Students - are you ready for post graduation? 

During school, you'll be focused on evaluating and treating patients.  But there's so much more to know before you graduate! It's important that you are diligent in those studies, too, and to find out what it takes to begin practicing.

Here are a few things that I consider the basics for starting up in practice:

• insurance panels
• NPI numbers
• health insurance claim forms

Ahh,insurance.  In my opinion dealing with insurance companies will be necessary for most, if not all future D.C's.  If you have plans to run a cash practice (and not see Medicare patients), great, but you'll still want to read further just in case your plans change.  If you see yourself participating in any insurance panels here are some things to consider:

• Don't wait until the last second.  Start getting information on the major insurances you will need to participate in for your area. Asking other doctors in your area or your state association. Be sure to look into non-participating and participating benefits - you don't have to be a participating provider to see patients with a certain insurance, just know ahead of time how the benefits will differ. 
• Every practicing DC must obtain a national provider identifier or NPI.  You can do this as a student at https://nppes.cms.hhs.gov. Make sure you remember your used ID and password!  Also remember that if you will be forming a separate entity (LLC, corp., etc) you will need an additional group NPI.  You will use these numbers for communicating with insurance and malpractice companies - they are a necessity!
• Another important number in your future is the Tax Identification Number or Employee Identification Number (TIN or EIN).  When planning for my practice, I consulted a lawyer to help decide what entity would best suit my future practice.  For reasons too many to mention, he recommended an S Corporation also called Professional Corporation (PC).  He also filed for my TIN.  This was a help because I knew things were getting done properly.  I do believe in keeping things simple but this whole process was fairly painless and in the best interest of my practice.  
• Learn how to accurately complete the Health Insurance Claim Forms.  This was very new to me.  This form is necessary if you plan on submitting claims to insurance companies by mail.  This form has to be filled out with precision or you will be denied until it is filled out correctly.  You can go online to find out the proper way to fill this form out or call the third party payor directly. But beware, not all representatives from the third party know what they are talking about when it comes to filling out the HICF form properly.  Submitting claims electronically is not hard and there are many benefits for doing this.  If you take only one thing from this blog, I recommend becoming well-versed ins submissions of electronic claims and electronic funds transfer (EFT).

Ask around, don't be afraid to ask for help. And if you get an opportunity to shadow a chiropractor, ask to see how billing works in his/her office.  A little work now will go a long way.

Right across the street from where I live is a quickie-mart type of a gas station. Each time I pop over there to pick up a small item I have forgotten at the grocery store, I am greeted by a young person who, no matter how busy they are, always stops to say, "Hello. I'll be right with you."

Their warm smile makes me feel welcome, even though they do not know my name. When I ask for something, they come from behind the counter to show me the selection.

What strikes me as being very different at this quickie-mart is that it is rare to find good, honest, happy staff of all ages who actually enjoy or at least seem to enjoy their jobs. No matter the time of day or the staff at this store, I always receive the same consistant service. Plus, I always see them working on cleaning the store, stacking the shelves, etc., when no other customers are in the store.

I shared this story with my husband who, until I told him about the experience, had never gone into this store. From that day on, he started stopping at the store on his way to work each day.

He, too, noted that the staff on duty were always pleasant ... and always working. When he finally asked a staff member why they seemed to so like their jobs and why they were always so busy - the answer surprised him.

The staff member said that the owner of the store, when hiring the young man, explained that this job could be the first step to his dream job, if each and every day he provided good service to their customers.

The owner also told him that people watch what he does and if he wanted to advance to an even better opportunity, he need only show his best face every day. The staff member told my husband he wanted to go to college and get into communications, but with no job skills this job was where he had to start.

He was determined to do his best in front of potential bosses.

Not long after this conversation, my husband hired this young man who now has a college degree and is in communications. Subsequently, my husband hired two more people away from this store, much to the delight of the owner, who understands that the attitude of service is the most beneficial way to get ahead.

So, when looking for staff, look no further than your service stations, your fast food stores or your retail giants. A happy, helpful clerk who offers good service with a ready smile might just be the staff person with a "can do" attitude you've been looking for!

Throughout my years of practice, I've always had a yellow page advertisement. We've run the gamut of ads from the large full page display pieces to small in column listings. Most recently, we've had a small advertisement and, despite it's diminished size, it's still been quite costly.

In preparing for next year's book, my office manager met with a salesperson. It was recommended that we increase our ad size as a means of improving our placement, at a substantially greater cost.

I balked and quite frankly almost "choked" at the proposal and asked to meet with the salesman. An appointment was scheduled and two individuals representing "The Book" came to see me during the following week.

