December 2008

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Guest Editorial: Debunking a cash practice myth

By Dr. Peter Meinhofer

As I have traveled around the country, many doctors that I have spoken with have the misconception that creating a cash practice will excuse them from proper documentation. Their belief is since they are not submitting claims to third-party payers, that they are not required to meet the standards that are dictated using the S.O.A.P. or P.A.R.T. formats. This myth must be addressed in order to protect both their patients and their assets.

While I believe that all of these doctors are providing the best of care for their patients clinically, I also believe they may be doing their patients a disservice that is inexcusable. As professionals we are required to have good records regardless of the patient’s payment method, and there are multiple reasons why we should want to do so.

As doctors, our records are a way of tracking what is happening for that patient from visit to visit. Your notes aid you in assessing patterns of subluxations, create plans for follow-up visits, and record methods of treatment. These records can also be beneficial for associate doctors who step in and care for their patients or in the event of selling a practice.

Without detailed notes a patient’s medical records can become more of an obstacle than a help.  In the future, that patient may have an accident or a work injury and their chiropractic care record will be part of that person’s overall medical history, and can have an impact on their settlement. Poorly documented notes may be the difference between a patient winning or losing their case.

Requests for notes can also come from organizations other than third party payers. State boards and other regulating agencies can request a review of a doctor’s notes on a number of occasions. One of the most common reasons for an audit is a complaint from a patient. When a doctor’s notes are scrutinized it is with the understanding that “if it is not documented, it didn’t happen.”

Lastly, I believe when a patient entrusts their care to their chiropractor, it is with the expectation that a good record is being kept on their behalf. If a problem with their records were to occur,

The fact is…that in this current climate of healthcare, a doctor’s best way to bullet-proof his or her practice is to be as thorough as possible in taking notes, and this includes cash only patients. You have the tools available to produce a professional note; from the simplest form of travel card/hand-written notes or dictation/transcription, to the ultimate solution of an EMR software system. Each tool has its own benefits and drawbacks to consider:

• Travel cards and hand-written notes get the job done; however they are quickly becoming a relic with the advanced technologies available today. Creating a S.O.A.P. format note on a travel card or in a written file is time consuming and will draw more requests for resubmission and audits. Because of these drawbacks, this is the least recommended option.

• Dictation and transcription will create a quality non-canned note that is produced in your voice and personality, but comes with great cost to your wallet and your staff time. When you factor in the time it takes to record, prepare, submit, and organize patient notes, this process will quickly become a perpetual practice headache.

• The preferred (and my favorite) method to a quick and clean note is with Practice Management & EMR software. There are many software programs available with a varying degree of technologies and costs, so you’re guaranteed to find an application that will meet your needs. Some software companies have made it tremendously simple to create a quality non-canned note in a fraction of the time it takes using other note methods.

 I recommend an integrated system that will combine the various applications and data needed to reduce practice overhead and increase overall efficiencies. This streamlined integration will actually help the process of quick and reliable noting. With so many options to help you produce detailed notes, there is no justification to challenge the need for producing well-documented notes for all your patients.

Dr. Peter Meinhofer is a customer sales representative for Integrated Practice Solutions, the makers of ChiroTouch; a complete chiropractic practice management software system designed to make your job easier and your patients’ experience better.

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