A Call to All C.A.s (And the docs who support them.)

I recently received a letter from the ACA (American Chiropractic Association) telling me that my membership will be revoked after August 31, 2008 unless I “associate” with a doctor who is a member. To be honest this was quite a shock. The ACA is a great resource for profession related news, publications and seminars etc. In all fairness to them, I was simply a “chiropractic assistant” member. I didn’t pay $600.00 per year, as do doctors or vendors who wish to join. However, since I am a chiropractic assistant, I joined as a chiropractic assistant. Someone within the organization realized that I was able to use the same resources that the doctors who pay $600.00 per year use, thought this wasn’t *fair* and brought it up with the membership VP and they decided to revoke my membership and that of any other chiropractic assistant who has a similar membership. They are now eliminating the chiropractic assistant fee, and plan to offer a “complimentary” membership to those C.A.s who wish to use their doctor’s memberships. This is frustrating to me, and I have begun a dialogue with other chiropractic assistants and even doctors and find that many feel as I do.  The ACA had just recently enlarged their chiropractic assistant’s resource area.

There are many chiropractic assistants who choose to be “career” C.A.s; that is, they may move from doctor to doctor at times, but stay within the profession.  There are others who feel that regardless of whom they work for, they want to have control over their professional memberships.  Is it right to have to rely on someone else for such an important resource? This could appear a bit discriminatory in nature as most C.A.s are female, while the majority of doctors are male. But I am sure that this was not the intent. There are C.A.s who work remotely often with more than one doctor, and so which doctor should provide her a membership? As I began to investigate I realized that there are many state chiropractic associations that have a similar structure. They, like the ACA, have great resources available for the C.A.s within their jurisdiction, but they limit the membership to doctors but allow their chiropractic assistants to use the benefits as an attached member. The disturbing part of this is that chiropractic assistants need to have the ability to obtain these resources on their own. Each C.A. needs to understand the rules and regulations of the profession independent of any doctor for whom they work. I am urging you all to do this. This is why I started this blog. Know your state’s rules and regulations so that you are compliant. Urge your doctor to be compliant with the rules and regulations of course, but most importantly, you do it! How can we be compliant if we are denied access to the resources? What if we are associated with a doctor whose dues lapse, or they decide they don’t want to join *that* association, or for some other reason are not a member. Simply put, we need to be able to have our own membership if they offer C.A. resources for anyone.

I have written a letter to the ACA, and have collected letters and signatures of support. My suggestion is to offer a standalone membership within any national or state organization that has chiropractic assistant benefits available. I proposed that the standalone membership fee be reasonable, but fair. We will not get referrals or have voting rights, but we will have the ability to use the resources, attend seminars and buy products at a reduced rate. I proposed something along the lines of a fee approximately ¼ of the doctor’s fees since our average salaries run at approximately ¼ that of the average doctor’s salaries.
I am still waiting to hear back from the ACA, and I have every confidence that they will in fact allow some form of standalone membership if they realize that we are serious about this. I am in the process of forming a committee of chiropractic assistants who are willing to work to see that chiropractic assistants get the benefits that we truly need with any organization that has C.A. resources available, at a fair price without the need to associate with a doctor. If you would like to help, whether to simply sign a letter of support, or in some other capacity, please contact me at practicalca@practicalpracticing.com and stay tuned to this site for more on this story.

And I will go one step further and urge all C.A.s to join and support your state and national associations where you have the opportunity. Stop by http://practicalpracticing.com/default_files/CAresources.htm as I will post an organization list that offers national benefits for chiropractic assistants. You can help by contacting your state’s association to verify the types of memberships that they offer, and I will add them to the list.

Thanks for all of the support! Please feel free to share your comments and thoughts on this story in the comments section.

Practically Yours,

the PracticalCA

Who’s In Charge?

“Can the doctor see me at 1:15 tomorrow?” “Sure!” So you have a patient scheduled in during the time that you are usually taking lunch. Why? “We scheduled her then because that was when she wanted to come in.” This is the answer that I usually get when I ask why they scheduled a patient during non-patient time. My next question is always: “who is in charge?” Learning to take control of your appointment book is the first step in managing the all important patient flow. Often when a practice is new, or in need of growing, the doctor is willing to see the patients when they are available, and there is little method to the scheduling procedures. This is not a practical way to run your practice.

