Active Care Model, Diversification To Drive Successful Practices
In today’s fast-paced, competitive business environment it is imperative to stay informed of the trends that will directly affect your practice and the way you will do business in the decade ahead. Tempus Fugit. Time flies. The half-life of your knowledge base has shortened to five years. This means that everything you knew five years ago, the way you ran your practice, the way you hired and managed your staff, and the way you cared for your patients, is now a defunct paradigm. It used to be that the half-life of your knowledge base was a decade, but in the age of technology, the clock has sped up. Thus, you must reinvent yourself and your business every half-decade (or less), or risk being left behind.
History is your practice’s worst enemy. To think about the future, you must abandon tradition and convention. The rules of the game have changed. The business you are in is no longer the sweet, soft, gentle business that it was in the decades of the ’80s and ’90s. In order to survive and achieve the practice success you deserve, you must fundamentally change the way you run your practice. What doesn’t work anymore? Gimmicks do not work anymore. 1990s-style reports of findings do not work any more. It’s hard to believe, but there are still doctors attempting to deliver three- and four-day reports of findings. In the era of managed care, you must be efficient at delivering your message on day one. You must become an expert at creating perceived value in the eyes of your patients from the first handshake on.
Active Model Of Care
The primary trend of the decade ahead is moving further away from the passive model of patient care and closer to an active model of care. The paradigm of passive care is now defunct. In the active paradigm, your patients actively participate in the healing process. The passive model is one where patients lie passively and receive treatment modalities applied by a physician or therapist.
Active care means giving therapeutic procedures a role in your patient care plan. The definition of a therapeutic procedure is, “a procedure applied one-on-one by a therapist or physician to improve function.” The operative word in this definition is function, since the language of the active paradigm, and hence the language of third-party reimbursement, is function. Therapeutic procedures, including kinetic activities, activities of daily living, therapeutic exercises, neuromuscular re-education, and gait training, should appear in your treatment plans. By employing therapeutic procedures and learning the language of function, you will be adopting the most powerful paradigm of the new decade.
The next trend you will confront is the need to master the tools of reimbursement. A comprehensive understanding and ability to correctly use CPT and ICD-9 codes is essential. Your insurance claim forms are printed in red ink, not because it is an attractive color, but because those claim forms are optically scanned by a computer.
The language in which computers communicate is numbers. A mastery of these numbers will allow you to communicate what it is that you have done and at which level you should be reimbursed — not to a human being, but to a machine. You must know how to code for what you do, and how to appropriately apply modifiers to those codes, to receive the level of reimbursement that your patients deserve.
Active care is outcome driven. The next trend is one of effectively employing outcome assessment tools, such as the Oswestry Questionnaire, Neck Disability Index, Visual Analog Scale, Symptom Diagrams and others. It is not enough for you to get your patients well and to return them to normal health; you must also prove you have done so. These tools allow you to effectively establish and communicate functional goals for your patients’ care. How you document the improvement of your patients’ ability to perform their activities of daily living establishes the medical necessity of your care. Your documentation drives reimbursement.
Objective Diagnostic Testing
According to the American Medical Association, “all injuries should be documented via computerized, objective diagnostic testing.” This powerful statement drives the next trend in outcome assessment. Adding objective diagnostic testing, in the form of neurological and musculoskeletal diagnostic tests, to your plan of care provides the documentation that insurance carriers are demanding. The practice of the future will be one based upon documentation through outcome assessment tools and objective diagnostic testing.
Consolidation And Diversification
Consolidation and diversification may appear at first to be divergent trends. However, on closer examination, both strategies will be important aspects of practice success in the decade ahead. The first trend is consolidation. Approximately 30% of medical physicians are in private practice. The group medical practice has become the most common model for the practice of medicine. This trend is now becoming more prevalent in the practice of chiropractic. Chiropractors across the country are finding safety in numbers. They believe that consolidating services in the form of joint practice is a more cost-effective, stable manner in which to deliver healthcare to the maximum number of patients.
The trend of consolidation is visible in the increasing prevalence of multi-disciplinary practices across the country. A decade ago, multi-disciplinary practice was a luxury and an interesting adjunct to a chiropractic practice. Multi-disciplinary practice is no longer new, is no longer radical, and is no longer a luxury. The trend of multi-disciplinary practice consolidation extends beyond the combination of physical medicine services under one roof. Multi-disciplinary practices in the future will include multiple healing modalities, including nutrition, therapeutic massage, acupuncture, and other disciplines. This trend is most appropriately referred to as diversification.
A diversified, consolidated practice will require the chiropractor to take on a greater entrepreneurial and administrative role. While the chiropractor of the past decade focused primarily on patient care, the chiropractor of the future will focus primarily on the effective orchestration and delivery of multiple types of services in a cost-effective manner. Employing professional coaches and consultants such as a practice management consultant, a financial planner, a diagnostic testing firm, a billing specialist and a marketing specialist will allow the chiropractor to more effectively assume his or her new role.
In the decade ahead, chiropractic philosophy will continue to move toward the forefront of healthcare. Those practices that master combining a subluxation-based chiropractic practice with a multi-disciplinary setting will become the predominant force in the delivery of non-crisis healthcare. By embracing medical and alternative health-care professions in a multi-disciplinary practice setting, chiropractic will change the way in which the country has embraced chiropractic as a healing modality.
The increased access to chiropractic care provided by forward-thinking chiropractors will contribute to the shift in the percentage of the country’s population who receive chiropractic — from the approximately 10% who currently benefit from chiropractic, to the 90% who do not necessarily think poorly of you as a chiropractor, but who simply do not think of you at all.
What’s next? As we progress through the decade ahead and beyond, what additional trends await us as a profession? A careful examination of recent legislation that will have a profound impact on how healthcare is delivered in this country provides the answer.
The current level of unemployment in our nation is at one of the lowest levels ever. Practically the entire country is employed. In addition, the adoption of several key pieces of legislation will affect how our nation’s workforce will receive their healthcare. Foremost, there has been a tremendous focus on creating updated ergonomic standards for the workplace by the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA). With anticipated new legislation, mandatory requirements will be placed on industry to deliver healthcare, ergonomic training and workplace safety, with steep financial penalties for noncompliance.
Those doctors who become proficient at post-offer employment screenings, functional capacity evaluations and the cost-effective care of workplace injuries will be at the forefront of this trend. The mastery of active treatment protocols, and objective documentation through computerized diagnostic testing and outcome assessment tools, will directly affect your ability to effectively function in the health-care marketplace of tomorrow.
The American Disabilities Act (ADA) and pending OSHA legislation will change the way all of us practice. You must act now and prepare for this new era, so that as these changes sweep across the nation in the months and years ahead, you will be positioned to capture the lion’s share of this extremely valuable market.
To paraphrase Charles Dickens, these are the best of times and these are the worst of times — to be a chiropractor. The trends that are moving ahead at rapid speed are all in alignment with this powerful new paradigm for chiropractic. You must focus your attention on mastering these new trends. The future has arrived, and the time is now for you to invest in the new paradigm as a part of your over-all success strategy.