nd, 2010 in Business, chiropractic business, chiropractic practice management

Reading time: 7 – 12 minutes

messy-office-03

I guess it happens to the best of us.

After writing over 300 weekly newsletter/blogs over the past several years, I finally missed one.  Technically, it was written. But circumstances prevented me from getting it published online in a format you could read.  Translation: virus, system crash, and a conglomeration of computer-generated evils descended upon me this past week!

Ironically, last week’s article was about preparedness, protocols and other systems for practice success!

One of the reasons I chose to write this article was the widespread lack of systems that I have observed (or not observed) in chiropractic offices over the last decade or so.  Unfortunately, this lack of preparedness, which often comes in the form of a lack of concrete systems or protocols for the practice is a major danger that lurks in all too many practices.  It leaves many chiropractors feeling overworked and causes practices to under-produce.

In fact, while some DC’s believe that their technical skills are the primary reason people seek their care versus the doc down the street, my observations and empirical data suggest the exact opposite!  In reality, there are scores of chiropractors whose hands-on skills are simply average but whose practices consistently generate in the top 5% of all chiropractic revenues.  This is not to say that the chiropractor who can’t adjust his way out of a paper bag is on the same playing field as you.  Minimum competency IS required.  However, that minimum competency is also presumed by your patient when they walk in the door.

Therefore, it is obvious that other factors are at work in your success.

Here’s a case in point:  Think of your favorite chain restaurant or secret love for a particular fast food joint.  Now, go behind the scenes at most of these restaurants and who do you see?

A stream of stuffed shirts, suits and ties representing organizational geniuses and experienced executives slaving away at the fry machine?  Hardly.  Typical employees at most fast food joints and chain restaurants include pimply-faced teenagers, ex-convicts or those who evidently fell off the career track quite some time ago.

And where are the owners of these franchises?  Well, let’s be more specific.  Where are the owners of the local store or restaurant chain?  The owners of the entire franchise are in some far off corporate suite in another state or lounging pool side at their villa.

But even the local owners of Cheesy Cheese Pizza Franchise #346 – where are they?  Likely, they are not slaving along side their slew of teenagers, dedicating their life to making the “best pizza East of the Northwest TinkiTinki River Valley.”

No, these owners have their Gerber e-Myth bible in hand and are no where to be found.

Contrast that with most chiropractic offices where the owner (you) is also the chief pizza maker (performing the technical side of adjusting the patients), may also be the assistant fry cook (x-ray tech), may also be the marketing director, financial coordinator, bookkeeper, inventory manager, human resources director, exit interview strategist, hiring coordinator, director of rehab and ancillary services, and chief financial officer.

Oh, and the typical chiropractor performs all those duties simultaneously in the typical manner of a (choose one): crackhead, chicken with his head cut off, or child just fed a steady diet of Fun Dip, donuts and pop.

Is it any wonder that chiropractors never seem to achieve anything but a subsistence level practice and that fewer and fewer seem to be genuinely thriving?

Having visited well over 300 offices in the last few years, I can tell you that 99% of DC’s fall into one of three categories:

  1. Fire-Frenzy.  No visible systems in place and if there are systems, they are woefully inadequate or obsolete.  These docs (and their staff) spend most of the time haphazardly putting out fires only long enough for the next one to erupt.  The one positive aspect of these offices is most know they are completely disorganized and hope to do something about it someday.
  2. Dangerously Deceived. These offices have some systems in place usually in a slightly murky form of a visit protocol (1st visit = NP Exam, 2nd Visit = ROF, Visit 3-396 = Random ) or sometimes a front desk system for processing patients or the phone.  By in large, though, these offices have still not developed systems to adequately train staff, maximize revenues, minimize patient schedule abandonment or efficiently utilize doctor and staff time.  As a result, several things emerge: the doctor is still forced to put lots of time and energy in to keep the practice running smoothly, they are always on the verge of a crisis (and may narrowly miss) and the doctor is destined for burnout (although he or she won’t admit it) because they are deceived into thinking they have systems in place.  This is the most dangerous category because they don’t really have effective systems and because the doctor has so much to lose  in the way of potential.  Unfortunately, this category is also the most common.
  3. So Close, But… These offices have solid systems in place but can never seem to make it to the “next level” where the doctor (and staff) feel that the practice is running smoothly or on autopilot.  The doctor is savvy enough to have developed systems that have all the basics are covered and consistently taken care of, but there is no real elimination of problems.  There is still too much doctor dependence and, at times, too much on the doctor’s plate.  Although this level of practice has obviously achieved a respectable amount of success, the development of effective systems and implementation is the only way for the practice to grow without the adding more staff, more time or more work for the doctor.

So, doctor, which category do you think best fits your office?

Now that we’ve identified some problem areas, let’s discuss some potential solutions for each category so you can start working on these issues right away!

Category 1: Your lack of systems will result in continual frustration for you and your staff.  Spend the time (because it is likely more plentiful than money at this point) in fixing this issue.  My recommendation would be to go visit other chiropractors offices 1x per week to see what systems they have in place.  To avoid being perceived as the competition, choose offices that are 25+ miles away and, if you can, get recommendations to only visit offices that are doing well so you can learn.  This is time and money (barely any cost) well spent and soon you will glean some helpful ideas.

Category 2: Your systems need to be firmed up a bit. Spend some time trying to identify problem patterns in your business.  Not just the once in a blue moon occurrences, but things that seem to happen repeatedly and/or with annoying frequency. Write a list of these issues down and begin to develop a systematic plan for solving them.  Then, move on to the next item until you have developed a series of systems to really address the problem patterns in your practice.

Category 3: There may be an issue or two that you need to specifically address in the manner of those in Category 2, but most practices in this category need to really focus on efficiency and delegation.  Since this is an issue to some extent in all categories, below is a flowchart that I have used to arrive at more efficiency and better delegation:

Do_or_Delegate_Flowchart

Time to Face Reality

When looking at the issue of profitability and practice success from a big perspective, an honest appraisal of your abilities, habits and motivation will tell you where you stand.  Is your business sinking?  Either get help fast or abandon ship!  It may be noble to be long-suffering, but the question is: can you afford it?

For those of you whose business is adequate but less than stellar, sometimes an objective opinion or outside assistance is needed to get you to that next level, to conquer obstacles and achieve longstanding goals. This is not to say you are incapable, but the often quoted words of our favorite Albert come to mind: you know the quote about insanity and doing the same thing and expecting different results.  Far be it from me to call you, a perfect stranger, a little nutty but, if the shoe fits….

Download a copy of my FREE Practice Analysis Questionnaire and get on your way to getting some help.  There’s no obligation and did I mention it’s FREE!

Hope this article has been helpful, encouraging, eye-opening or just frustrating enough to spur you to do something about it – chiropractors, we need you in business and you need your business to be profitable and pleasurable!

To Your Success!

Tom Necela, DC

P.S.  Don’t worry, this post will be on-time next week – I have identified the bugs, eliminated them and placed my own precautionary systems in place so this won’t happen again, lest I be guilty of not practicing what I preach!

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