I was shown several colleagues' advertisements, all which were much larger than mine, as well as many of the "bells and whistles" which could be added to the product. After listening to the pitch, I shared my  personal perception that many consumers no longer use the yellow pages to find doctors.

And I questioned its value to my practice.

My premise was naturally challenged and one of the gentleman even asked the dreaded, "Do you really want to maintain and possibly increase your practice?"  This sparked some interesting banter and conversation.

In our office, we track our new patients and their origin of referral carefully. While the yellow pages at one time was an excellent resource, its effectiveness has been diminished by savvy consumers, managed care networks and the Internet. While chiropractors and other professionals continue to utilize the medium (sometimes because they're afraid not to),  I strongly recommend that you track your "return on investment" as you should any ad or promotional tools.

And by the way.... after going through the exercise and discussion with my friendly salesmen, they "upgraded" me -- from an "in column" listing to a much larger display ad. And they included many add ons - at no additional cost.

So it does pay to ask!

Happy Days!

Have you said to yourself, “Maybe I should hire someone to help me.” 

If so you are probably working at capacity and looking to do one of several things:

• get some time off
• increase your practice volume
• increase your practice income
• position yourself to become more visible in your community 

Each of these items are similar but very different. If you want some time off, you essentially are hiring someone to work your practice while you take some time off. And, you and are willing to pay for your time off by paying the individaul you hire. 

A fair trade of dollars for time ... and this can work if that is what you are looking for. 

However the individual you hire may have different ideas than simply putting in hours and collecting a paycheck (some may not). 

So the first thing you need to ask yourself when you feel the need for some help, is quite simply, "Why am I looking for help and what do I want to achieve?"

Once you have honestly answered those questions you can begin the interview process and be in a position to fully understand and convey to your new hire what your expectations are and that will help to ensure that both you and your new hire are meeting each others expectations.

Read more on other aspects of hiring in a future blog.

In a previous blog, I reported on the new wave of "MinuteClinics" in CVS.  Well, it's here...and the statistics are very interesting.  The first two clinics have opened in Massachusetts with license applications in place for 26 more including services in WalMart stores. 

But here's something you may not know...it's about the billing, collection and participation with the patient's insurance company. 

As you know, these clinics are staffed by nurse practitioners, not doctors.  On average, the charge the patient's insurance company $59 for most visits.  They are approved to treat 39 conditions including strep throat, ear infections, sinus infections, insect bites, minor burns and rashes.

The Massachusetts secretary of health and human services stated that the biggest non-financial barrier for patients is hours of operation (not cost!).  She further stated that "most providers are open 9-5 when people are working or their kids are in school. 

Being open beyond those traditional hours and increasing access is drawing people to these MinuteClinics.  If you haven't done so, read Dr. Vincent's latest blog...it talks about this very thing! 

And guess what else...the President of this CVS subsidiary said their demographic studies and catchment area studies showed that this model will work! 

Now, my point is more direct and not about the concept of the in-store clinics...it's about the fees. 

Re-read my comment above... FIFTY NINE DOLLARS...yes, billed to insurance where possible but FIFTY NINE DOLLARS is the fee. 

And people are gladly PAYING IT. 

Why?  Because they are getting the services they want and need.  It's that simple. 

Having spent a lot of time with students who are either about to or have just graduated, I know it is hard for some of you to put a realistic value on the services you render.  Do you not think YOUR service is worth $59?

Think again. 

Be sure it isn't you who puts up the barrier to collection of a fair fee.  People will pay for what YOU and they mutually value....if you don't believe me, go to one of these clinics and see for yourself.

Not too long ago, doctors were advised to schedule office hours in the 9-5 mode.  Well, times have changed with consumers who have entirely different expectations! 

The demands of the workplace and lifestyle activities demand that you creatively apply marketing principles in order to provide your patients the features that they want. 

Be mindful that it is all about convenience.

Demographics and a survey of people in your catchment area will reveal the hours that best meet the consumer's needs. 

A great example of patient-centered office hours belongs to a DC friend of mine who practices in the heart of Cape Cod, Massachusetts.  There is a large retirement population on the Cape and as it is with many retirees, they are early risers.  With that in mind, he starts office hours at 5:00 a.m.  He always finds his patients waiting for him at the door...often with a hot cup of coffee for him in hand.  Later, he found that other patients (particularly in the labor trades) also preferred to schedule their appointment prior to going to work. 

By ending his day at 2:00 p.m., he was able to pick his children up at school and spend valuable time with them.  As time progressed, his office hours were from 5:00 a.m. to 7:00 p.m.  His associate doctor saw patients from 2:00 p.m. to 7:00 p.m. and also worked Saturday mornings giving the office the most comprehensive hours in their catchment area and beyond.

What office hours have you discovered work best in your area?

