I was recently asked at a Starting Into Practice workshop what types of insurance are needed after graduation.

There are several insurance considerations that need to be made prior to practicing.  Many of the considerations will depend on whether you open your own practice or practice as an associate.

A good resource to use is the NCMIC Starting Into Practice Guide, pages 183-188.  The guide can be accessed through the Starting Into Practice website:  http://www.startingintopractice.com/Resources/Forms/Default.aspx

Here are some of the insurance coverages you will want to consider:

• Malpractice Insurance:  Should be purchased immediately regardless of whether you are starting your own practice or practicing as an associate.  Purchase malpractice insurance as soon as you are licensed.
• Business Insurance:  Purchase immediately if you are starting your own practice.  This insurance will provide coverage for your building (leased or owned), your business personal property, general liability, and usually includes extra expense and/or business interruption coverage.  If you enter into a lease, be sure to examine the insurance requirements very carefully to be sure you are covered properly.
• Workers' Compensation:  Purchase immediately if you are starting your own practice and you hire employee(s). 
• Bonding (sometimes called employee dishonesty):  Purchase as soon as possible if you start your own practice.  This coverage protects against fraudulent activities of employees (example – embezzlement).
• Disability Insurance:  Purchase as soon as possible whether you start your own practice or practice as an associate.  If you sustain an injury or illness and cannot practice for an extended period of time, this coverage will assist by providing a portion of your earnings to help with expenses.
• Health Insurance:  If you start your own practice, you will want to purchase this as soon as possible for yourself and possibly your employees.  If you are practicing as an associate, check to see if your employer provides health insurance.  If not, you’ll want to purchase this as soon as possible.
• Umbrella Coverage:  If you’ve started your own practice and have purchased business insurance, an umbrella policy provides an additional liability limit in excess of your general liability, business auto, and potentially other lines of insurance.
• Life Insurance:  Purchase as soon as possible. If you are starting your own practice and are securing a loan, the lender may require that you obtain life insurance so the debt can be paid off in the event of your death.

The above list may not cover all of your unique exposures.  The best thing to do leading up to graduation is to find a reputable and knowledgeable insurance advisor who can help you put together an insurance plan. 

It will help your advisor if you’ve put together a solid business plan outlining your practice path, whether that is opening up your own practice or practicing as an associate. 

NCMIC does have a staff of experienced insurance advisors who can assist you with all of your business insurance planning! To find out more about business insurance available through NCMIC, click here.

In the chiropractic community, we are in the midst of Homecoming season!  Many colleges host Homecoming celebrations during the summer months.  June through August, NCMIC will be attending seven of these events at colleges across the country.  More to follow in fall months, as well.

Why do I bring this up?  As a student or new graduate, the Homecoming events present many opportunities to you.

• Networking - What a great opportunity to network and share ideas with your colleagues!  The events not only provide the venue to reconnect and make new aquaintances, but you have the opportunity to discuss challenges and opportunities in your practice.
• Products and services - Most of the events feature exhibits.  You can peruse the latest products and services available to the profession.  Many vendors offer show discounts, so you can save money on things you need to buy anyway!
• Support your college - These events are important to the college as well as current and future students.  A strong showing at the events makes the college stronger.  Good for students and good for the profession.
• Continuing education - And, yes, you get CE credits for attending!

So, while you are getting your CE credits, you also get other great benefits and support your school.  I know you can get many of your credits online, but nothing replaces the fellowship and opportunities presented by the in-person, live meeting.  Our colleges do a great job planning and presenting their Homecoming events and they are worthy of your support.

Hope to see you at your Homecoming this year!

Over the years, many practice consultants have espoused different methods to develop a successful practice. I've personally tried many including mailers, spinal screenings, newsletters, radio and TV, yellow page advertising, patient appreciation days, public lectures, sponsorships and so on.

While each of these activities can and have been beneficial for some, it's my opinion that you must "own" and be comfortable with the methods that you use and that they suit your personality.

Quite frankly, performing a spinal screening at a mall or flea market, or giving a "wellness workshop" at a drug store is not how I've wanted to build a practice or portray myself in the community.

Those venues and endeavors can be "home runs" for some, as they provide access to many who previously may not have been exposed to the benefits of chiropractic care.

Whatever your technique or marketplace, building a successful practice involves time, talent, treasure, effort and energy.

Personally, I've been most comfortable and successful by developing professional relationships while being involved in community activities.

