A dear friend from my chiropractic college days called me recently. We caught up on family and friends and discussed future plans. He recently retired, having been very successful in practice, also making wise investments and saving for the future. He had multiple offices and was both an excellent clinician and terrific marketer.

He called to congratulate me, having seen that I was going to be honored by the state association and asked how I was going to announce this accolade. Quite frankly, I had not given it any thought, but Dr. J had a valid point and a few recommendations.

Growing and maintaining a practice takes ongoing effort and while you might have provided superior care to someone when they were in acute pain, they may quickly forget how wonderful your care was when a new development occurs.

Every day we see and hear new announcements about different individuals and industries, as well as their awards and community participation. Publications are pleased to make note of those who contribute to the betterment of society.

Dr. J. being the "master marketer" thought that my award was newsworthy particularly as it was an acknowledgement of excellence from my peers.

He recommended a press release with photo to our local media outlets with the standard "five W's of PR" to include...who, what, when, where and why.

He also reminded me that as articles are published they remain on the internet and can be viewed by prospective patients and the public forever.

While we sometimes may be overly humble, tooting our own horn can provide exposure to you and your practice and the important work and activities which you participate in.

Happy days!

There is nothing worse than an office environment that is bland, systematized and mechanical - where staff function as if they were dehumanized and robotic. 

Although efficiency and getting the job done is important, why not accomplish it in a relaxed, caring environment that is flavored with touches of humor.

Ancient medicine proclaimed the virtue of laughter and it has held true to this day that chuckle has the capacity to stimulate the healing process.  We all need a daily dose of humor, even in the workplace as long as it is used with discretion.

Humor can improve job performance by:

• Reducing stress and anxiety
• Relieving boredom of tedious work
• Boosting performance
• Building staff cohesion

Some of those difficult patients and situations can be best handled with a light touch of humor...without creating a comedy club!

Your office should project life, hope and a positive attitude.  And remember, always take your job seriously - never yourself!

Do you ever wonder why the success of great department stores and even extremely successful grocery chains always involves change? 

They change their window displays. Their merchandise is moved constantly. Their stores always look crisp and neat.

They do this because their customers have lots of options and they shop there because the store provides value and a shopping experience that makes the event memorable. 

What about your office?  Have you really taken a look around and really examined the entire office, from the original painting and pictures on the walls to the tables and carpeting in the office. 

If your magazines are Readers Digest from 1981 and the pictures have not been moved or the carpeting is getting a bit ratty around the edges, it is time to MAKE SOME CHANGES.  Patients need to feel that their doctor cares about them, that the staff cares about them and that the facility in which they are being treated is also “cared for.” 

A coat of paint does not cost much. And ensuring that the magazines are current, the plants are not dead, the restroom are spotless, the equipment sparkling and clean - these all bring about  a sense of pride and enjoyment.

Change is inevitable growth is intentional.

The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form. The revised Advanced Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The revised ABN replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).

When a physician or supplier has a “genuine doubt” that a service will be covered, they are required to notify the patient of this fact. The ABN form is required to be used for a service that is covered. In the Medicare program, chiropractic coverage is limited to coverage for spinal manipulation by means of the hands or hand-held device. For all non-covered services, a standard letter informing the patient of the non-coverage or the ABN may be used. The Notice of Exclusion of Medicare Benefits (NEMB) form can no longer be used.

The newly revised ABN form may be used at this time; however its use becomes mandatory on November 1, 2011.

The latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) is now available for immediate use. Mandatory use of this version begins on November 1, 2011. All ABNs with the release date of 3/2008 that are issued on or after November 1, 2011 will be considered invalid.

The mandatory use date has been changed from September to November to accommodate those providers and suppliers with pre-printed stockpiles of ABNs so that they have additional time to exhaust their supplies of the outgoing ABN.

The newest version of the ABN and the instructions for use can be accessed through this link. There, you'll find:

• forms and instructions
• manual instructions
• implementation announcement

Summary:

The following outlines the significant changes found in the newly revised ABN form.

1. There is a new ABN form that must be downloaded and filled out for your office.
2. For repetitive or continuous non-covered care, notifiers must specify the frequency and/or duration of the item or service. See § 50.14.3 for additional information.
3. When a reduction in service occurs, notifiers must provide enough additional information so that the beneficiary understands the nature of the reduction. For example, entering “wound care supplies decreased from weekly to monthly” would be appropriate to describe a decrease in frequency for this category of supplies; just writing “wound care supplies decreased” is insufficient.
4. Notifiers must make a good faith effort to insert a reasonable estimate for all of the items or services listed in Blank (D). In general, we would expect that the estimate should be within $100 or 25% of the actual costs, whichever is greater; however, an estimate that exceeds the actual cost substantially would generally still be acceptable, since the beneficiary would not be harmed if the actual costs were less than predicted.
   
   

Recently, my mother-in-law took ill and we spent quite some time in the hospital.  As you can expect, all 5 of her children were pretty shook up.  Because of her age and medical history, there were a lot of variables and numerous specialists coming in and out of her room ordering test after test.

