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Issue 15 - November 2004 Roundtable Q&A Should I or shouldn’t I?” That is the question that gnaws at many chiropractors who want to grow their practices but aren’t certain if signing on with a practice-management consultant is the right choice for them. To help you answer this question, Chiropractic Economics asked the industry’s top practice-management consultants several questions concerning the profession, practice management and the process of selecting a practice-management consultant. The consultants we talked with were (in alphabetical order of company name): • Mark Sanna, DC, We hope their insights will help you determine what is right for you.
A look at critical issues Sanna: Chiropractors must learn to master the art of documentation so that they can effectively communicate the value of their work to interested third parties. They must practice with a standard of care that is based upon empirical evidence. They must become aware that to participate in the mainstream of healthcare reimbursement they must become compliant with the standards of coding. And they must combine philanthropic efforts to reach a level of financial commitment as a profession to impact the legislative process that controls the purse strings of chiropractic reimbursement and recognition. Humble: Critical issues? They are: • How to establish and market your practice professionally and ethically; To address these issues, chiropractors need to communicate effectively, understand finance and business and have a burning desire to succeed. SINGER: Patient education and compliance. Patient education is the precursor to patient-treatment recommendations. Patients must first know, understand and want chiropractic care prior to a doctor’s making recommendations for care. To educate patients, chiropractors need not only good communication skills but a proven program to get patients to understand how chiropractic works, why it is valuable and why it is worth the cost. Fernandez: Today, we have insurance companies that raise patient deductibles, reduce the number of covered office visits and reduce the fees for chiropractic services. Cash patients hold onto their money. Along with this, the medical profession is aggressively extending itself into pain management and spine, rehab and sports-injury clinics. To overcome these challenges, chiropractors have to develop, launch and maintain an aggressive marketing campaign that will help assure growth and survival. It is imperative that DCs choose an area of the spine to specialize in — such as upper cervical, postural correction or traumatically injured — and act to establish themselves as“The Authority” on treating these types of neck and back pain. Maule: According to the American Chiropractic Association, 64 percent (about 160 million) of the population are undecided about the benefits of calling a chiropractor. I believe the most critical challenge chiropractors face is getting the exposure and education of chiropractic to that 160 million so that we can push them out of the “undecided” category into the “will call a chiropractor” category. This would solve all problems — except that we won’t have enough chiropractors to treat everyone! We must develop our marketing, communication and business skills. It is not the results of chiropractic or chiropractic skills that hold us back; it is the lack of business skills that have caused us to hit a wall. Sigafoose: The biggest issue we have is failing to separate chiropractic from therapy. We need to market what we do and what we don’t do. Plasker: Most chiropractors are realizing that third-party pay is slowly but certainly drying up — but they don’t know how to package their services to ensure success. And many chiropractors are not attracting as many committed patients as they want. Their marketing is outdated and ineffective. To meet these challenges head on, chiropractors need to be willing to change the way their offices function and how they communicate with patients and the community. Hoffman: Chiropractors generally fall into three categories: • Doing well (very profitable and successful), The reason why some people fall into category three is not because of their chiropractic education. It’s because they have not received an awareness education — awareness of what it take to run a successful business. Mertz: Many chiropractors do not have a firm foundation of philosophy on which to build their practices. They do not know how or where to market their services. They haven’t been trained to deliver corrective and wellness care. They are financially dependent on managed care. And they haven’t learned to hire, train and lead their teams properly. These are all issues that they must deal with to become effective in today’s changing healthcare arena. Gay: The most critical factor in our profession is the limited participation and financial support of chiropractors on issues pertaining to their right to practice. Many doctors take a “wait and see” attitude toward important changes in state and federal legislation. Every chiropractor needs to work on the issues that hold back our progress. Now is the time to cooperate as a group of concerned healthcare professionals to show that we can provide a healthy society based on what we do for our patients. It is time for every doctor to contribute in time and money to the continuation and momentum of this profession. Cash, reimbursements or something else? Sanna: Chiropractors must possess a comprehensive understanding and ability to use correct CPT and ICD-9 codes. Insurance claim forms are printed in red ink, not because red is a nice color, but because claim forms are optically scanned by a computer. Computers communicate with numbers. A mastery of these numbers allows chiropractors to communicate what they have done and at which level they should be reimbursed. Humble: Practices can be: • Cash-only, The last is the best. You should have a strong CA presenting your financial policies and you should run your practice in a way that places you in the driver’s seat to accept only those insurance policies that meet your criteria and deny those that don’t. You need an in-depth understanding of money, fees, insurance, coding, the value of services offered and how to collect cash to be successful. Fernandez: I recommend accepting payment any way possible — cash, insurance, Medicare, Medicaid (if it pays for chiropractic care in your state), barter, charge cards, etc. Why would you care who writes the check, as long as it is written? You don’t have to feel unsure or overwhelmed by insurance paperwork. An experienced consultant can show you how to deal with carriers. Maule: Each practice has to establish its true worth and value. You do this by deciding on a bottom line — a level of reimbursement and quality of care below which you will not go. This floor becomes the criteria for making all decisions, such as if you should participate in a particular plan and how you should structure your cash patients. Sigafoose: Use insurance for its value, then have affordable fees for cash patients. Plasker: The way to structure your payment policy is not to become insurance-based or cash-based — but to become care-based. Being care-based means that you make recommendations based on what you truly believe