Being engaged in clubs, joining organizations and initiatives which are important to the betterment of my region has been the cornerstone and success of my practice. Whether serving on a Chamber of Commerce committee, walking neighborhoods with a political candidate, building a Habitat for Humanity House, or volunteering to aid the needy, each of these activities has provided access to like-minded and diverse individuals who I've nurtured and established long standing relationships with and who've played a part in my success.

These relationships have been built on trust and communication and by consistently saying what you'll do...and then doing what you say. By doing so, you build credibility, support and an environment for sharing as well as friendships.

As I look back and reflect on the "ways of the world," relationships assist in all businesses and organizations.

• My first job as a child as a babysitter was as a result of a referral from a family member.
• Students often obtain letters of recommendation for colleges and fraternities of their choice from those who have been a part of those institutions in the past.
• Employers frequently fill "prized" job positions with those that they know or through recommendations of those that they trust.

Building bonds of trust generally takes time and is also about sharing common interest and values.
Most advisors and consultants will recommend that whatever your project, whether building a practice, club or organization ....have specific goals. Know where you will want to go.

It may be simple or include very specific steps, but having a clear picture will assist the process. Reaching out to those who we know and those who have knowledge of our talents is a great place to build and cultivate professional relationships.

These supporters can further your development by specific referrals and by also introducing you to their network of friends and colleagues. And don't forget, it's a "two way street" of assistance and it is always important to say THANK YOU to those who assist along the way.

Building a practice is much like any important aspect of life. It takes time, effort and energy. Building relationships is based on mutual trust, doing the right thing and communication.

It's been a productive mode for me as it's been fulfilling both from a professional and personal perspective. Whatever your method, work hard and be dedicated to your practice, patients and profession. Happy days!
 

Hopefully by now you’ve heard about Medicare’s Electronic Health Record Incentive Program – also known as the “Meaningful Use Rule.”

The rule establishes incentives for health care providers to obtain and use certified electronic health records (EHR) technology.

The Medicare program allows for a maximum possible incentive payment of $44,000 over five years. These incentives are intended to help health care providers offset a portion of the cost of purchasing, implementing and using certified EHR technology.

But before you can begin receiving payments (the first ones went out the week of May 23, 2011), there are several steps to work through.

The first is signing up for a Provider Enrollment, Chain and Ownership System (PECOS) number. To get started, click here or call 866-484-8049.

If you’re not sure whether you have a PECOS number, click here

If you have questions about the process, contact your Regional Extension Center at www.regionalextensioncenters.com. There are 62 RECs throughout the U.S. to help answer questions from registering for Meaningful Use to receiving funds.

When disaster strikes close to home, it serves as a reminder to be thankful.  With the recent tornadoes of the Midwest and South,  we were reminded once again of all we have to be grateful for.  When the dust settles, one can't help but wonder...what if? 

Do you have a plan for emergency weather in your area? I realize this varies depending on the climate of your region, but a few basics apply to all situations.

1. Awareness - TV, radio, internet.  Pay attention to what's going on around you.  I was amazed to see a woman walking by with a stroller just minutes before the golf ball size hail and 70mph winds arrived.  
2. Power- I have a habit of waiting until the light blinks before reaching for charger cords - not anymore.  When the power went out, I was grateful to have a charged smartphone and laptop with me. 
3. Shelter- Where will you go?  Most of us have a plan at home, but what about at work?  I now know that the bank next to my office has a basement in the event of future tornadoes.   
4. Exit Plan  - We are fortunate to have fabulous meteorologists in our area and this time we had plentyof notice.  Because of this, we rescheduled patients and sent employees home that afternoon.  If you don't live in "tornado alley" you may not appreciate this, but here in Oklahoma - when the weather man says get ready to get below ground - we listen!
5. Basic Essentials - Food, water, flashlights, batteries, work gloves, spare clothes?  What might you need to survive in a shelter for a period of time?  

I am happy to report our office and the homes of my family and employees were spared.  However, it did get us thinking...what if?  There are others nearby who weren't so lucky.  

We are currently investigating data recovery options and other improvements to our emergency plan - for the proverbial 'next time'. 

As the saying goes... "an ounce of prevention is worth a pound of cure."

The Department of Health and Human Resources published its final rule on Jan. 15, 2009 mandating the transition into the International Classification of Diseases, 10^thEdition (ICD-10) for all covered electronic transactions for dates of service on and after Oct. 1, 2013.   The Centers for Medicare and Medicaid Services has made it abundantly clear that there will be no grace period for the transition into ICD-10. 

