Chiropractic Economics Blog

While getting ready for work, I had one of those morning news programs on and could not believe my ears. While most of the news was much of the same from the night before, one story caught my attention.
The story was on e-mail and how we, as a society, are addicted to it. According to AOL Mail’s fourth annual E-mail Addiction Survey (www.ChiroEco.com/e-mailaddiction), nearly half (46%) of e-mail users said they’re hooked on e-mail (up from just 15% last year) and 51% check their e-mail four or more times a day (up from 45% in 2007). One in five said they check their e-mail more than 10 times a day. While I originally laughed at the statistics it was reporting, it got me thinking.
While I am not one of those hooked on e-mail, I am among the one in five that check it more than 10 times a day. And how can I not be?
My inbox is filled with “businessy” items such as article submissions, editorial inquiries, and newsletters keeping me up-to-date with the world…chiropractic and otherwise. And if I haven’t checked my e-mail, what kind of a response can I give to people who call to ask if I got their e-mail?
My e-mail program is always on, and in order to efficiently do my job, it needs to be. There it is, running silently behind my other open programs because, for me, 95% of the e-mails I receive are work-related; rarely do I get personal messages, and nowadays you can spot the spam.
So, am I addicted? No, I would just say I am an e-mail advocate. How about you? Do you find yourself addicted to your e-mail, or do you see it as an effective, business tool?

As Chiropractic Economics online editor, I am constantly surfing the Web to find the latest news and buzz about chiropractic. Today, I saw this story from about a Noblesville, Ind., chiropractor who writes a column for his local newspaper (”Dr. Justin Gilmore: Caring for your spine: why chiropractic care is for everyone,” http://www.county29.net/cms2/index.php?option=com_content&task=view&id=15678&Itemid=237).

This is a good example of grass-roots marketing. It positions you as an expert, increases patient referrals, and it’s free! And now that most newspapers have Web sites, your message can have a global reach.

ChiroEco.com has several articles about this kind of marketing approach, which I have listed below. Please feel free to post a comment about this blog, the articles we publish, or anything that’s on your mind. We welcome all feedback!

Kick off your marketing with these essential steps, http://www.chiroeco.com/article/2004/issue9/9mark2.php

27 tips to jump-start your marketing, http://www.chiroeco.com/article/2005/issue1/1marketingtips.php

How to Get All the New Patients You Can Handle, http://www.chiroeco.com/50/market/howtoget.html

Just do it! Establish yourself as a wellness leader, http://www.chiroeco.com/article/2006/Issue3/PR1.php

The making of a ‘star’ 30-minute TV shows put you in the limelight, http://www.chiroeco.com/article/2005/issue1/1marketing3.php

How to become the scoliosis professional in your community, http://www.chiroeco.com/article/2005/issue14/MKT1.php

Focus on Perceived Value, Not Lowering Prices, If You Want To Increase Revenue, http://www.chiroeco.com/article/2000/Nov/Prac2.php

I received a substantial gift card for Christmas. I carried it around for several months and just cashed it in on something for my home. I appreciated not having to dig into my savings to buy the items that I wanted.

Gift cards have been on my mind because I recently read an article in Employee Benefit News about a new type of employee benefit — wellness gift cards. According to the article, Highmark, a subsidiary of Blue Cross-Blue Shield, launched a healthcare gift card program for employers. Employers can purchase the cards in any denomination. Employees can spend them like any other gift card, except that it can only be used for certain merchant codes, such as to fund co-pays, pay hospital bills, purchase prescriptions, or obtain alternative medicine, such massage. (The article did not specifically mention chiropractic, but why not?)

One benefits manager heard about the cards and bought a couple dozen as rewards for employees who went through a complete health-risk assessment program. The manager said it was a surprise bonus and served to reinforce the healthy behaviors the employees had established.

A retail massage chain recently opened in my area. It offers patrons the ability to buy gift cards.

I’ve been to a number of different chiropractors’ offices, but I’ve never seen gift cards offered. Personally, I think it’s a good idea — the gift of health.

What do you think? Do you offer gift cards?

Until next time,

I remember a time when “wellness” was a foreign word in corporate America. Proponents of wellness programs couldn’t get these programs past the concept stage, because top management perceived such programs as an expense, not an investment.

That was 20 years ago. Now, however, it seems everyone wants to get on the wellness bandwagon. The reason why is simple: Healthcare (that is, sick care) is expensive; in comparison, wellness is cheap.

I just read an article in Employee Benefits News, a news magazine for human resources and benefits managers.

The headline was “HSA tames cost hikes.” The article discussed two things one small company (87 employees) did to control healthcare costs: It switched from a traditional healthcare coverage to Health Savings Accounts (HSAs), and it implemented a wellness program for its employees.

