Managing Managed Care — and succeeding!
Dr. Haezebrouck juggles more than 70 MCO networks in a thriving practice
By Todd Stumpf

Utter the words "managed care" and some chiropractors start pulling their hair out. They find it difficult to survive, let alone thrive, in today's insurance environment.

Not Joseph Haezebrouck, DC. He has built Bi-County Chiropractic in Marietta, Ga., into a thriving part-time (30 hours per week) practice that sees between 75 and 90 patients a week and generates gross revenues of $360,000. And he has done that by learning to deal with approximately 70 managed-care organizations while working only part time.

His secret? He has learned that succeeding in a managed-care environment is about managing: It's about managing time, practice policies and procedures, and communication.

IMPACT OF MCOs

Haezebrouck did not start his practice with the intent of becoming involved in so many managed-care networks. But when he began to see declines in his practice, he realized that patients were going to chiropractors who were in their insurance networks.

He realized that joining provider networks was the means of stopping that trend and keeping his patients. "We would have been knocked out of being able to keep many of our patients if we hadn't joined their managed-care systems," he says.

As he began to fill out applications to get into networks, he incurred a learning curve. Unless you gave the insurance company the exact information it was looking for, you wouldn't be approved, he said. And that's what happened to him.

His wife and office manager Deborah, along with a chiropractic assistant, began attending independent state association seminars, sort of "how-to" programs in which practitioners could learn the ins and outs of the managed-care industry.

The seminars were based on the insurance commissioners' guidelines, along with the rules upheld by the state board in Georgia.

Haezebrouck's office manager is his wife Deborah.

Once he and his office staff learned what was expected of a managed-care provider (and how to get into networks), they put their managing — and problem-solving — skills to work.

The ways in which they had previously managed the clinic would no longer work, Haezebrouck said. "It was a personal choice. I had to get out of my comfort zone of doing things the way I had always done. For instance, I had always done handwritten notes. The notes were for myself. They didn't make the case plan any better when I communicated the results to the insurance provider."

Managed-care organizations seek specifics, said Haezebrouck. Reports need to be streamlined and their facts succinct. Who, what, where, and why must be provided in documentation without leeway for interpretation.

And communication always needs to be clear. The person on the other end, the one reading notes or reports about a patient, will never meet that patient, nor be able to put a face with a name. Patients become part of a statistical universe run by claims administrators who make judgments about practitioners' diagnoses and treatment rationale. If notations aren't clear and precise, payment of service may be denied.

LMT Derek Boudereaux discusses therapy with a patient.

Haezebrouck quickly found he needed to be an educator to everyone, himself included. "With every patient we had to focus on the patient and the diagnosis of why they were in my office," he says. "The patient had to fill out a lot of paperwork on every office visit. Managed care gives you a limitation on what you are able to collect from a patient, but we have that knowledge up front."

How does he know? He and his staff know co-payments — and other requirements of managed-care networks — because of how he and the office staff manage procedures. "We constantly learn with each assessment, phone call, or dispute with a misinformed insurance-claims case manager. We share our knowledge in-house, and then 'just do it.'"

Having a staff who understands the environment and its rules and regulations is critical, Haezebrouck states.

Another area that has benefited from his management is communication. His staff is well trained to keep communication flowing easily.

"If one patient takes a considerable amount of time, we do our best to inform other patients who are waiting or maybe even under care, just so they know there's an occurrence in the office," Haezebrouck explains. "It boils down to communication. My staff has developed ways to work without running amok in a busy day."

The staff communicates quickly and efficiently, making fast choices but appropriate, keeping care at a quality level. It has a sort of assembly line sound to it, because that's the direction it's headed. In order for patients not to feel they are simply running through the office on a conveyor belt, steps are taken to make sure patient care doesn't lag in order to adhere to the schedule. "We accomplish this well with pure respect for each patient," he says.

To do that, Haezebrouck and his staff simply apply the Golden Rule: "We treat our patients as if we ourselves were the patients. My staff members kick me if I'm running slow or having an off day. They're right behind me, prodding me along the way. And vice-versa. And it works."

EARLY GROWTH

The practice has grown by word-of-mouth and also by association. Haezebrouck is a member of many provider networks — approximately 70 — which opens himself up to a large number of possible patients. When prospective patients seek care and need to choose from a book full of providers, his name is available.

BMC — before managed care — when he first opened his practice, he made himself available to anyone and everyone in the community, giving healthcare speeches, offering screenings at schools — anything to get in front of people. Then it became a matter of having something to offer that people would want — and want to refer to others.

That "something else" was physical therapy. Even though he is a solo practitioner, he applies his former training and education as a physical therapist to enhance the chiropractic experience of his patients.

His physical-therapy experience also helped in another way: Because of his work as a PT for seven years, prior to attending Life Chiropractic College, he understood the value of building an extensive medical referral community.

After graduating from Life College of Chiropractic in 1982, he started building such a network in the Atlanta area. "Nurses, surgeons, internists, neurosurgeons, podiatrists, dentists, and maxillofacial surgeons have all been woven into a nice provider group of direct referrals when the occasion finds a need," he says.

Those medical personnel refer to him, and he refers to them. "Referring to medical specialists is automatic for me. It's always been comfortable for me and important to treating the entire patient. I found out how open-minded the medical community really was just for that gesture, especially when recognizing conditions that may present severe or life-altering changes."

Teamwork — The Bi-County Chiropractic Clinic team consists of (from left) Julie Moore, Christine Opalecky, Derek Boudereax, Haezebrouck, and Deborah Haezebrouck.

SIDEBARS:
Reining in managed care
Part-timer
'On-the-go' rehab for patients
Blending chiropractic and physical therapy
Ingredients for a successful practice
For the birds
Vital statistics

Todd Stumpf is a freelance writer who frequently writes for Chiropractic Economics. He can be contacted at tstumpf22@gmail.com.