Why Some Chiropractors Chase $44,000 Only to Lose $544,000 or More

One of the most common questions that I get around here is on EMR. Everyone wants to know what’s the best EMR system to use or when is a good time to implement EMR or how to implement EMR.  You get the idea.

Those of you who have read or heard my thoughts on EMR know that I dance all around this issue constantly.  It’s not that I think EMR is a bad idea.  On the contrary, most of my clients utilize EMR in their practice.  It helps them improve their documentation, compliance and practice management.

Notice I said, most — not all.

Considering my background, this may come as somewhat as a surprise.  Why would a known “expert” in chiropractic biling, coding, documentation and compliance – someone who lectures regularly on the topic and has consulted with chiropractors all around the country to help them improve in these and other areas in their business – why in the world would I not simply require all my clients to be on EMR.

Two reasons:

1)      My approach is different than most practice management groups, coaches or consultants.  I am not looking to create a herd of clones of me or a bunch of DC’s all practicing the exact same way, in different locations.  Cookie cutter approaches don’t work for everyone; witness the devastation left behind by many chiropractic “gurus” who try to bang your square peg into their round hole.  In short, everyone’s needs and practices are different and so are their EMR requirements or timelines.  That’s the way I choose to work, but really that’s another story for another day.

I believe reason #2 for not requiring all of my clients to be on EMR is more vital.

2)      Prioritization. Simply put, there are more pressing items to deal with in your practice.  Certainly, this thought will not endear me to EMR companies, but I really don’t care.  I still think EMR can be a great asset and tool for your practice, but for some chiropractors, there are definite reasons NOT to choose an EMR system – or at least not yet.

Unfortunately, no one is talking about why NOT to pursue EMR.  This may be because many of the chiropractic coaches or management groups are being paid to endorse a specific EMR.  This may be because EMR sounds flashy and/or because chiropractors love to “buy the next big thing.”

That said, here are 7 situations that would warrant putting EMR lower on your “To-Do” list:

1.  You have bigger fish to fry. $44,000 is certainly nothing to sneeze at, but it’s not absolute (see #7) and it’s not a figure that represents the most amount of money your practice could possibly increase in one year — not by a long shot.  Case in point: several recent examples from clients of mine.  Client A:  had a pretty good practice going before he hired me, but little to know ancillary or passive income generated. One year later, the results are in. Over $150,000 increase in his practice, 60% of which was generated passively.  Do the math.   Client B: This doc had several problems.  Wanted to get an EMR system. Had a deadbeat associate was costing him $4500/mo.   Untapped potential in the practice + major lack of focus.  I helped this Client prioritize his goals, give the associate the boot, bring his documentation to better compliance on paper and start profiting from the untapped potential. Took him 6 months to get rid of the Associate he supposedly needed.  6 months later, practice is producing aaproximately $10k per month more.  Had he diverted his focus to getting EMR, he might earn $44,000 in time, but he would have lost the $120k in growth, still been saddled with a$54,000 per year associate and spent $10K on the EMR.  Client C: underwent a major expansion of services that sapped just about all his time  and energy.  In the meantime (per my advice), he stayed ashore while the EMR boat floated by.  End result: practice hit “best evers” 3 months in a row in services, collections, and dollar per visit average, mainly due to the fact that he is now billing for services he was previously performing, but never collecting.  He may miss the $44,000 boat, but he will eventually get on; in the meantime, the revenue from his expansion bought him a yacht. Sum total of these three clients: FOCUS! PRIORITIZE! and reap the rewards!

2.  Your practice is in the toilet or headed there. If you are struggling to survive or remain profitable, EMR won’t bandage your wounds for you and it won’t save you from death.  Focus on increasing production and getting people in your doors.  Spending $10,000 on EMR system won’t bring patients in, no matter how many press releases you issue about it.  Save your money and work on your practice instead.

3.   You are paranoid about audits. Certainly, audits are a scary and real presence in chiropractic. But some of you just need to settle down and do the math.  For example: your practice generates $2000 per month (See also situation #2), a payer audits you and asks for 50% back – sounds painful. That payer represents 10% of your patient base. You do the math and figure out that you owe them $1200.  Hardly a reason to run out and buy a $12,000 EMR system.


4.   Your practice is on a major growth spurt or has recently encountered massive change. Tread carefully here.  There is such a thing as having too many balls in the air.  Your practice, your staff and even your patients can only tolerate so much change.  So, if you’ve already tried 3 EMR systems in the last year, moved to a new office, hired 2 new staff, 4 new massage therapists and tripled your practice in the last year, congratulations!  Now, take a breath and make sure that you can sustain all those good things.  EMR will still be there when things settle down. The good news is, you’ll be able to afford it.

5.   You are a perfectionist. Truth be told, many chiropractors have documentation that stinks. But occasionally I run into docs who have a disproportionate sense of how good their notes need to be.  If your notes are so good that lawyers ask to frame them and even the IME reviewer can’t find a fault, stop obsessing about them.  EMR can probably help you get even better, but your desire to improve is dysfunctional and will be unappreciated. The extra few bells and whistles you can add will likely be missed or by a reviewer or auditor who is accustomed to working at warp speed and seeing such slop that your notes look superior anyway. It’s possible that you are a perfectionist everywhere, but unlikely. Find something else to fix in your practice and leave the EMR alone for now.

6.   You have just entered practice. Why a new grad needs a $15,000 EMR system when they have no patients is beyond me.  I am sure some of the companies offer a great student discount package, but it’s no bargain when you have to sell it for half the price you paid for it 2 years later, when your practice goes under.  Save your money, invest in patient-acquisition.

7.   You want to go for the $44,000 Stimulus. That’s fine in theory, but make sure you you’re your other ducks lined up as well. Case in point: instead of scrambling like mad to potentially qualify for the $44,000 stimulus package, which you may or may not achieve, be sure your practice is ready to receive the money that you are owed from payers by converting to HIPAA 5010 Format now. If you are not fully converted to 5010 standards by the January 2012 deadline, there are definite – not potential – consequences: you won’t be paid. If that’s the case, you’ll wish you didn’t spend so much time and effort chasing the $44K while you let the $544K or $644K (or however much your practice earns) slip through your fingers. So to me that’s a higher priority item than the possibility of an EMR stimulus.  By “fully” converted that means that you have done the internal conversion in your office, external with payers/clearinghouses that you use and also tested the new format to make sure it works.  For more info, see my upcoming WEBINAR – Get Your Chiropractic Practice Ready for HIPAA 5010.

Hopefully, this post helped some of you fence sitters.  If so, remember me and come to my assistance when the EMR goons try to take out my knees at my next seminar!

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