The wellness program included screenings for weight, blood pressure, and cholesterol and showed that 65 percent of employees had weight or nutritional problems and 58 percent had high cholesterol.

Following the screenings, an employee committee developed a series of programs to address these problems: a daily walking program, a weight-loss contest, nutrition classes, lunch-time seminars on health and wellness issues, and exercise and yoga classes.

After one year, the article said aggregate cholesterol was down 10 mg/dl; 69 percent of the workforce received flu shots; and annual preventive-care visits increased from 30 percent of employees to 74 percent.

United Healthcare, the company’s insurer, projected 139 percent return on investment in claims savings for every participant in the wellness programs.

If you are considering expanding your healthcare services to industrial or corporate consulting, don’t overlook the little guy. The “little guys” might be your “in” in industrial consulting.

All things considered, small employers have a greater need than the “big” guys: They generally don’t have a dedicated staff person to organize wellness and safety programs; because of their small populations, health insurance costs them more; and they can’t afford to have a workforce that is less than 100 percent able to perform.

Bigger is not always better.

Until next time,

Whenever we ask readers “What kinds of articles interest you most?” the most common answer is “marketing.” I’m sure that most people would like to read an article that gives them a “magic bullet” — the sure-fire thing that would guarantee a flood of patients through their doors.

Magic bullets, unfortunately, do not exist. Marketing professionals themselves search for amagic bullet to make every campaign successful, and they have never found one. Although they don’t always agree on the specifics of how to market successfully, they do agree on one thing: Whatever your campaign, you need to be consistent. Marketing is a process; it is not a one-time activity.

I would add another ingredient — you need to be persistent. Persistency can pay off.

Consider, for instance, the one type of marketing practice-management consultants invariably recommend — sending press releases. The goal of a press release is twofold: If the press release is published, it gets your name in front of readers. And even if it does not get published, it gets your name in front of editors who are always looking for expert sources. That’s important, because it’s always better to be asked for your opinion as an expert than it is to be perceived as self-promoting.

Press releases work; but you have to be persistent. Sending one press release every six months will not cause an editor to think about you when he or she needs an expert resource.

I get press releases from all types of sources daily. About twice a week, I receive an e-mailed press release from a practice in North Carolina. About twice a week — not twice a year. The subject line always says, “News release: xxx clinic announces …” or “News release: xxx clinic hosts …” The PR agency that handles this clinic’s public relations always finds something to announce, whether it is the addition of a staff member, a charity event, or a seminar one of the doctors is conducting for patients.

The fact that I am writing about this clinic proves the point about persistence. I “bit” and visited the Web site. It is excellent — content for everyone, and interactivity — even an active blog. I would bet that the editors of the local media are familiar with the doctors in this practice and would call upon them for expert opinions.

The clinic? Check it out for yourself. It is www.carolinachirowellness.com.

So you see, persistence counts.

Until next time,

I just came back from a weekend in Chicago where I visited my two small grandchildren, ages 3 and 5. Since I live in Jacksonville, Fla., I only get to see the grandkids about twice a year. Those semi-annual long weekends are never enough; I miss out on so many of the things they are learning to do.

The one advantage of visiting infrequently, though, is that I have a different perspective of the kids than their parents have. I can see how much they have grown since the last visit, and how well they have mastered “little” things, such as dressing themselves, expressing their thoughts, and understanding and respecting boundaries. It’s not that their parents don’t see these accomplishments; it’s just that I see them with a fresh eye. And my perspective allows me to take great joy in them and to “ooh” and “aaah” over what they do.

Several years ago Kent Greenawalt, CEO of Foot Levelers, launched the Campaign for Chiropractic. He mobilized the profession’s leaders and educators and asked them to stand united behind a single public relations campaign, both in spirit and with money to support it. The vehicle that drives the campaign is the Foundation for Chiropractic Progress (F4CP).

F4CP started small. But it is growing and getting better all the time. Its aim is to position chiropractic so that the public will consider it as a healthcare option.

I think the advertisement F4CP placed in USA Today last week (April 25) was significant: It was an endorsement of chiropractic by three medical doctors.

Some people might look at the ad and think, “That’s nice.” But you need to put the ad in its proper perspective. During the 1960s medical doctors were ordered by the AMA not to associate in any way with chiropractors! Wilk vs. the AMA caused the AMA’s directives to be stricken down.

Yes, chiropractic has a long way to go. Only about 12 percent of the U.S. population goes to a chiropractor each year, so clearly F4CP needs to continuing its education and public relations program.