The World Health Organization first began the implementation of the ICD-10 codes.  Its goal is to create a world-unified set of codes for diagnosis and procedures.  It has been a long-time coming.  As an example, Great Britain transitioned into ICD-10 in 1995.  Even Canada went to ICD-10 in 2001.  In the entire world, the United States is the last to transition.  It will happen! 

Several courses, including those taught by myself, have begun to expose providers and staff to the ICD-10 implementation.  Many take the attitude that 2013 is two years away; I will deal with it when it comes.  These doctors have their head in the sand. Preparing for the largest health care change in the United States is not a flick of the switch.  The claim form, software programs, staff training and yes, doctor training will all have to occur before October 1, 2013. 

Any claims filed after October 1, 2013 with ICD-9 codes will be rejected.

Action Steps:

1.  Organize

Organize those responsible for ICD-10 implementation in your practice and begin a team to learn the codes, form transition comparison tables of the codes and hold in-house staff training.

 2.  Learn

Along with the new ICD-10 codes, documentation supporting these codes will have to change.  The ICD-9 classification has about 65,000 codes, although only about 70 codes are used in the chiropractic profession.  In the ICD-10 classification of codes, there are over 155,000 codes.  The variation of codes is staggering.  Much of the reason for this great expansion is due to the fact that ICD-10 codes are more specific than anything we use today.

For example, if we compare the ICD-9 and ICD-10 codes, you can see the vast difference.

The difficulty arises when you convert the ICD-9 code for cervical sprain (847.0) to the ICD-10 codes, the ICD-10 now becomes two codes.

ICD-9-CM 847.0 converts approximately to:

• 2011 ICD-10-CM S13.4XXA Sprain of ligaments of cervical spine, initial encounter

Or:

• 2011 ICD-10-CM S13.8XXA Sprain of joints and ligaments of other parts of neck, initial encounter

Note the specificity in the code descriptions. When comparing the codes in this manner, it is important to consider what the documentation will need to reflect in order for the doctor or a coder to accurately select a code.

 3.  Implementation

Those who wait to prepare for the conversion will certainly have a delay in payment.  Some entities are actually encouraging providers to take out a loan to prepare for the delays!  Training can easily be the largest part of any ICD-10 implementation budget. It is important that as early as possible a training plan is developed.

Avoiding ICD-10 will only make the transition more abrupt and costly for the office.  Physicians, practices and facilities that do not adequately prepare for ICD-10 risk not getting paid for the services they render. The best advice is to start implementation planning now, the longer it is put off the harder and more costly it will be.

“For tomorrow belongs to the people who prepare for it today”

HOW to market. WHERE to market. WHEN to market. WHY market. These are just some of the subjects discussed when considering the topic of marketing for your practice.    

Marketing has changed so rapidly in the past 20 years that it is almost impossible to comprehend how fast things are changing.  

Not long ago, THE YELLOW PAGES, were the key with large ads, then bold type, then full color etc. and today if an analysis were done (and it probably has) YELLOW PAGE advertising would rank near the bottom for effectiveness.

That is the point of this blog. Marketing should be targeted regardless of how much money you have. This is especially important when you're just starting out the budget is usually very lean. 

Today it is almost mandatory that a website is one of the earliest items on your TO DO LIST.  Make the website easy to navigate once patients access the site.  Be truthful because not only will patients have access but so will every attorney, regulatory board, insurance company, bank and others parties who are finding out about you. 

It is important that your website be up-to-date and that there are no old numbers, data, staff photos of long-gone employees, or outdated information about you.  Websites that you can modify and change at will are important and someone needs to monitor it on a regular baiss.

Your business cards and stationery as well as any advertisment placed about you should all contain the website because that is where today's consuming public goes when looking for information.

Write a weekly blog which contains information of interest to your readers or a potenital patients who may want to visit you.

A short video explaining who you are and what you do in your office might be another helpful marketing piece so people can see what you look like, hear you speak and find some comfort level in having seen you and heard you before you visit.

Try using the website to foster a community spirit especially if you are engaged in any local volunteer community efforts, fundraising events, or special non-chiropractic related items. Efforts by you and your staff engender a community spirit and are well received by people looking for someone they will feel comfortable obtaining care from.

List your credentials, but do not embellish them, do not claim superiority as this not only is barred by most state statutes, but fuels animosity among your colleagus. And patients see this as a negative not a positive.

Finally, marketing is not simply a website, business cards or ads in the newspaper. The best advertising and marketing is WORD OF MOUTH - and that comes only after exceptional service, positive results, and a culture of caring is created in your office. 