Discover how you can serve the unique needs of your community and dare to do it!

We've all heard about doctors and even chiropractors who have "no bedside manner." Patients and the public at times wonder how some of them are so successful. Frequently their clinical skills are excellent, but often a major component of their success is a great support team and staff.

One of the most important decisions we each make is hiring those who work with us. While we each possess different needs based on our practice type and personality, certain key traits and characteristics should be considered as you assemble your "dream team."

Over the years, while in school and following graduation, I've had both the pleasure -- and at times displeasure -- of working with many  individuals. They've come in all sizes, shapes, backgrounds, and varying intellectual capabilities.

While interviews, recommendations and a "gut sense" are all important, a few of the unique traits which I look for when hiring are the following:

• Attitude - I've always heard that "attitude is altitude." Being positive, enthusiastic and friendly pay great dividends in any setting. Most people and patients want to be in an uplifting environment. I'm always impressed when I've called someone, and while I can't  see their face, I can tell by the inflection in their voice that they're smiling.
• Work Ethic - Hard work, commitment, and the ability to multitask  can often overcome a lack of experience. A person who is dedicated to their tasks can usually be trained.  In fact, many doctors would rather train their staff to perform in a specific manner to suit the offices needs and requirements.
• Responsible - Those that will assume responsibility and take "ownership" are a great asset to any organization. As we all know, many employees are "nine to fivers." I 've tried to instill in staff that it is  everyone's responsibility to insure each patient has an excellent experience.

Having a committed staff who share your goals is quite a challenge. It takes hard work and certainly a bit of luck. One "rotten apple" can ruin the chemistry, but if you establish parameters and criteria, and continually refine and train your team, I'm sure you'll be very successful.

Happy Days!

The best advise I can give to you whether you are just starting out or 40 years post graduate: take every precaution to make sure the care you're providing isn't misunderstood or misinterpreted. 

Unlike many other health care professionals, chiropractic care is very "hands on."  As a DC, than means you have to be especially careful with all of your patients to avoid anything that could be interpreted as inappropriate touching. 

Unfortunately, in today's litigious society, it's important to err on the side of caution in case a patient might think your contact was inappropriate.  Even the lightest touch, even it if is unintentional, should be acknowledged by an apology. 

For example:

• If you brush up against your patient while helping him or her turn over
• You lean over a patient who shifts position at that moment and briefly touch in an inappropriate place or manner

It might not seem like a big deal to you...but the most important thing you can do is apologize. 

Right then, no delay. 

There's no need to make a big deal about the event, just acknowledge it, and reassure them it was an accident and will not happen again.

Err on the side of caution. 

How have you handled situations like this?

Here are some simple questions that you can use as an indicator of how well your practice is doing. 

1. How many husbands and wives do you have?
2. How many children are in your practice?

The reason is equally simple. If either spouse is coming to you for care and the other is not, it may indicate that you may not be doing an adequate job of explaining the benefits of chiropractic care for the family. 

Additionally when both are coming for care, there is a vastly different attitude about chiropractic which is positive and supportive because both understand the value proposition of what chiropractic health care brings to their family.

The children issue is very simple.  To parents, their child is their most priceless possession. If they entrust you with the care of their child, you have earned their confidence for many other health decisions.

Take a look at your patient list. Is there room for improvement?

I have the unique opportunity to not only have a large practice, but I also teach part-time at Logan College and teach throughout the United States for NCMIC and Foot Levelers. In my travels, I meet many highly qualified doctors, student and staff.  However, I wonder where everyone else is hiding?  Where is their enthusiasm that they had as students still in school? 

The biggest threat to the chiropractic profession is, in my opinion, ourselves. 

Research has been released over the last decade that further supports what we do.  Insurance companies, legislation and the medical profession want to contain and eliminate the chiropractic profession.  This is nothing new.  After all, this is what we, as a profession, faced when Chester Wilk D.C., et al filed the lawsuit against the AMA. 

What is different is the "fire in the gut" that our colleagues had at the time. 

As President of the Illinois Chiropractic Society and a board member, I have seen the apathy virus continue to invade our profession. 

Have we had it too good? 

Older doctors have a better established practice.  The younger doctors seem to be uninvolved, until it comes to learning how to make their practice more lucrative.  They need to realize that the only way to build a practice is to polish every facet.  Whether it be continuing education, political action committee, involvement in their state society or involvement in their national association, this helps to enhance their practice.

In addition, we must be vigilant in public education.  Research shows that manipulation of the spine leads to improved performance and decreased deterioration.  This must be communicated to the public.  Become involved in your community!  In our technology age, the Internet, websites, television and radio and civic and church meetings are all outlets for this information. 

Apathy within the profession is the best friend to our enemies.

What do you think?