Can you remember what your grade-school teacher said about posture? “Sit up straight.” “Don’t slouch.” “Shoulders back.”

Research shows your teacher’s admonitions are just as important today as they were back then:

• A 20-year University of London study looked at more than 4,200 men aged 40 to 59 and found a strong correlation between losing height and mortality. The authors speculated that slumping-over postures caused a physical restriction of breathing, which significantly increased risk of cardiovascular disease, stroke, and respiratory mortality.1

• Another study showed that women with a jutting-forward head posture were found to have almost half again the risk of dying during the course of one four-year study.2

• The Harvard Medical School Adviser3 also reported, “Research suggests that vertebral fractures have been overrated as a cause of height loss and hunching. Another big reason may simply be bad posture.”

In addition to those compelling studies, many of the complaints that bring patients to your office can be traced to poor posture. Remember: As long as a body is not falling down, it is mechanically balanced, albeit imperfectly. But the body compensates to maintain balance, resulting in areas of complaint and/or initial injury often distant from posture distortions. (See the example, “Compensation,” on page 46.)

If the cause of the problem is posture, the solution is to combine chiropractic and posture training — that is, to become the chiropractic posture expert in your community.

Regardless if you focus on disc and low-back problems, subluxation-oriented wellness, sports, rehab, or pain relief, becoming a posture expert provides you a marketing edge by showing people something they know they have a problem with (their posture), and then demonstrating improvement with care.

Besides providing valuable clinical information, from a marketing perspective posture assessment effectively differentiates the posture-based practice. A research-oriented, posture-based patient education program creates value in patients’ eyes by demonstrating how posture can truly provide a window to health and aging.

And when care plans incorporate posture exercise along with chiropractic, patients not only feel better, they get excited when they see the positive changes in their posture.

TAKE A PICTURE

Posture assessment can be described as visual palpation. To help document posture distortions — and to show improvements to patients following treatment and posture exercises — you will need to take photographs.

You can use sophisticated $20,000 software and a video-camera system, or a simple Polaroid or digital camera. The decision obviously depends on economics (how much you are willing to spend), as well as what you are going to do with the information you document.

If research is your goal, you’ll want a system that provides the highest possible standards of reproducibility. Factors as varied as maintaining an absolutely constant distance and squaring of camera, subject, and background; floor surface and level, visual cues in the background; lighting; operator training; and a host of others must be controlled.

In a research setting, a more expensive system is justified and necessary.

If clinical assessment and care is your goal, in most cases a more modest system can suffice.

For many techniques, clinical assessment of posture is a tool correlated with x-ray and requiring precise measurement.4 Unless a specific technique-related observation drives a clinical determination, you probably do not require the scientific precision of a high-end system.

On the other hand, consider what your patients need to see. Images capable of creating value in the patient’s eye can be taken with a five megapixel digital camera and printer. Color is better, but black and white suffices.

While some posture professionals invest in elaborate software and/or hardware systems, others merely take a picture, print it out, and then use a marker to draw gravity lines to demonstrate asymmetry to the patient.

However, if one of your goals of posture pictures is to create the perception of value, then providing a professional presentation of what they need to know is important.

Some DCs use a posture-assessment software program to generate a report for the patient. Such programs usually allow basic image editing, cropping, adjusting brightness for over- and under-exposure, and offer other features, such as drawing lines and measuring degrees of deviance from true vertical or horizontal. All are valuable in demonstrating biomechanics and value to a patient.

However, be aware that patients (and other professionals) may view programs with proprietary algorithms to rate the patient’s posture according to a numeric “secret formula of ideal posture” as being marketing driven.

GET STARTED

When a patient presents with a problem, first visually assess posture. If you suspect poor posture as a culprit, address the problem with these five steps:

1. Explain the importance of posture. Patients understand the significance of posture assessment when you explain posture is quite literally how the body balances, and that balance happens from the bottom up.

When you include the five principles of motion, balance, patterns, compensation, and adaption (see sidebar), patients grasp how posture affects their health.

2. Take pictures. Using whatever system(s) you have purchased, take baseline pictures of the patient. You will refer to these pictures to show improvements.

3. Use plain talk. Use a straightforward “just the facts” approach to describe the biomechanics of posture, and then allow the picture to speak for itself. A simple posture report with geometric lines to explain biomechanics, gives credibility, which is essential to create and build the perception of value.

4. Treat. Develop a treatment plan that incorporates posture exercises and muscle therapy (as needed), along with adjustments.

5. Compare. As treatments and exercises progress, take additional pictures to show improvements.

Steven P. Weiniger, DC, is managing partner of BodyZone LLC, www.Bodyzone.com, the online health resource and referral directory for posture-exercise professionals, DCs, and massage therapists, and PostureZone.com. He can be reached at 866-443-8966 or by e-mail at DrWeiniger@BodyZone.com.

References

1 S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP; Lucy Lennon, MSc; Peter H. Whincup, FRCP, PhD, “Height Loss in Older Men: Associations With Total Mortality and Incidence of Cardiovascular Disease,” Arch Intern Med. 2006;166:2546-2552

2 D. Kado, MD, Huang, DrPH, A. Karlamangla, MD, PhD, et.al., Journal of the American Geriatrics Society, Vol. 52, issue 10, p. 1662

3 Harvard Medical School Adviser, Harvard Publishing, Jan. 24, 2006

4 Janik TJ, Harrison DE, Cailliet R, Harrison DD, Normand MC, Perron DL, “Validity of a Computer Postural Analysis to Estimate 3-Dimensional Rotations and Translations of the Head From Three 2-Dimensional Digital Images,” JMPT, February 2007, pp. 124-129

Are you working in a practice in which you have no ownership — and thinking about going out on your own? Flying solo?