Look at your appointment book; do you have staff meetings scheduled? What about marketing time? Do you have SCHEDULED paperwork time for both your staff and doctors? When a patient calls and asks “what are your hours” what do you answer? These are some critical points to consider when setting up your front office procedures. The practical way to handle your appointment book is to first establish the difference between office hours and patient hours, within your practice. While a practice may be open or “manned” from say, 8:00 a.m. to 6:00 p.m., this does not mean that you could or should see patients during any and all of those hours. For a practice to run effectively and for staff and doctor to properly handle all of the supportive tasks that come from running a practice properly you need to have clearly defined patient time, as well as time for all of the responsibilities that must be done. Scheduling is one of the most important systems in a chiropractic office! If you would like a step-by-step module for setting up your practice schedule, then click here: http://practicalpracticing.com/default_files/coursecatalog.htm

Motivational Musings

I always talk of the chiropractic profession being one of the most unique of all health care professions. While most M.D.s can expect to work in group settings for their entire professional lives, many D.C.s work as the lone doc with one or two C.A.s. Some are fortunate to practice in areas where there is a close-knit network among the local D.C.s. However, it is more common to see a doctor practicing in an area where they have limited opportunities for positive interaction with their brothers and sisters in the profession. Most doctors I’ve spoken to feel that this affects their ability to stay *up* and inspired while performing the day to day operations of a single doctor practice. There are some steps that the chiropractic assistants and the doctors can take to reduce the isolated feelings and help stay motivated in between even the most motivating seminars.

• Remember to set attainable goals for staff and doc. Review these goals regularly and revise as needed. Often goals are not met because they are not truly made a part of the plan of the practice. Write your goals down, and then write how you plan to reach the goal and each staff member’s part in it. Share these goals at your staff meetings and realize that it will take a team effort. I often see C.A.s who are given a charge to meet a really far-reaching goal, but were given no plan to do it. So, set your sites high, but make sure that you each have a part in the plan and are able to work together to reach your practice goals.
• Regularly assess the entire staff to make sure that positivity is the goal for the office! We all know how one bad apple can spoil the whole bunch. Everyone on staff needs to do regular self-assessments about the level of negativity that they may be carrying within themselves, as well as sharing with others. While venting (an occasional moment of blowing off steam) is necessary for everyone at one time or another, regular negative comments or attitudes with anyone on staff has an effect on the entire practice. If you find that after following the recommendations for helping to stay *up* one or more members of the staff is still having a hard time, it may be time to reconsider whether he or she is the right *fit* for your practice. If a C.A. finds that she is working for a doctor who is consistently negative, share this post with him or her, and let them know that you are committed to helping to develop a more positive work environment.
• Get involved with local, state and national associations. This is an important step in feeling a part of the bigger picture of chiropractic. Additionally, it’s important to be a part of your state association so that you can stay up on the ever changing rules and regulations that vary state to state. Make sure that you attend as many local events as you can, and go with the intention of finding like-minded D.C.s with whom you can network. Get your C.A.s and your spouse involved in the events and it will make it more likely that you will be able to connect with others.
• Plan community service campaigns! Serving others is the quickest way to forget your own trials and tribulations! While you may not be working with other chiropractic professionals in the community, working alongside people who are willing to serve, while seeing people in situations that are typically much worse than anything we may experience, can help both D.C. and C.A. to reap the rewards of serving their fellow man. Organize regular community service campaigns and involve your patients as well. Calling the principle of your most needy school, and asking for needs that are not covered with the usual community events is a great way to get involved with your patients and the entire community! You’d be surprised how many principles are aware of children who need the very basics; shoes, coats, school supplies, clothing and more. Keep an ongoing list and have a regular campaign to cover those needs. This is just one of many similar campaigns that you can organize as a staff. Regularly check the community calendar of your local newspaper to find events that your practice can be involved with. Anytime you help to build a sense of community, the isolated feeling that many feel in this profession can be lessened.
• Plan your seminar attendance to include motivational seminars! As you set your C.E. seminar calendar, make sure that you are seeking out meetings that will be motivational and inspirational. While it is understood that some of your needed credits will be in areas that are of a more technical nature, make sure that you budget your seminar time to include regular motivational gatherings as well.
• Make sure that you are going over your patients’ progress in regular staff meetings! Does your staff share the miracles with one another in regular staff meetings? C.A.s are you keeping up with your patient’s progression? Are you sharing the little positive comments that your patients give to you, back with the doctor and other staff? Does your office keep a miracle journal; a place where you record the miracles that occur with your patients? If you don’t, begin today! The great thing about keeping this journal is that you will find your staff will begin to focus on looking for the miracles that are occurring each and every day in your own practice! State laws vary on displaying patient testimonials, so check with your state association or board to find out what you need to do to post any within your practice or in patient literature. Make sure that you consider the HIPAA regulations as well*, and if your state and HIPAA rules are different, follow the most conservative of the two. Even if you are not interested in using the *miracles* in promotional materials at this time, the value of these for helping staff and doctor to stay on purpose; focused on the great benefits of chiropractic care, is worth the effort. If you do a brief staff meeting in the morning before patient time, then go over at least one miracle and remind everyone that “today we will see miracles!” Challenge everyone to find at least one miracle a day. These don’t have to be total cures from an incurable disease; miracles can be small, but make a big difference in the lives of your patients. “Mrs. Smith slept through the night for the first time in 2 years.” “Joe E. said that he went the entire week without a headache!” With each small miracle, staff and most importantly, doctor, can be reminded that the reason that you are here is to be a healing conduit. Get excited with each miracle and of course keep these in the journal. All miracles, big and small, need to be entered as well, and one C.A. needs to be in charge of making sure that your miracle journal is kept current. All staff members need to be a part of this. And entries should be shared at each staff meeting.