is necessary for each patient to get the best results over a lifetime. When you do this and have your financial policies set up to promote and support this model, patients will choose to participate and you will begin to collect money from a variety of different sources. Hoffman: Insurance benefits continue to decrease, for both the patient and the practitioner. Does it make sense to chase something that is bad now and getting worse? We recommend that some portion of your practice begin to incorporate what we call “universal care at an affordable fee.” This type of program allows both the patient and the doctor to have an equal exchange for the value of services rendered and care received. Mertz: A chiropractor’s finan-cial strategy should be determined by the kind of quality, patient behavior and performance it produces. Patients who are involved in some form of advanced payment program are the most committed, enthusiastic and satisfied patients in all of chiropractic. Practices laden with heavy billing strategies have great difficulty delivering patient-centered care, which leads to poor retention. The happiest and most profitably chiropractors have converted their practices to be cash-dominant. Gay: The cash model is becoming more of a practice reality only because managed-care is a barrier that forces unnecessary paperwork. The answer is to combine cash and insurance-reimbursements that will allow the patient the ability to continue with the necessary care after insurance benefits discontinues coverage. When does a doctor need a coach? Sanna: I have always had a practice-management consultant — and still do! Success is a system, not a personality trait. You can learn the procedures, protocols and tools to become a success. The right consultant functions with ethics and integrity and has a commitment to your success and the success of the profession. But no one is going to make you a success but you. Humble: Signs include a lack of adequate marketing skills, low new-patient volume, collections and services less than that of the average DC, no staff enthusiasm, a loss of passion for the profession and worrying about money as opposed to being excited about going to work and taking care of patients. SINGER: A doctor whose practice is not growing needs management help. So does one who has lost the fun and excitement of practicing or who want s a “new game” or desires to expand to new heights. Good consultants who are experienced can figure out ways to resolve specific problems that would take the doctor years to resolve. Consultants take the guesswork out of running the business and provide systems that correct obstacles so that the doctors can implement the steps and get results. Fernandez: It’s time to seek expert advice when you want to open your own practice or when your existing practice is not satisfactorily responding to your practice-building efforts — for example, the practice is declining, has plateaued or is just not growing fast enough for you. Maule: There is not one tell-tale sign of when a consultant is needed. But typically a consultant is needed when a practice: • Brings on its first associate But practice management is not just for declining practices. We’ve seen a definite increase in practices doing $50,000 or more a month that want to go to $1 million a year or more. And some doctors just want to grow more and work less. Sigafoose: Low volume and few new people. Plasker: Doctors need a consultant when they are tired of trying to figure things out on their own, have reached a plateau and want to get to the next level or want to connect with a group of like-minded chiropractors because they are tired of feeling as though they are on an island. Mertz: Chiropractors who would benefit from a coach are those who have: • A poorly developed practice-building plan; Gay: Everyone needs a coach. Some of the signs include procrastination, no procedures or systems in place, limited or no internal or external marketing materials and a lack of marketing plans. Some advice from the pros Sanna: The only way to accomplish the goal of consistently strong new patient numbers and a predictable PVA is to implement consistent systems. These systems can’t be built on the doctor’s personality or personal charisma. Choose a consultant to help you develop a system who: • Is familiar with the practice of chiropractic today — not 10, 20 or 30 years ago. Times have changed and what used to work in the past doesn’t work any more Humble: Believe in yourself and have no reservation to let others know you do. Get involved with other successful practitioners whom you would like to emulate. Disassociate with those who bring you down and only complain. When you select a consultant to help you, pick someone whose philosophies match yours; who has successful operational experience; and who can deliver the breadth and depth of services you need. Be certain you understand the fee structure: Will you pay per seminar or project or for membership? Is a contract required? Are there hidden fees? Is there a payment schedule? Is there a guarantee if you are not satisfied? SINGER: Learn how to consult with new patients in such a way that they discover through your questions that their health problems are actually reducing their enjoyment in life as well as their ability to work and to have good relationships with family and friends. Use progress charts to measure the patient's improvement toward optimum health. This type of chart will increase your pull by 20 percent. Fernandez: There are many effective ways to educate your patients and boost your PVA. A good consultant can teach you those that will best serve you and your practice. If your new-patient numbers are not what you want, the problem is undoubtedly a lack of enthusiasm on your part and a lack of patient education. Learn how to educate your patients and community by using more effective doctor/patient communications, pamphlets, newsletters, networking skills, advertising, healthcare classes, office signs and similar things. Maule: Doctors can and should do many different things to increase PVA and new-patient visit numbers. But one thing is to use our procedure for advanced multiple scheduling (AMS). AMS is highly effective for increasing PVA when done correctly. Sigafoose: Educate your patients and set reasonable fees. A coach is someone who tells you what you don’t want to hear and shows you what you don’t want to see. If you are comfortable, then assume you are not growing — at least to the degree you should be. Mertz: Begin with the end in mind. All too often, chiropractors attempt to promote short-term care in the hope of stretching it into long-term patient care. Statistically, it doesn’t happen. Ironically, patients are ready to commit to long-term care right from the beginning if you effectively communicate the purpose of doing so. Gay: The patient needs to have an experience that makes him or her want to come back and continue care. This starts with the first call to the office and continues through the consult, a comprehensive exam and the report-of-findings (ROF). After giving an explanation in the report-of-findings, give the patient the best adjustment he or she ever had. Then, follow through with a call the night of the first adjustment. |
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