When shopping for a malpractice insurance policy, one of the features most companies will tout is the consent to settle clause. 

Simply stated, this means if you have a malpractice claim against you, your insurance company can't settle the claim without your consent to to so.  It gives you more control over the case to protect your reputation.

But when we talk about looking for value in a malpractice product, this is one area you need to read the fine print and understand what you are buying.

There are a few gotchas commonly found in consent to settle language.  One common loophole for insurers is what's called a "hammer clause."

It works like this. 

Let's say a doctor has $1,000,000 per claim limit.  During the course of the doctor's case there is an offer on the table to settle the claim for $100,000.  The doctor doesn't want to settle because he/she feels they have done nothing wrong and it is their reputation on the line. The doctor does not provide consent and the case goes on to trial.

With this scenario, the hammer clause says that if the doctor does not agree to settle, the maximum the insurer will pay is the amount the case could have been settled for.  So in our scenario, even though the doctor has $1,000,000 in coverage for this claim, the insurance company will only pay $100,000, the amount the claim could have been settled for.  Any amount a jury may award over that amount is the responsibility of the doctor.

If you find a malpractice policy with a hammer clause in the consent to settle language, it should be a cheaper policy...it is less coverage.  However, the question you must ask is whether it is the best value.

Regardless of the size of your practice or the number of employees you work with, regularly scheduled office meetings can be important to your success. Just as large corporations and sports team members meet, huddling with your staff, allows time to discuss strategy and a game plan for your practice/small business.

No doubt, we've all attended meetings that were "snoozers" or simply gripe sessions. However, a well planned, positive meeting with a clear purpose, can be fun, useful, and productive.

Similar to each patient having a specific treatment plan, each office should establish meeting intervals which are suitable to their needs. I know of some doctors who meet with their staff each morning prior to seeing patients. Others gather weekly, while some find that a monthly encounter is suitable to their requirements.

Whatever you establish, stay with your plan, as regularity is important. Here are a few suggestions for your consideration which have worked for me.

• Set and share the agenda with staff and have a specific time allotted for the meeting
• Discuss relevant topics about the office... no griping
• Review new patients since the last meeting
• Provide educational component [specific condition, benefits of a modality]
• Discuss a recent patient and their positive response to treatment
• Set an office goal until the next meeting
• Comments for the "good of the order"

Prior to the conclusion of your meeting, review and summarize what occurred, what decisions were made and what actions steps are required, by whom and by when.

Office meetings can provide a framework for your practice success. Stay positive and Happy Days! and I'd love to know what's worked for you regarding staff meetings. Click on the comment button to share your ideas.

The  impetus for writing this blog was this week's edition of the Boston Sunday Globe section with the headline "Economic Survival Guide." In this article, Massachusetts business leaders were interviewed and asked to give their assessment of the current economic situation.

I do not want to bore you with all of the responses but one the interviewee's comments compelled me to share them with you.

Roger Berkowitz is the chief executive of Legal Seafoods Inc, a restaurant chain with a sterling reputation throughout the eastern U.S. When interviewed he said:

“This is my fourth recession and while each has its own nuances, they all boil down to the same challenge: there are too many seats in any given market and not enough guests. The Darwinian concept 'survival of the fittest' clearly applies. At the end of the day, those of us who are offering great value to our guests will prevail.”

Bingo!

How does that comment apply to every chiropractor ,,, whether you are a start-up, in midstream or preparing for your exit from practice?

Your strategy need not be complex.

You must show a fanatical commitment to your core competencies of:

• clinical and business excellence
• patient centeredness 
• a willingness to collaborate

Have a glowing presence in the community-at-large.

Become part of the fabric of the healthcare community where interprofessional relationships will grow and sustain the practice.

In every moment of truth be authentic and congruent with your words and actions. You may not control the economic trends but you can choose how to proactively deal with it in order to thrive instead of survive.

The last quarter of the year is always a good time to review the equipment in your office for age, quality, relevance and tax considerations. Ask yourself this: how long have you had each piece of equipment?