But I urge you to look at F4CP’s accomplishments in the same way I look at the development of my small grandchildren. Take pride in what it has done and support it in any way you can so the Campaign can continue to develop and grow. Make it your “baby” and take pride in what it does.

Until next time,

I am not a big fan of health-insurance companies. To me, they are like death and taxes: necessary but not nice.

Because I am not a big fan, I was pleasantly surprised by an April 3 newspaper article I read in the Indianapolis Star about WellPoint, the nation’s largest commercial health insurer in terms of membership. The article said that WellPoint would this year begin halting reimbursement payments to hospitals and doctors for 11 medical errors considered preventable.

Some of these errors include surgery on the wrong body part, a wrong surgery performed on a patient, surgery on the wrong patient, bed sores, sponges left in the body after surgery, urinary tract infections associated with catheter use, injuries due to falls, and blood incompatibility.

In 2007 the Centers for Medicare and Medicaid Services (CMS) authorized the nonpayment for six medical mistakes. (On April 14, the agency announced it would be seeking to withhold payment for nine additional preventable mistakes.) WellPoint, which provides healthcare benefits to about 35 million Americans, is following the lead of CMS. The newspaper said other insurers may also stop paying for certain medical errors.

Skeptic that I am (having been “burnt” many times by insurance companies), I immediately assumed that if WellPoint withheld payment for services (even though those services resulted in pain and suffering), the patient would be stuck with the bill.

Not so! Again following CMS’s lead, WellPoint said it would make sure its members are not billed for any of the errors it refuses to pay. Not only that, but according to the newspaper, officials at WellPoint, said any savings WellPoint gets from stopping payments for mistakes would result in reduced premiums for patients.

Bravo!

I am not a fan of insurance companies, but I am a fan of accountability. Doctors and nurses are not infallible; they make mistakes. But there is no excuse for mistakes that can be prevented. And there is no reason to reward healthcare providers for mistakes that could have been avoided.

Now if we could only get WellPoint and all other insurers to pay just claims on time, insurance companies might gain my respect.

Until next time,

Today is April Fool’s Day, and perhaps you were the butt of a harmless prank, such as these:

About two years ago, a colleague in our office found a telephone message left on his desk while he was out to lunch. It asked him to call Jay Raffe at a local telephone number. He didn’t know the man, but he picked up the phone and called the number. When the phone rang, the person on the other end answered, “Jacksonville Zoo.”

Jay Raffe. Giraffe. He still laughs at himself for falling for the oldest joke in the book.

Did you put Peeps into your kids’ Easter baskets? Peeps are those marshmallow confections that look like little chickens. They used to come in only one color — yellow — but now their sugar is dyed blue, green, and purple, in addition to yellow. All of the colors taste the same.

When my husband confessed his liking for Peeps (which are only manufactured at Easter time), I stocked up on them.

One recent night when I doled out our Peep dessert, I sampled both a blue and a purple Peep, while he munched on a blue one. I innocently said, “They taste different!” He looked at me skeptically, said, “No, they don’t,” then took the blue Peep out of my hand and bit its head off. “See,” he said. “The blue one tastes the same as all the others!”

When I smiled broadly, he realized the joke was on him. We both laughed.

These are innocent pranks. No one was inconvenienced and the person on the receiving end of the joke didn’t lose anything except a small bit of dignity.

This week I began the very time-consuming task of analyzing the data you provided for our 11th Annual Salary & Expense Survey. This is an enormous task, even though we use powerful survey software to gather and crunch data.

Over the years that I’ve analyzed this data, I’ve learned that the first thing to do is to review the raw data. Mistakes can easily happen. For example: One question asks the respondent to input an annual salary in whole numbers. A few people forget to put zeros on the number, and instead of entering (for example) $35000, they may input $35. Obviously, the lack of zeros would skew the data.

I reviewed all the data and thought I had caught all of the errors, so I began to do my analysis. I compiled information on several sets of statistics, and was typing in the range of ages of respondents on my data sheet. The software told me the age range was from 26 through 100.

A 100-year-old chiropractor? Unlikely. So, I looked at the information the 100-year-old respondent entered. I followed the data to the end, and came to an e-mail address: nobody@nobodyherecares.com.

I’m sure the person who went to the trouble to input phony data throught he (or she) was being funny. I didn’t laugh.

Why would someone go to the trouble to enter fake data? Why would someone want to jeopardize the integrity of the only survey on the income and expenses of chiropractors — a survey whose results are reported by the U.S. Department of Labor in its Occupational Outlook Handbook?

This was a sophomoric gesture that caused much inconvenience. Fortunately, I caught the sabotage in time. I hope it never happens again. I would prefer for the jokester to just opt out of receiving our e-mail.

