Educate to Collaborate

In a recent paper by (Garner et al 2008) the most poignant aspect of this study is the statement by the authors “After the first two focus group sessions, educational sessions were run to expose providers [MDs in the clinics] to chiropractic treatment by demonstrations and presentations of the published evidence on chiropractic.” (p 19) 

EDUCATION, EDUCATION, EDUCATION is the key foundational component.  To allow chiropractic to be integrated into the medical community in your area, you need to teach medical providers about chiropractic research.  If you are having trouble building collaborative efforts please visit our site to learn more.

Respectfully,

William J Owens Jr DC DAAMLP

1:  Michael J. Garner, MSc, Michael Birmingham, PhD, Peter Aker, MSc, DC, David Moher, PhD,

Jeff Balon, DC, MD, Dirk Keenan, DC, and Pran Manga, PhD, DEVELOPING INTEGRATIVE PRIMARY HEALTHCARE DELIVERY: ADDING A CHIROPRACTOR TO THE TEAM. Explore 2008; 4:18-24. 

What the MD learns about Chiropractic

 

In a recent Members consultation, I wrote about how most MDs learn about chiropractic care.  This is a very interesting point to make because it can lead to misinterpretation of what we do and what our outcomes are.   Most MDs incorrectly learn about chiropractic from their patients NOT the chiropractor.  In a recent conversation with a MD in my area, he mentioned that he only hears about chiropractic when the patients tell him that it didn't work!  He also said that he knows chiropractic is beneficial to his patients, but the ones that feel better don't come back to see him for that problem.  When he looks in the chart often there is no report or indication of what the chiropractor did and why the care trial failed.  This is one of the many reasons most chiropractors do not received as many MD referrals as the patient population would indicate. 

Approximately 85% of the population will have lower back pain at some point in their lives.  Chiropractic care has been shown to be effective in treating lower back pain in the acute, subacute and chronic phases.  Chiropractors treat approximately 7%-15% of the population which is far lower that the US population with just back pain, not to mention the myriad of other conditions chiropractic can help.  So, for chiropractic to be properly  integrated we need to be better communicators.  For more information, please visit www.teachchiros.com.



Respectfully,


William J Owens Jr DC DAAMLP

Importance of Infrastructure

When it comes to fundamentals, Chiropractic practice is no different than any other business entity.  The foundation of how things run and how staff are trained is important to long term success.  I talk to doctors daily and there are always those that seem to be stuck in a rut, then their practice numbers decrease and they end up back to where they started a year ago.  This cycle of rain then drought creates a lot of stress on the doctor and staff.  The problem is, these offices are not updating their infrastructure to handle more patients and all the stuff that goes with them.  Updating infrastructure by the way does not mean spending more money, creating more space or hiring more people.   What it means is constantly assessing how things can be done more efficiently and how we can use technology to produce better results.  

Have you ever started referring patients to a MD (or any other health professional) and in the beginning patients can be seen that week or the next, reports come back timely and patients overall have a nice experience.  Then word gets out that it is taking 6 weeks to see the MD, the patients had to wait for 3 hours to be seen and you never see a report?  The next thing that happens is referrals start slowing to that MD and the practice starts failing.  Why would that happen?  The answer is simple.  The infrastructure that they started with was adequate to a certain level of patient visits.  Then the paperwork started to back up (the MD didn't re-assess his systems to make them more efficient) and then things started getting overlooked.  The MD then blames everyone else citing that they need to work harder because "he/she cant do it all" and then it implodes. 

When you are in a growth phase (which you should ALWAYS be in by the way) monthly or quarterly review of where the "snags" are in your system is critical.  If you are having concerns about yours systems, call me and I will help you.  I can be reached at 716-228-3847. 

Working to Get Better

Today's business and health care environment continues to require more attention to detail than the year before.  When you are in your office, it is critical that you look for ways to get better.  Getting better simply means identifying the items in your practice the hinder growth and patient flow.  Then sit with your staff and other providers to agree on a solution.  Common barriers are:

Patient intake
Work excuses/disability notices
Records requests
Documentation
Referrals to other specialists

As an example, one very good way to reduce the amount of time it takes to generate a work excuse or disability notice is to have a wireless printer at the front desk for doctor generated forms.  When I am in the room with a patient and they need something, I generate it in the EMR and it prints to the front.  I then tell them "your disability notice is up front, grab it when you leave".  This also goes for MD referrals and imaging orders.  This takes 10 seconds and now there is a record in the  patients electronic chart with the order.

EMR that combines billing AND notes can cost as little as $99 per month and is the wave of the future.  You need to seriously consider a plan to change over, otherwise the demands of health care are going to hinder your growth.  It is easy and makes practice fun, but it requires a plan.

Respectfully,

William J Owens Jr DC DAAMLP

Reporting to the MD

I am in the process of writing a Consultation on being effective when creating you documentation.  The idea is to DO IT ONCE and once only.  The quality of your report should meet the needs of the insurance carrier, regulatory agency, covering doctors and co-treating providers.  I talk to chiropractors on a daily basis that work too hard on reporting.  Everything is a different document and the redundancy is spectacular!

It is simple, an initial report that meets all of the criteria of the E/M level you are billing as well as any treatment modalities.  There is the daily SOAP progress notes that cover your evaluation and treatment between evaluations and then there is the re-evaluation.  Following medicare guidelines, that is required every 30 days. 30 days is the marker not the number of patient visits. Most doctors don't get that.  The re-evaluation is the same as the initial but shorter time and subsequently a lower E/M code. That is it. 

To be successful in an integrated practice style (that can mean that you practice separately from the other providers or in a group practice) you MUST be able to teach though your reports.  It is easy but you must understand the proper descriptive terms and proper vocabulary for a cooperative care practice.