Serve, and Grow!

Getting your good name out, and keeping it in front of the public is a must in starting and growing a practice! Chiropractors are known for being willing to serve their communities, and hope that in doing so; they will see that their community supports them as well. A wonderful and SIMPLE idea to serve and have your name in front of the public is to offer spinal screenings for children, at no charge of course! You don’t have to pack up and take your staff to the local school and perform screenings to an entire elementary school! Instead, follow the formula below and you will be offering a rewarding service that will be appreciated throughout your community!

• Have your staff member who is in charge of advertising, search for any and all “community service” bulletins in your area. This includes local television, radio and newspapers that offer a FREE listing service for anyone who is offering a service at no charge to the community. Have her call and get the email addresses or fax numbers or other required way to submit your ad. Prepare an Outlook category with all advertisers and the proper email addresses for the ad to be submitted to everyone in one click. Make sure that she asks how often you will need to resubmit your ad. (If you are doing it monthly, weekly etc. at a set time, will you need to resubmit it each time?)
• Pick a set time, “every Tuesday from 3-4,” or “The 2^nd Thursday of every month from 3-4″ and mark it on your calendar. (3-4 is a good time because many parents are picking up their children from school at that time.) Make sure that the doctor will be in the office during that time, at every set date! This should be promoted in house as well as to the general public. It should be included in your own calendar of events every month! Your staff should tell everyone that has children, or grandchildren about this service! Explain the difference between being screening by a spine doc., instead of the school coach etc..
• Prepare an “ad” *that states the necessary information on your offer. Make sure that you make it clear that there is NO CHARGE, and explain that a parent or guardian must be present and that you want the child to bring his or her backpack and/or purse when they come in. (Make sure you follow any applicable state regulations on disclaimers etc. for “Free” offers.)
• Set it up as a “backpack screening.” That is, have your C.A. be scripted to explain that “our screenings are a bit different than those your child may have had in school. We ask that you have your child bring in his backpack, with the “normal load” that he carries in it daily.” When the child comes in, after doing the usual scoliosis screening, do a posture analysis against a mirror, on a S.A.M.S. or similar unit or have a grid on your wall in your adjusting room so the parent can see the results. Do the analysis without the backpack, then of course have them put it on and recheck. Bring up any points that you notice. After this, ask the child (if age appropriate) or the parent “does he experience any headaches or leg/neck/back pain etc.” A great way to get a discussion going on the parent’s health is to ask “do any of these symptoms run in the family?” “Oh I see, he is having regular mid-back and neck pain; is this something that other members of the family have experienced? Is there any history of arthritis or other joint condition?” You can see where that discussion goes. If applicable, correlate any perceived connection between the load he is carrying with the symptoms and explain “good backpack habits.”
• Keep the screening brief. Have a handout available* for the parent and child with recommendations on backpack safety. Make sure you have information on your clinic and assure the parent that you are always available if they have any questions or need to recheck.
• If the child is having any symptoms, urge the parent to follow the same guidelines as their dentist teaches and come by for another screening in 6 months. You can have your C.A. casually ask if they would like to put the child on the screening appointment calendar, so that you can call and remind them in six months. (No pressure! Just something to help them keep track if they want to.) Offer to let them come back for one of your patient education nights or other clinic event if they seem to want to know more. Do not pressure in any way to become a patient unless they ask!
• Make sure that you get the parent’s email address and other contact information.
• Keep a file of all screenings and properly document all findings and family history etc. Make sure that you follow up with emails on children’s health, and the other symptoms that the child may have been experiencing, as well as any that the parent listed when you asked about family history.
• At the six month point, call to ask if they would like to bring him back in so that the doctor can check to see if there is any change in the findings that were present earlier. No pressure!So there’s a simple way to serve and open up a channel that will be one more way to get and keep your name out in the community!

Practically Yours,

 

PracticalCA

*A sample ad and a “Backpack Safety” screening handout are available at no additional charge for our “Premium Content” subscribers.

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Proper Documentation, It’s Not Optional!

I was recently involved in a discussion with several D.C.s who were discussing some documentation issues when one doctor chimed in “that’s why I am all cash, I don’t have to worry about documentation issues.”

Why is proper documentation considered optional for Doctors of Chiropractic? This issue has been plaguing the profession for many years, and while many D.C.s cry “discrimination” when talking of all the burdens the medical establishment, insurance companies and public perception has heaped upon the profession, D.C.s need to realize that at least some of the blame lies with them because of the history of shoddy documentation within the profession.