In the course of my travels, I’ve met countless practitioners who quit

employed positions to go solo. For some, it was the best decision they ever made. For others, it was their biggest regret.

What does it take to go solo? Here are a number of traits (in no particular order) that “soloists” consider essential for making a successful “go”:

• Self-confidence and a willingness to take risks. A New Jersey practitioner realized he was chained to a high-volume practice he’d grown to despise. Yet, it was hard for him to leave because going out on his own meant, initially, living on a reduced income.

This “golden handcuff syndrome” keeps many chiropractors from pursuing their dreams.

• The ability to work independently. A solo practitioner has to be able to work independently, without the benefit of colleagues to consult.

As one DC explained, “It’s more lonely and less social than I anticipated.”

• Tenacity. Those who make it on their own don’t have failures; they have learning experiences. They don’t spend a lot of time blaming managed-care networks, insurance companies, or medical doctors for their problems.

They know they always have a choice — a different strategy, a different path to take, a decision to view the unexpected as a challenge, not a crisis. As one practitioner put it, “If it is to be, it is up to me.”

• Goal orientation. Goal-setting turbo-charges your business plan. It forces you to make commitments and reduces unnecessary conflict.

• A willingness to work long hours. That means you need a high energy level, especially at the beginning. “While your family may cheer your decision,” said one DC, “they may not fully appreciate the demands on your time — especially if they’re used to a certain lifestyle. As time goes on, they may get impatient and irritated. Mine did.”

His advice? “Cement family support by having a realistic discussion about the demands of a solo practice, especially one started from scratch, before you proceed. You don’t want constant arguments or questions about when you will start making money.”

• Versatility and a willingness to do things you previously delegated. You must be willing to do clinical and office-related tasks.

To keep his overhead low, one chiropractor recalled being a jack-of-all-trades — clinician, x-ray technician, receptionist, and bookkeeper — until he could afford part-time and, eventually, full-time employees.

• A high tolerance for ambiguity. Many aspects of solo practice are unpredictable. Uncertainty, as they say, goes with the territory.

In addition, a successful soloist should have:

• Management skills. These skills enable you to hire, manage, and retain great employees — the backbone of any well-run, high-performance practice.

• Networking skills. Networking helps establish relationships with primary-care physicians, pediatricians, OB/GYNs, orthopedists, rheumatologists, physical therapists, and other potential referral sources.

• A financial cushion (or bank loan). This should be big enough to carry you until the practice is well established. Numerous practitioners with whom I’ve talked admitted when their income (derived mostly from third-party plans) failed to cover their expenses, it was the “straw” that finally did them in.

As one DC said, “When my husband started asking if my practice had become a hobby, I realized it was time to quit.”

Finally, the last thing you need is luck. Nothing beats being in the right place at the right time.

Flying solo can be scary, and it takes a lot of planning. But, when it works, it can be one of life’s most satisfying and rewarding ventures. “I’m working harder than ever,” said one chiropractor who has been on his own for less than a year. He then added, “I’ve never been happier.”

Bob Levoy’s newest book, 222 Secrets of Hiring, Managing, and Retaining Great Employees in Healthcare Practices, is published by Jones and Bartlett Publishers. He can be reached at b.levoy@att.net.

Should my CA ask for insurance information when a patient makes initial contact with the office?

Many years ago, it was not common to ask about insurance coverage because insurance reimbursement and claims processing were a lot simpler.

Nowadays, it is common to ask for insurance information on the initial telephone call. Most chiropractors who instruct their staff not to ask about insurance on the initial telephone call do so because they do not want the patient to think that all their office cares about is money.

Recommendation: Ask your front-desk clerk to gather the information on the initial phone call:

• Patient’s name, address, and telephone number;

• Insurance company’s name, address, and telephone number;

• Insurance ID/policy number or Social Security number;

• Patient’s date of birth; and

• Chief complaint.

Another important question is, “How did you find out about our office?”

If the patient was referred to your office by another healthcare provider (such as an MD, DO, or another DC) requesting your opinion and advice, you may be able to bill a higher level CPT code known as a “consultation” code (CPT codes 99241, 99242, 99243, 99244, and 99245).

Consultation codes have a higher RVU (relative value unit) and fee range than regular new-patient codes (99201, 99202, 99203, 99204, and 99205) and may be used with new or established patients.

In a consultation situation, the patient is not being transferred to you. Instead, the requesting doctor is asking for your opinion or advice. You cannot use consultation codes, however, if the patient or patient’s family member requests your opinion or advice.

To bill a consultation code, you must perform the same key components involved with regular new-patient codes — history, examination, and medical decision making. Then, you must send a written report to the requesting doctor. Medicare recently clarified that while verbal requests for consultations are permissible, they should not be routine and the communication must be between the two providers, not staff.

When you provide a consult, make sure to cover the three R’s of a consult — Request, Render Opinion, and Report — and document them in the file. Ask the requesting provider for a copy of his or her notes indicating the consult was requested to make sure you have solid documentation of the request. Train your staff members to understand the importance of asking these items. If the front-desk CA is too busy to collect this information initially, he or she should call the patient back to get the information prior to his or her visit. This is a new-patient telephone interview.

Proper new-patient information saves time. When new-patient information is not properly accumulated, financial arrangements can become “cloudy.” It’s very difficult to discuss a patient’s financial obligations when you do not have a clear understanding of his or her insurance benefits and what the patient is expected to pay.

Find out how to take great posture pictures.  Go to www.ChiroEco.com/pictures.

Marty Kotlar, DC, CHCC, CBCS, is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, by e-mail at drkotlar@targetcoding.com, or through the Web site, www.targetcoding.com.