Many doctors are proud to hold onto equipment for a long time (and get the most out of their money). When a major equipment company launched a program recalling old spring loaded hi-lo's, they were amazed that many of the tables turned in for a refund on a new purchase were 25 years old (or older). The doctors did not seem to notice that the equipment was out-of-date, even though the company was recalling the tables for liability reasons.

Many doctors have an excellent way of keeping things new and enjoying a tax break at the same time.

Let's say that you and your accountant have set up a plan where your equipment depreciates over four years. That means that you can replace about 25% of your equipment each year.

Plus, new equipment offers you many "soft benefits" in addition to tax benefits, including:

It reflects a more state-of-the art office run by a doctor who recognizes that equipment changes can benefit his patients - and his staff.

1. Improvements in equipment design - especially important for equipment you use daily.
2. Your patients will notice that their doctor always has the latest equipment and, even if they don't say anything to you (but they usually do), they will tell their friends when making referrals.
3. Your staff benefits from improved equipment because it helps with patient care.
4. It also instills a sense of pride with your staff that their doctor is up-to-date.
5. You benefit from the image you create of a doctor with the latest equipment.

Start planning now. And if needed, talk to your accountant about your equipment depreciation schedule. Now's the perfect time.

The recent release of the Office of Inspector’s (OIG) 2009 Work Plan states the the OIG will begin increased audits of chiropractic care for maintenance. 

This has prompted several questions regarding "maintenance visits" in Medicare.

How do you know when the case may be maintenance?  Also, are there alternative codes to file when the doctor knows that the care is maintenance? 

A recent seminar indicated that the code S8990 could be used for maintenance care.  Is this true? Mercy Conference guidelines state that two re-examinations that are essentially unchanged indicate MMI. 

Maintenance care with Medicare:

1. Denoted by the manipulation code.  CPT guidelines state that you must use the code that most clearly defines the service you are performing.  The S code only describes a code that is not elsewhere defined.  Therefore, if you are performing a manipulation, you must use the 9894X series of codes to define this manipulation.
2. In Medicare, the AT modifier denotes that this is active care.  It goes only on the manipulation code.  If it is maintenance, then you only put the GA modifier.
3. When appending the GA modifier, it indicates that you have a signed ABN form on file.
4. Maintenance care or non-covered services do not have to be filed with Medicare unless the patient instructs you to file with Medicare (Option One) or if they have another insurance that needs the denial from Medicare to pay.  If the above are not present, then the patient would mark Option Two on the New ABN form and you would not have to file the maintenance care.

With some purchases I make, it is all about the price.  I want the lowest price because I don't perceive any significant difference in quality between the less expensive product and the counterpart with a heftier price tag.  Canned vegetables, for example ... I think the generic isn't significantly different from the brand name.

But when I shop for other items, like a car, computer, or television, it is all about the features, price and the overall value.  The lowest price is not always the best value. 

Many people think about insurance in the same way I view canned vegetables.  However, this is a product where value is the key, not price.  Insurance is unlike other products we purchase because we don't ever want to use it and most people don't really understand exactly what they are buying.  As a result, the lowest priced option is many times very attractive.

The problem is that not all insurance policies are created equally.  It is in your best interest to read the fine print and be an educated consumer.

Malpractice insurance for example. 

Most products on the chiropractic market appear similar in scope and coverage.  What's the difference between the policies and how do you find the best coverage?

In my next few blogs, I'm going to look at some different features to examine when you are shopping for malpractice insurance.  When I visit the chiropractic colleges, I hit on these topics and hope these blogs will help refresh your memory and be a useful tool when shopping.

Please comment on the blogs with your experiences when shopping.  It is always interesting and instructive to hear what consumers are experiencing in the market.

In the midst of adjusting patients, reading x-rays, marketing, patient education,etc. It can be tempting, if not necessary, to delegate certain tasks to your staff and walk away.  While some tasks can be forgotten once assigned, don't let insurance coding and documentation become solely your staff's responsibility. 

I'll share a personal experience from a recent seminar hosted by my state association.  This was not for C.E. credit and it occupied a beautiful fall day when I could think of many things to do besides sit in a stale room all weekend. 

But there I was, because my gut told me I needed to be there.  

This seminar topic was coding and documentation for Medicare.  In case you haven't noticed, Medicare is changing their rules and if you want to be paid (or want your patients to be reimbursed for you non-assignment doctors), then you better sign up for training camp! 

