Work Smarter, Not Harder, to Survive

Work Smarter, Not Harder, to Survive

Many would argue that chiropractic colleges did not prepare us properly for the business side of chiropractic.  Likewise, many would say that none of us were ready for the hardship and strife we faced last year.  The pandemic, staff shortages, inflation, rising costs, and decreased reimbursement have also taken their toll.  One fact that has emerged now more than ever is that you must work smarter, not harder, to survive.

Businesses have been affected by the pandemic.  FEMA statistics tell us that 40% of companies have never reopened, 90% will close within two years after the disaster, and 56% of businesses have no contingency plan.  Hopefully, you remained open through the pandemic.  Now is the time to not only ramp up your practice but have a clear sense of how your practice will adapt to the coming trends in healthcare for the next several months, and, yes, even in the coming years. 

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Step One:  Have a Vision 

Gather your most trusted advisors, including family, staff, and consultants.  A certified compliance consultant may give you insight into regulations and rules on such issues as discrimination practices, CDC guidelines, Occupational Safety and Health Administration (OSHA) guidelines, and, most significantly, HIPAA.  HIPAA and OSHA requirements require forming an Emergency Mode of Operations Plan and the ability to grant access to patients of their health records and health care.  Weather-related emergencies, power outages, sickness, fires, and water damage are a fact of life.

Step Two:  Have a Communication Plan

Communicate your vision and goals for the future.  Even though many people are vaccinated, others are not vaccinated and do not plan to be vaccinated.  We have all experienced the “cold and flu season,” but now add the COVID season onto the list.  At the time of this article, there is evidence that the Delta variant of the COVID virus is gaining prominence throughout the United States.  The vulnerable individuals include patients, doctors, and staff over the age of 60, immune challenged, and experiencing pre-existing conditions.  Although the chiropractic philosophy plays a part in your thinking, your business decisions need to be based on sound objective principles.  How is social distancing in your reception room, check-in, check-out, and treatment rooms going to look in the future?  What type of personal protection equipment (PPE) and cleaning policies and procedures will continue?  No matter what, you should consider monitoring CDC guidelines for such protocols. 

Communicate with staff, patients, and your referral sources what is new within the office.  Have you added services such as wellness care, orthotic evaluation, or rehabilitation?  You are the captain of your ship and must chart the course of your future.

Step Three: Design the Office to Maximize Efficiency

Although you are an administrator, you are also the doctor.  It is difficult to wear two hats at the same time.  You need to have administrative time and doctor-patient time.  Time is the one commodity we can never have enough of.  To work more efficiently, ask yourself, for patient care, as the doctor, what are my job duties?  The doctor’s responsibilities are to examine the patient, render a diagnosis and treatment plan, and perform the manipulation.  All other duties may be delegated.  Use technology to make your life easier!  The staff may collect information, and the patient or authorized representative may supply information directly by portal or questionnaire. The health information is then reviewed by the physician or other health care professional. The extent of the history and physical examination is not an element in selecting the office or other outpatient services code.

Use technology to reduce time in the office.  Reduce patient time in the office by emailing intake forms to the patient or have them available on your website.  When updating their information, encourage patients to use a secure online email or portal to process their forms on your website, complete questionnaires, electronically sign documents, and process payments.

When a patient initially calls the office, the front desk staff should triage the patient, get all insurance and financial information, and schedule the patient for a virtual consultation either that day or the next day.  Processing information immediately reduces no-show patients.  Consider using telephone or video conferencing to pre-screen patients (pre-consultation).  Clinical staff will call the patient, update the chief complaint(s), history, mechanism of injury, surgeries, medications, and COVID history.  The time the clinical chiropractic assistant takes to do the consultation is not charged for directly, but aids in reducing the doctor’s valuable time away from other patients.  When the patient arrives in the office for the examination, the doctor reviews the information contained within the intake forms and the consultation notes.  The doctor can then ask the patient any follow-up questions and perform the examination.  Any information gained on the examination day would constitute elements of the Medical Decision Making (MDM).  The doctor will examine the patient, but the days of patients sitting in the office with a clipboard filling out forms are over.  Under the new evaluation and management guidelines, consultation is no longer an element used to determine the level of examination.  Medical decision-making is the preferred element to determine the level of the examination and management code.  Time may be used instead, but indications are that insurance companies will audit your documentation of time if they think it is excessive.

Step Four:  Expand Your Wheel of Services

Like a bicycle wheel, the axle of the practice is manipulation.  Each spoke entering into that axle is another stream of income.  Diversity of income streams will benefit the patient and provide you with other sources of income.  Examination, x-rays, orthopedic supplies such as pillows, custom-molded orthotics, nutritional supplementation, and rehabilitation are examples of other services and income sources.  All of the services, when medically necessary, will ethically be used to treat a patient, thus providing a win-win for the patient and doctor. 

As outlined by Medicare and other insurance companies, a service will be considered medically necessary if utilized to improve the patient’s function.  Consider tools that you may offer in the office to improve function.

Step Five:  Document Everything

Documentation is the key to risk management.  It is required for compliance, but, without it, you also risk the backlash of possible litigation for negligence.  Cases have been brought forth by employees of companies such as Target and Walmart, alleging that the employer did not adequately protect their staff against the COVID virus.  When brought into question, your compliance manual will establish the record of your good faith effort to meet compliance requirements. 

Your documentation should include your policies (your intent) and procedures (step-by-step actions to accomplish the intention).  After establishing and conducting training, make sure to document and have the staff and doctors sign an attestation of their knowledge of the policies and procedures. 

It is no doubt that the Coronavirus pandemic will shape our lives, activities, and memories for years to come.  Proper preparation, accomplished by training, will ultimately lead to a successful stable practice.  Learning to work smarter, not harder, will ensure a thriving practice for years to come.

About Author

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

Dr. Mario Fucinari has helped train doctors and staff over the last 20 years. He received his bachelor's degree from Wayne State University in Detroit and his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1986. Dr. Fucinari was the recipient of the 1998 and the 2003 President's Award from the Illinois Chiropractic Society (ICS) for his work with education and training and most recently received the 2012 Chiropractor of the Year award from the ICS. Dr. Fucinari was the first chiropractic physician to attain the Certified Medical Compliance degree. Two years later he earned his degree as a Certified Instructor for the Certified Medical Compliance Program. He is now the Chairman of the Chiropractic division of the national medical compliance program. He has produced classes and publications on HIPAA, Clinical Documentation, Medicare, and Stroke and Cervical Manipulation. He is a worldwide speaker for NCMIC, Foot Levelers, ChiroHealthUSA and several state associations and a Certified Chiropractic Sports Physician [CCSP].Online CME CoursesConnect

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