We know that historically, some of the chiropractic colleges had a greater focus on teaching proper documentation, though most are improving their curriculum in recent years; we still have to realize that there are many doctors who graduated before there were any real standards of documentation taught. Others may have had the opportunity to learn it while in school, but figured it wasn’t going to apply to them because they didn’t want “that kind of practice.”  State licensing boards have been inconsistent in requiring regular C.E. credits on documentation and in monitoring D.C.s documentation practices.  The ACA recently sent out a release urging the licensing boards to get involved in the much needed push for the profession to raise the bar on its collective documentation practices. Siting the 2005 OIG study “ which was based on a random sampling of claims data from 2001, concluded that 67 percent of the claims examined as part of the study contained documentation errors or omissions that led to what the OIG considered to be inappropriate reimbursement under Medicare.”  While most of the patients likely received care that meets the “medically necessary” standards,  the fact that the doctors couldn’t or didn’t provide the adequate documentation to justify “medical necessity” means that the doctor is putting himself at risk for having to defend himself for receiving reimbursement for treatment that in the OIG’s eyes, is not medically necessary.  (You can read the ACA release by clicking here.)

Whether it’s because the main focus in school is the miracles that can be a part of a D.C.s life, or the fact that many who choose to go into the field shun the medical look or “feel” to their practice; whatever the reason, many D.C.s seem to forget that they *are* a part of the healthcare field, and by choosing to treat patients, they must abide by certain standards of practice. This is not optional. The need for proper documentation of care in a practice has little to do with the collections method. Whether you are a cash practice or you accept insurance, there are still minimum standards of documentation that must be met on all patients.

So maybe you don’t think that you need good documentation to collect from a patient. You are all cash, so you don’t have to worry about having to justify treatment to an insurance company. You may even choose to do as some docs do: document one way on cash patients, and another on insurance – not a good idea! You still need to realize that you are contributing to that patient’s medical history. This patient may not have insurance today, but they may apply down the road and list something that you treated them for as a pre-existing condition. What will you do if they request your records? What if a patient of yours has an accident, or files with Disability down the road? Will your notes make or break your patient’s case? What if you have chosen to not properly assess and document the patient’s history, subjective and objective findings, diagnosis, treatment, progress and release? A patient, who entrusted you with part of their healthcare, has a right to expect that your records will document that portion of their health history and the care that they received.

Don’t get lulled into believing the hype that with an all cash practice, you are safe with poor or irregular documentation procedures. While you may not have to worry about compliance to insurance participation contracts, this does not mean that there is no oversight. Your State Board, the OIG and of course local authorities still have the option of coming and requesting an audit. The rule of thumb is that if it isn’t written, it didn’t happen. What will you do if your patient challenges the charges at some point? You didn’t record any times in their charts, yet you are charging them for a timed modality? You don’t have notes to justify the level of E/M code you charged for their examination. What if there is a malpractice suit against you? Will your notes exonerate you, or be the cause of your demise? Sometimes, chiropractors are like teenagers; they act like “nothing bad will happen to me” and so they choose to ignore the fact that they could one day be audited or investigated and decide that they will not document properly.

The good news is that it isn’t too late to learn or sharpen your documentation skills. In future posts, we will review some good documentation sources, and explore how to get your staff on board to conquer the documentation Goliath in your office! This will be a giant step in helping you to be compliant, and also helping to move the profession forward in an area where it has been lacking in the past.

Practically Yours,

the PracticalCA

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The Patient Walk

How many times have you found yourself looking at a person as they walked by and noticing them as a perspective chiropractic patient? “WOW! She has a high left shoulder, probably from carrying her handbag on it.” “Look at his forward neck carriage; he must get headaches a lot.” “That guy’s wallet is so thick, that must knock his pelvis out of line every time he sits down!” Why do you see this while others will not? Well, you are seeing them through the eyes of a Doctor of Chiropractic, or a CA who is obviously good at what she does. You see with your perspective and notice things that other people may not ever see, unless it is a gross deformity.

So you are picking up on things that you, through your perspective, have trained yourself to watch for – or ignore. We can do this in many different ways. A mother will notice things that might hurt her child, while she is able to block out other things, like that child banging away on a toy hammer. Our unique perspective allows us to view the world around us in a manner that we tailor to ourselves.