Now, I understood most of what they were doing and why certain tests were being done.  In addition, I also realized how one treatment might cause complications to other systems.  Unfortunately, the doctors did not do a great job conveying such information to the family.

I could see the anxiety and frustration in their faces when she would be doing well and then take a turn for the worse without any explanation of why.  More importantly, they were not properly educated as to the severity of the condition and complications that could arise from the various procedures.

In short, I feel that they had unrealistic expectations of her prognosis. 

Granted, we do not have such extreme situations in our offices, but I do see the correlation when it comes to patient prognosis.

If we do not spend the time on that first visit and thoroughly review any diagnostic tests with the patient and educate them as to any variables which could complicate their prognosis or even limit treatment options, there is a good chance that they will have unrealistic expectations in terms of their prognosis.

Educating the patient and other family members when appropriate on that initial visit could reduce the questions of frustrated patients. 

It is no secret that Health and Human Services (HHS) announced they were canceling their proposal to send “mystery shoppers” posing as patients to call doctor’s offices and request information, appointments and determine whether they had encountered problems with access to care. 

The firestorm which erupted following this disclosure caused the administration to cancel this “government spy” on doctor’s project.   Actually if it were not the government doing it in a clandestine fashion, the idea really has merit for your own office.

Every doctor should do some of this “mystery shopping” in their own office to see how efficiently and effectively the practice is running. 

The success of the television show, Undercover Boss in each and every case revealed to the CEO that there was much to learn and much to correct regardless of the company.

Often, doctors determine that they only want to do the clinical side of practice and relinquish the business side to staff.  If they are lucky, the practice may run well because of luck in securing good staff.  A great portion of the time however, the practice is less than desirable because the doctor is missing in action.

The bottom line: become involved in every aspect of your practice from the moment a patient calls your office and walks into the reception area, every detail is important. 

You never get a second chance to make a first impression.

Recently we had a student ask a question of us that we thought might be of interest to you as well. So jump in and share your experience or thoughts concerning the following!

"What information do I need to consider before opening and running a "cash" practice?

Here are a few words of wisdom and caution we have elicited so far,

"A cash practice depends on the economics of the area you choose to practice in and the benefits available to the patient."

"The best advice you could receive is to find yourself a reputable tax accountant or CPA who will help you set up ethical accounting practices."

"New practitioners may fall prey to "cash box" living, pulling $20-$30 dollars from the till to pay for lunch and then not accounting for it when the time comes to pay the bills."

"Will the D.C. refuse Medicare patients then? If they don't, they can be required to submit insurance forms."

"Remember, when patients have insurance, they tend to stay within the parameters of their company's rules to maximize benefits. They are given a book of providers that they may visit for little or no outlay of their own money. If you are a "cash only" practice, you will not be listed in the book of providers which may slow business growth."

"Inform your patients when they make appointments with you that you ONLY accept cash, credit and debit cards. Reinforce this policy with a placard at your front desk. Then get a credit card processing machine, (NCMIC offers this product) for the ease of the patient and prompt payment."

"The most successful practices, cash or otherwise, are the practices where the doctor listens to, educates and cares about...the patient. Then the patient is quick to refer and referrals build business."

I had a great question the other day from the Ask The Expert feature on www.startingintopractice.com.

The question was from a doctor who is in an associateship, but is planning on opening a practice in another state.  His wife is from the other state so they are moving home, in a way.

His question:  Which comes first...securing financing or securing a location and lease?

The answer:  Neither and both.  These two pieces need to occur in tandem.

The problem is that the lender likely will not close on financing until space is secured AND a landlord likely won’t close a deal for a lease until financing is in place.  So, both these issues need to be dealt with in at the same time.

A great first step for this doctor is to contact a commercial real estate agent in his target community.  They will be able to provide a great deal of information on what is available in the market.  If his wife is from that community, he may be able to tap into her network of friends and family to get a good referral.

Once he gets an agent, they will be able to provide estimated costs and available properties in the area.  From there the search can be narrowed down to a limited number of properties based on demographics, who he wants to serve, where he wants to be in the community, etc.  Now he has a better idea of costs to plug into the business plan and start talking with lenders.

Talking with lenders is another process that will take some time.  Again, tap into any networks available through contacts in the community.  Then start shopping the business plan around.  Once he finds a lender that will work with him, the ball will start rolling.  Now he can negotiate the final lease and negotiate the final terms of the financing.  Again, this will likely happen at or around the same time.

One more thing.  Anytime doctors are dealing with leases and contracts, a review by a local attorney is in order.  Again, it is best to look for referrals to find one.  The attorney will be able to give advice on the contracts needed for office space and financing.  The review of these contracts will cost a little bit of money (typically $200-$300) but will save you much more by preventing a mistake.

Quite a process and no two doctors' experience are the same.  The key is finding good people to provide advice and guidance and working through the process in a well planned and thoughtful manner.