It takes a concerted effort on part of both chiropractic assistant and doctor to keep your practice a positive place for staff and patient. Make that part of your goals, to build a place where positivity and healing miracles are shared regularly, and you will see that it is easier to stay focused and positive throughout the year!

Practically Yours,

The PracticalCA

*If you need help with the HIPAA regulations and how they apply to your practice, check out the HIPAA 101 course that is beginning August 15^th in the PracticalCA’s classroom. Watch our site for more information. http://practicalpracticing.com/default_files/comingsoon.htm

Veto “Vetoed” By Congress

Worries are over! President Bush’s veto of the Medicare cuts has been overridden by congress. For all who were holding claims for the 10 business day period, it is now safe to send them in, since as of tomorrow the hold is released. For more information, click to read the story here: http://www.reuters.com/article/topNews/idUSWAT00979420080715?feedType=RSS&feedName=topNews

The Medicare Rollercoaster Ride Continues

AP is reporting that Bush plans to veto the bill that was passed last week rescinding the across the board Medicare cuts to all doctors, this afternoon. A senior spokesperson in the Bush camp, speaking on condition of anonymity because the veto has yet to happen; states that while the President is not against the doctors getting the proper compensation, he is concerned about how the legislation was written to finance the doctors’ pay. Congress is expected to quickly override the veto. Stay tuned to this site for more information as it becomes available.

the PracticalCA Breaking News

Good news for all docs! The Senate passes the Medicare bill! Senator Ted Kennedy made a showing in the Senate today, for the first time since he was diagnosed with a brain tumor, to spearhead the campaign to rescind the impending across-the-board cuts in Medicare reimbursements.  Click the link below to read the Washington Post story online!

http://www.washingtonpost.com/wp-dyn/content/article/2008/07/09/AR2008070901884.html?nav=hcmodule

To Fee or Not to Fee

That’s often the question! Should you charge for copying a patient’s record? If yes, how much should you charge? As a general rule of thumb, it is not recommended to charge a patient for a copy of their records, so long as it is no more than once a year. With the new HIPAA regulations, a patient is allowed access to their medical records and some are collecting them once per year to keep up with their own medical chart. If an attorney requests the records for a Personal Injury case, or if the state or other third party entity requests a patient’s records, then most offices do charge. Can you set your own fees? Yes, within certain limits. Here’s a link to help you determine what the legal limit is in your state for records copying fees. http://www.lamblawoffice.com/medical-records-copying-charges.html

Practically Yours,

the PracticalCA

The PracticalCA News Desk

Good news for all physicians (at least for the time being!) A nearly 11% across-the-board cut of Medicare payments to all physicians, including D.C.s, was temporarily held off when the Department of Health & Human Services Intervened. They requested a 10 business day freeze on processing any Medicare claims effective July 1^st. This will hopefully give Congress a chance to take care of business and get these impending cuts reduced or eliminated. By requesting a processing freeze, this means that no claims will be processed at the new (lower) rate until at least July 16, 2008. Keep this in mind when you are submitting any of your Medicare claims that there may be a bit of a delay. Stay tuned for more information on this story that affects all in the medical field! If you would like to read the Washington Post article, click here.