How does this affect your practice? When was the last time you walked through your practice and saw through the eyes of a patient? Things that to you or your staff may be “necessary” or one of those things you’ll get to “one day” may be seen as clutter, chaotic, messy or worse to your patient, or prospective patient. Not to mention clutter contributes to lower employee morale and productivity. It definitely affects your office energy, Chi or whatever you want to call the “flow.” I’ve seen clinics increase their stats by 1/3 or more in a single month and the only change that they made was doing a walk-through and getting the clutter under control!

Start at the door the patients come through and walk through your building following the path that a normal new patient may take. Is your office clean? I mean, you may *know* the cleaning staff has been in recently, but what does it look like to a patient? Is the carpet well worn? Are the chairs in need of replacing or recovering? What else do they see? That cute phrase you printed out and posted unframed over your desk, that box of face paper that sits under the hall table, the stained grout in the tile, all of these things you have learned to tune out, but a patient will see and it may cause him or her to make an unfair judgment on you or on your practice capabilities. What does your CA workspace look like? Is it neat and orderly, or are papers jammed all around in stacks that take time sorting with each paperwork request? Do you use your office to do Reports of Findings or consultations? What does it look like? Are your Diplomas and certificates well framed and hung up or do you have them tacked up with thumb tacks? Is your desk organized or does it look like you could work for a month and still not be able to see the Mahogany finish underneath those many stacks?

The patient walk is an important tool in keeping your practice patient ready at all times! A quick walk should be done twice a day! Once in the morning, and again when you return after lunch. The quick walk is to make sure that you are ready to see patients for the next few hours. Check the bathroom, (these should be checked several times a day depending upon the volume of your practice.) Check all of the patient rooms, stand in front of the CA window/desk and of course walk through the waiting room and pick up those magazines and anything that is amiss. The OM should be the one to do this if possible. Make sure that the patient walk is on your “Daily” (list of all responsibilities for everyone on staff) and list it as both a morning and afternoon responsibility.

Once a month, do a full patient walk to evaluate the state of your facilities. Use all the senses when you do this.

• Hearing: make sure that PHI is not being revealed to other patient’s as a CA talks on the phone to verify insurance. Or when a doctor does an exam or pre-adjustment evaluation and asks the patient for their subjective information. Can you talk to a patient about financial issues in a private manner? Is your patient comfortable talking to you about their symptoms, questions or concerns? Are you sure? I spoke to a chiropractic patient just this week who said that her doctor has a much too open setting and she is not comfortable going over what she needs to. She is thinking of looking for a new doctor, because she wants to be able to discuss her symptoms and ask what she needs, out of the earshot of other patients. Not to mention, if she is being overheard, then this is a HIPAA violation.
• Visual: Of course look for the clutter, the area in need of repair, the dirt…but also look and see if your practice is appealing, clean and orderly. Make sure that you are HIPAA compliant as far as files and paperwork not being available to patients standing around work areas. If a patient can see it (well enough to read) or is close enough to touch it, it is a HIPAA violation.
• Smells: Of course evaluate for odors as well. Not just from being unclean, but if you are close to say, a nail salon make sure that you have quality air purifier to remove the toxins and the smell. There are also wonderful electric diffusers that you can purchase and use good aromatherapy oils with. Peppermint is soothing and pretty universal in its appeal. Or you could choose from citrus or other mild oils. Steer away from flower scents as these may affect people with allergies.
• Aesthetics? Is your office comfortable, relaxing and inviting? Is there plenty of space in the hallways so that two people can comfortably pass down the hall at the same time? What do your patients see when they are sitting in your waiting room chairs? When was the last time you sat in your waiting room chairs? Are they easy to get in and out of? If you haven’t updated your patient waiting room chairs lately, realize that many of the newer models are larger and accommodate a wider range of patient sizes. This may prevent a potentially embarrassing situation should a larger patient not be able to find a chair that fits. What about your patient adjusting and therapy tables? Are they always clean? Even down in the face slot…and under the face paper? If you are a single doc. office, you may not have had the opportunity to lie down on your own tables for a while. Try it out. Face down, face up and see how they feel. Is it time to recover or replace?

In short, take a critical look at your office and do it regularly. Then, get to it and make the needed changes. Start today with your full-office Patient Walk, seeing it from the patient’s perspective and make a list of what needs to be cleaned, replaced or reconfigured. Next make a plan to take care of the most critical issues first, and then go down your list from there. It’s even good for two or more of the staff to do it together, as one person’s perspective will be different from the next. Make sure that this task is added to your daily list and that all staff members are on board as to the importance of seeing through the eyes of the patients, not just their own eyes.