I looked around the room and saw many doctors standing near the exit waiting to make a run for it, while their CA's filed in the conference style tables with notebooks in hand.  Anything wrong with this picture?  

This seminar was teaching us how to document and code to get paid!!!  Why were the CA's more concerned than the DC's?

Rumor from my collection of DC colleagues across the country is that many state association are hosting Medicare information classes to educate doctors on the changes of this federal program.  Don't want to play with Medicare you say?  Ok, but remember that today's baby boomers are tomorrow's Medicare recipients - and that's a large percentage of the population, (a.k.a. potential patients).

My point is simple.  While coding may look, smell, and sound like 'staff responsibility' you are putting yourself in a dangerous situaton.  You are held liable for what is on those insurance forms and everything in every file.  Like it or not, proper documentation and coding is part of this job.  

In closing, I encourage you to consider attending the next CA seminar you hear about. You just might learn some good stuff!   

In fact - post a comment on this blog and share what you've learned. 

In my last post, I talked about whether you have a "waiting room" or a "reception area." Here are a few of my recommendations for keeping on schedule:

• Get to your office at least 30 minutes prior to the first appointment.  You will see that the majority of your patients will be EARLY for their appointment so why not start off ahead of schedule? There are days that I see my first 3 patients prior to when the first one was even scheduled! In a 3-4 hour shift you are bound to get behind...so why not buy some time? Make sure the staff understands this concept as well.
• If there is a patient who you know will take extra time and they tend to get you behind schedule (and we all have a dozen or so of them) make sure the front desk schedules them appropriately.  Sometimes, I will even walk to the front desk and tell them where to schedule my "special" patient or do it myself.
• Review the appointment book prior to starting hours so you are prepared and even prepare the front desk with special instructions when necessary.
• Make sure that the front desk is not grouping patients together so they can get out early! I always remind the CA's that we have SCHEDULED OFFICE HOURS and will be here for those hours with or without patients so you might as well spread them out and fill in appropriately....not grouping patients will leave room for that EMERGENCY or the occasional "walk-in" patient. Most of the time, patients who are "crammed in" will cause you to run late and chances are you will be there to the end of your SCHEDULED OFFICE HOURS anyway doing paper work or what not, except you had to deal with patients who were irritated and inconvenienced! My favorite question from a patient when I was behind schedule... "What makes your time more important than mine?"
• DON"T BE AFRAID TO ANSWER THE PHONE YOURSELF..wait until you experience the astonishment of the patient on the phone when their doctor answers the phone and schedules them...personally. Now that gives the impression of being busy and doing what it takes to stay on schedule!
• Going in early, staying late or working through the lunch or dinner hour every once in a while never killed anyone.  Patients will appreciate the extra commitment on your part to ease their pain and anxiety....talk about holistic medicine!

These have helped keep my "reception area" from becoming a "waiting room."

What works for you? Leave me a comment and share your thoughts.

Hiring and training staff is perhaps the most important process you undertake to have a successful practice.  Doing it right can lead to tremendous profits. Making mistakes can quickly sink you into bankruptcy.  No pressure...

Humans have a fascinating memory system.  We tend to remember three things about any one particular event:

The other day a patient came into my office and before he even sat down, the CA at the front desk said, "We can take you right back if you're ready."

When I got to the treatment room where, he asked me if I was having a slow day."No." I responded .."Why do you ask?" "Well, the waiting room was empty and they brought me right back". 

In fact, it was a pretty busy day!

Maybe it was all of the waiting on tables or bartending during my school years, but I hate to see people wait!  Granted, sometimes there is not much you can do with emergency patients and other unforseen delays but appropriately scheduling patients can prevent getting behind schedule.

Many physicians in my area have a lousy reputation of making people wait for an hour or more.  I guess this gives the perception of being really busy. But when you routinely make people wait that long, how long before it becomes more annoying than impressive?

At what point is it time to re-evaluate your office procedures for scheduling patients?

Post a comment here and give me some of your ideas of how to keep a reception area from becoming a "waiting Room" and in my post next week I will share my secrets with you!