Once that word of mouth advertising takes off, it is like a forest fire fueled by high winds. It takes on a life of its own, and all you have to do is live up to the expectations.

Last week I went to a favorite local spot for lunch.  The restaurant is a well-run, local favorite that had just been sold.  The previous owners did a great job in transitioning the new owner/chef - they introduced him to the "regulars,"had a nice article and pictures in the local paper, etc.

But that day, the restaurant was in total chaos. The internet line had gone down and they were not only unable to process credit cards, they also could not open the cash register!  The long-time wait staff and the new owner were in a frenzy.  People were lined up trying to get a credit card payment receipt; people who were paying with cash needed change and there wasn't any available.

And I watched the whole drama unravel in front of my eyes.

The senior waitress kept digging into drawers under the counter looking for that "old manual credit card machine" and paper receipts...none could be found. 

Apparently in an effort to make things neat and clean the old owner had put this all somewhere...but no one knew where!  The new owner left the kitchen and was on hold with the internet server. Orders were backing up. Customers were getting angry. What a mess!

Having experienced failed technology in my own business, I calmly stepped over to the senior waitress and said "run a duplicate copy from the machine, write in the customer's card info, have the customer sign it and give him the duplicate of it.  Process the tickets manually when the system comes back up.  Have one person handle this, get the chef back in the kitchen, and get the waitstaff back on the floor with the customers!"

She looked at me totally stunned. 

Once some sense of order was restored, I told them that this is the type of thing that needs a contingency plan (I hoped that were having weekly meetings) and the plan needs to be written up, put in a binder and placed where everyone knew where it was.

I got a big "thank you" and hopefully helped them know that contingency planning is a MUST no matter what business you are in.

I'm not one for getting pumped up by false praise or insincere compliments, but I do realize that without some form of inspiration, some use of imagination, I can get bogged down by the day-to-day rigors of the working world. 

As a full-time student myself, I understand how narrow the focus of life can be with all the studying, tests, etc. So how can one break through the monotony of school and work so that you are able to look beyond today to where your success lies?

It's a funny answer. Read more!

The president of NCMIC, Dr. Louis Sportelli, shared a quote by Charles "Tremendous" Jones that has stayed foremost in my mind. 

“You will be the same person in five years as you are today except for the people you meet and the books you read.”

No truer words were ever spoken. Reading can encourage you when you are in a slump, give you a way to move beyond the roadblocks you might see ahead of you as you plan for your new business. A book can help you establish your plan, lift your spirits, or offer a little humorous respite from your daily grind. Books can change your outlook on life!

I've recently picked up a book called, The War of Art : Break Through the Blocks and Win Your Creative Battles by Steven Pressfield. The book is about values and focus. It explains how you can keep a drive inside of you and have the focus and discipline to get done what needs to be done. Isn't that what we need to do when we are feeling overwhelmed? 

Whether you are a student, new doctor or seasoned D.C., sometimes we all need a little break as we work toward our future. Summer is here. Why not take that break with a good book that could be just the medicine you need to reinvigorate yourself. Now pick up that book and get reading!

Do you have any special books you've read that have made a difference in your life? Share them with us, won't you?

An extremely important assset for any business is a solid network of individuals and professionals interested in seeing you succeed.  A good network of people is very much like a garden.  You simply can't just plant seeds and expect everything to go well.  There are all sorts of challenges that can present themselves and interfere with your network.  

For example, poor marketing techniques that damage your reputation will severely weaken your network.  

Today I want to talk about the most insidious damage that can happen to your network... inactivity.

Staying in contact with your network is like the water for your garden.  Without frequent water, your garden will suffer.  However, there is a challenge in a business setting.  Keeping it fresh and reasonable can be challenging.  If you are always talking about your business, people in your network can get burned out.  

So how does one stay in touch with their network, without wearing them down?  

There are many ways to deal with this, but here is my favorite:  hold a fundraiser for a charity you hold near and dear.  It gives you an opportunity to interact with your network, they get something positive out of it, and you are helping a cause.  Win, win, win.

I've been involved in many fundraisers, but also run one myself.  We are entering our third year of the "30 for 30."  We help kids with cancer go to camp through the Children's Cancer Connection.  It has been a wonderful experience on many levels.  

Interestingly enough, I started this process without any thoughts to my network as far as keeping it healthy.  It was simply an observation I made as I was in process last year.  I noticed an uptick in referrals and help from my network as I was communicating with them.

What's the old adage?  Give and ye shall recieve?