An article that every chiropractic staff member needs to read, and discuss among the staff! We’ve all heard the bad press recently about the risk of chiropractic cervical adjustments and strokes. If you have had patients who have expressed concern, or had questions, hopefully this will ease their minds. Read this Press Release from the ACA about a new study that shows that patients are no more likely to experience a stroke after visiting a D.C. than they are when they visit their medical doctor! Click here to read the release and make sure that all of your staff is aware of this great news!

PracticalTip: Medicare Reminder

Something to remember when you have a patient who comes in as a cash patient; or under private insurance but later becomes eligible for Medicare. When you enter the new insurance information, make sure that you check to see if the name you have been using prior to Medicare days is the same as what is on their card. You must have their name entered just as it is on their Medicare card, to prevent the claim from being rejected.

Example: a patient comes in and fills out paperwork as “John M. Doe” and this is what you have them listed as in your computer; and it was acceptable for their private insurance claims. However, their legal name is, and the Medicare card reads “Jonathan Mark Doe” you must file under the eligible name. An incomplete or incorrect name is a common reason for rejected claims with Medicare.

Another PracticalTip from the PracticalCA!

For more in depth Medicare information and much more; subscribe to the “Premium Content” edition of the PracticalCA weblog. With tips, forms, tutorials and more – all you need to have a Perfectly Run Practice! Check out http://practicalpracticing.com/default_files/subscriptionlinks.htm or email me at: subscriptions@practicalpracticing.com.

PracticalCA Tip: Assessing a True Chiropractic Emergency

“Is there any way the doctor can see me NOW?!”

The emergency call; something that most D.C.s are prepared for and willing to do, but how do you really determine which call is something that you should jump in the car and run to the clinic for, as opposed to it being a patient who simply expects the doctor to change his or her schedule because they are not willing to change theirs when they need a visit? How do you know for sure that this is a true chiropractic emergency and it warrants bumping another patient back, coming in on off-days or staying late etc.?

I remember one call many years ago, when the patient called and said that she was “really in pain, could the doctor see me today (Sunday)?” My husband explained that I was out of commission with some health issues, but if she really needed it, he could see her at our home. She said “Yes! Please!” And she came over, and interrupted our family time. By the end of the visit, when she said something to the effect of “Sundays just work for me,” I realized that this patient was not a true chiropractic emergency, but that she simply had not wanted to reschedule her “busy calendar” to come in during normal business hours. It was then that I realized that it would take only one quick question to assess the true chiropractic emergency. And with it, the patient would never even know that they are revealing what is really going on.

“How long have you been hurting?”

They may say; “I woke up this morning and could hardly get out of bed.”

Or you may get; “I’ve been hurting for 3 weeks now, been meaning to get in for a while.”

So which one are you going to rearrange your schedule for? The person who had an onset of today, or one who has been hurting for three weeks and finally decides to call you on a day that you are not seeing patients? The fact that this patient has been hurting for a while, and has been holding off coming for weeks, means that their visit does not warrant emergency treatment. Of course there are exceptions to the rules; “I’ve been out of town for the last 2.5 weeks just gritting my teeth until I could get back to see you.” Of course, that would be a different situation. Just take a moment to listen to the patient and you should quickly be able to determine how to handle things. If you determine that this is not a true chiropractic emergency, simply tell the patient that “the earliest the doctor will be available is tomorrow at 9:00 a.m., can I put you down on the schedule?”

Remember, YOU need to be the one who controls YOUR schedule. While there are true chiropractic emergencies that doctors should be ready to handle; most of the time the patient is the one who needs to adjust their day, to make time for a visit during true office hours!

 

Practically Yours,

 

the PracticalCA