But in case the person doesn’t, the next time I conduct a survey, I will scan the raw data with an eagle eye before I begin to analyze the results.

Until next time,

When you have aging parents (and in-laws), you acquire a lot of experience dealing with healthcare providers. That experience can be frustrating.

In early February, my 86-year-old mother attempted to hang a dish towel on the clothes line. When she tried to lift her left arm, she experienced pain under her left shoulder blade, which she described as being similar to a “crick in the back,” and found she could not lift the arm at all. She could, however, use her hand and fingers.

She went to her primary-care physician, who, thinking it was a torn rotator cuff, sent her for an MRI. The test came back inconclusive.

He then sent her to an orthopedist. This doctor did not do a thorough exam, but immediately concluded (because she could not lift her arm) that she had had a stroke and sent her to the hospital. (She had no other symptoms, such as slurred speech.)

Two CAT scans later, the ER doctor said my mother definitely had not had a stroke nor a heart attack. The ER MD found what she thought was a schwannoma, however. Because my mother was not in immediate danger, she discharged her and recommended she see a neurologist.

The neurologist ordered another MRI, which was also inconclusive. He could not give a diagnosis, but sent her to (don’t get your hopes up!) a physical therapist, not a chiropractor. She has had therapy several times, with no improvement in movement.

I have repeatedly asked her to see a chiropractor. She says she will, if the therapy doesn’t work. Her reasoning: The neurologist ordered this treatment. In her mind, the medical doctor knows best and she has to finish his course of treatment. Medicine trumps chiropractic in her mind.

My mother has never experienced the benefits of chiropractic. I do believe she will go to a DC eventually. Of course, I don’t know if chiropractic treatment will help her, but I have a strong suspicion it will.

My frustration? In my job, every day I read about and write about the disconnect and the antipathy between allopathic and chiropractic medicine. But when that disconnect hits home, well, it becomes frustrating and disappointing.

The neurologist my mother saw is regarded as the best in her locality. I am disappointed he did not consider a chiropractic opinion before sending her to a PT. If only he had an ongoing dialogue with a good chiropractor!

About a week ago, I had an enlightening discussion with David H. Durrant, DC, of the American Academy of Spine Physicians (AASP, www.spinephysicians.org). AASP was founded in 1995. It is open to healthcare providers who treat the spine. Dr. Durrant told me the organization’s membership is growing rapidly — and that about half of it is comprised of medical doctors. The growing MD-DC membership of this organization tells me is that a dialogue is taking place between neurologists and chiropractors. That dialogue should help develop a symbiotic relationship between the two communities.

The neurologist my mother saw must not be a member of AASP. Too bad –for her and his other patients. Maybe my mother’s treatment plan would be different if he had been a member, and maybe she would now be able to use her arm.

Until next time,

I subscribe to a number of RSS (really simple syndication) feeds as a way to make sure we publish all the news that may affect you and your practice. It seems that at least once a week for the last couple of months, I’ve been seeing press releases from the notorious anti-chiropractic group that is active on the eastern seaboard.

This group has been active for several years. It has put up billboards, plastered advertising on the sides of buses, and bought television advertising. Worse — it keeps feeding the popular press with sensational press releases. Some newspapers and, more recently, television stations that are notorious for reporting biased “journalism” take delight in “warning” the public about the safety of chiropractic.

I put “journalism” in quotes because I do not consider these biased reports to be journalism. A journalist would make every attempt to provide a balanced story. The articles that have appeared in print and on TV are far from balanced.

When I see the propaganda spread by this anti-chiropractic group, I am reminded of the blackballing efforts made by the American Medical Association in the 1960s — efforts that the courts made illegal with a permanent injunction as the result of the landmark Wilk vs. the AMA case. I grew up in the era when the AMA called chiropractic quakery and forbade its members from associating with DCs. It took the education I have acquired as editor of this magazine to learn the truth about chiropractic. What if I had not become editor of Chiropractic Economics? Would I be harboring prejudices against this noble profession?

I just hired a new assistant editor. As part of his training and education, I gave him a copy of Chester Wilk’s book, Medicine, Monopolies and Malice. If you have not read the book, do it now. If you have not read it for years, it’s time to read it again — to take a refresher course on the hard journey chiropractic has had to take to get to where it is now. (I hope this book is on the required-reading list of all chiropractic students.)

Perhaps Dr. Wilk’s words will inspire you to fight back and support the Foundation for Chiropractic Progress (www.F4CP.com), which is valiantly trying to educate Americans about the value of chiropractic, or get involved in your state and national chiropractic association. Strength is in numbers.

The anti-chiropractic group is hoping its yellow journalism will taint everyone against chiropractic. We can’t let that happen.

Until next time,