 

Practically Yours,

PracticalCA

The Open-Ended Phone Call

Isn’t awkward when you follow recall procedures and call to check the status of a patient who missed an appointment, and they don’t call you back? So now what do you do? You already left a message with your name and the office number, but they haven’t called you back. So now what do you say when you call again when you are unsure whether or not they got your message, and maybe just ignored it?

Here’s a PRACTICALtip; always leave an open-ended message when you call. Rather than saying “please call me back at this number…” leave a message that says “please feel free to call me at 555-1212, as soon as you can. If I do not hear back from you by Wednesday, (no more than 2 days) I will be checking back in.” This will make it easier to call them back if they have not responded. They know that you will be calling again. Make sure you note the call in your recall or tickler file, and FOLLOW THROUGH!

Practically Yours,

PracticalCA

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The role of the Chiropractic Assistant

The Chiropractic Assistant, or CA, is one of the most demanding and unique healthcare jobs around!  Heck, it’s one of the most unique jobs around PERIOD! What a WONDERFUL position! What other job allows you to be a witness to MIRACLES each day as you see each patient’s quality of life improve?!

The average chiropractic office typically has 1 or 2 employees who serve in this role and by definition; they are to assist the chiropractor in his or her daily responsibilities of running a chiropractic office. A Practical CA understands their responsibilies and takes them seriously. A Practical CA has an understanding that the best thing that any staff member can do, is to strive to ease the stress of the doctor by making sure that the office runs as smoothly as possible.

The typical CA job description may look a lot like the list below, with more or less,  depending upon how the practice is set up and how many staff members there are. These responsibilities are often divided up between 1-3 people:

• Greet Patients
• Handle Scheduling
• Front Desk Collections
• Manage Patient Flow
• Janitorial Duties
• Babysitter (doctor’s or patient’s children.)
• Marketer (often with very little marketing experience.)
• Cheerleader (keeping the doc happy, and the patients happy too!)
• Doctor/patient liaison
• Insurance coding and billing
• Collections
• IT Responsibilities
• Administrative Assistant for Doc.
• Therapy Application
• Patient Education
• HIPAA Compliance Officer
• Human Resources Manager
• Customer Service Rep.

Since most chiropractic offices are typically a one doctor office, with one or two staff members, the chiropractic assistant must truly be the “Jill-of-all-Trades.” She should be flexible, knowledgeable and able to learn quickly. There is no other position anywhere, like that of a chiropractic assistant.

While the chiropractic colleges of the United States may do a good job of turning out doctors who are ready to adjust spines, they often fall short in teaching the skills that the doctor will need to run a successful practice. To make matters worse, there are few consistent, reasonably priced resources to help train doctor and staff and keep up with the many changes in the rules and regulations of the profession. States vary on their policies and procedures, insurance companies vary on theirs. State associations can help, but they often vary in their accessibility. Doctors usually rely on other D.C. friends/associates to get information, or they take whatever *facts* the many seminars or PM groups teach (with little oversight.) Never knowing for sure if what is being taught could potentially cost them their license, or worse; land them in prison.

There are many different types of chiropractic practices. Some offices mirror the look and the feel of a medical office. But more often than not, D.C.s shun the “medical” look, and want their practices to have a less traditional medical feel. In foregoing the medical feel of a practice, they often forego understanding and compliance of laws and regulations that they must abide by. Because of this, they are putting themselves and their staff at risk for penalties, fines and even prison time! Couple this with sparse chiropractic assistant training and certification, the average chiropractic office often has many issues of non-compliance in areas such as:

• HIPAA Training and Implementation
• Fair Credit Act training for collections procedures
• Participating insurance plans compliance
• Medicare compliance
• Federal inducement bylaws

While many practices do recognize the importance of seeking out and utilizing CA training resources, most fall into a trap of choosing to not spend the time or money making sure that their staff is well-trained. Whatever their reasons for this: high turn-over, lack of available training resources, cash-flow problems or other, an under-trained staff will affect the patient’s experience in your office. It also will affect the practice’s bottom line. Quality training is an invaluable resource in the office. In addition to reducing the likelihood of experiencing a compliance issue, it will ease the stress of all involved, patients, staff and doctor. Most importantly, a well-run practice will help the doctor to be able to focus on the important tasks at hand; patient cultivation and care.

In subsequent posts, we will explore a variety of issues that the chiropractic office staff may experience. We will in effect, be your Virtual Chiropractic Assistant with a goal to ease the stress of both staff and doctor.

Practically Yours,

PracticalCA