Infrastructure Introduction: Part #2
From the Desk of: Dr. Mark Studin
What do I give my associate chiropractor to read or do so that I get the maximum benefit from this program?
IF YOU DO NOT HAVE AN ASSOCIATE DOCTOR WORKING FOR YOU SKIP THIS CONSULTATION
“I love you, I love you, I love you… I am gone and opening right next door!” Mark Studin 2018
- NEVER GIVE THE FOX THE KEYS TO THE HENHOUSE
- YOU ARE ONLY AS STRONG AS YOUR WEAKEST LINK
- FIXING THE WEAKEST LINK
Prior to giving you the formula for ensuring greater success with your Associates, I want you to understand what associates can do to you versus what your expectations are of what they can do for you. First and foremost, you must have two legal document requirements with associates; a signed staff office policy and an Associate’s agreement both done by a lawyer extremely knowledgeable in both labor and healthcare. Should you not have both, you are inviting disaster to your practice and it will be your fault because you have been foretold. I currently have both documents to offer created by a highly regarded lawyer in healthcare and labor that will help you resolve these problems. The following two scenarios explains my stupidity and the purpose of these opening paragraphs is so that you are not as much of a “shmuck” as I was.
John was like a son to me, he grew up in the neighborhood and I would play ball with him, go running with him, listen to his trials and tribulations about girls and helped him through college as well as making sure he went to the right chiropractic college and made it known throughout his education that he had a job upon graduation. When he started working for me he knew nothing about practice or patient care as he was a typical new practitioner. After a year, he started to function incredibly well, and I gave him a significant raise. After two years, he came to me and wanted an unreasonable raise reflecting over seven figures (that was over 20 years ago). I gave it to him hoping that he would “step up to the plate” and bring more to the office that he was getting. I was wrong. Within a year he left my practice and opened his own office down the road taking with him my marketing person who he initially had a covert affair and I’ve never heard from him since.
Ralph was another story; hands of gold but zero business acumen. I brought him on when I was treating 650 visits a week alone and started adding days to the clinic to spread out the physical demands with Ralph covering those days, so I could reduce the stress on my body. This was such a resounding success that I voluntarily paid him approximately 30% more than his asking salary. To me, it was well worth the money to keep him happy with the understanding this was more than any other chiropractor would be willing to pay him and more than he can earn on his own. After three years of raises, bonuses, benefits, benefits and more benefits to ensure his happiness and financial security Ralph came to me and said “Dr. Mark I love you, however my brother is opening up in the next town (2 miles away) and my mother is going to be running the office. As this is going to be a family business, I would like to join them.” Having the utmost respect for Ralph and his family, in spite of my personal disappointment I gave him my “loving blessings” with unrestricted permission to allow any patient he had a relationship to go with them with one caveat. That caveat was for him to communicate verbally with any patient he chose (with no compensation to me) to take with him but there can be no mailings to all of our patients and he cannot take the patient list with them. Three months after he left I got a copy of the letter that he sent to all of our patients imploring them to leave my practice to join him because apparently, he “snuck into my office” in the middle of the night before he left and stole our patient list and was doing mass mailings to steal our patients. Of course I confronted him to put an end to this, but the damage was done. The next and last I heard about Ralph was about five years after that incident where he was working as a mechanic in the automotive industry and no longer in chiropractic.
The moral of both stories is that if I had a contract with both, I would’ve had restrictive covenants and theft of office clauses as strong deterrents with significant consequences to prevent both. I made a “rookie mistake” that cost me dearly in both scenarios both financially and emotionally. I will never make that mistake again. It is my goal for you to not make the same mistakes that I have already made because the world doesn’t need one more schmuck at that level.
NEVER GIVE THE FOX THE KEYS TO THE HENHOUSE
Some of you are lazy and want to give this entire program to your Associates to “make it happen.” You give them unfettered access to all of the consultations, forms and systems and say “your job is to bring in personal injury cases” because you know that the money is there, and you personally do not want to invest the time or energy to make that happen.
Note: There are some very special Associates that have a significant level of integrity and will not “screw you.” I can only share with you that I have never experienced that. For those Associates that are reading this, I can say with a great degree of certainty that should you function at a significant level of integrity no matter the temptation to take advantage of the relationship you will usually succeed beyond your expectations because in the end you will get what you give, and your future depends upon it!
It is my strongest suggestion that you, the owner of the practice should read every single consultation and then “cherry pick” those you want your associates to read. The ones you pick should be centered around compliance, patient triage and documentation. I suggest you copy them, place them in a three-ringed binder and have your associate read them and initial that they have read them to ensure they are following your directions. I then urge you to have regular office meetings with your Associates centered on these issues.
Personally, I would never give unrestricted access to my associates to learn how to create referrals because those who control the referrals “control the game.” I, as the owner, control the game of my practice and therefore maintain control the referrals.
YOU ARE ONLY AS STRONG AS YOUR WEAKEST LINK
Every defense and plaintiff lawyer know this and when working a case that has potential litigation prospects (every personal injury care), both sides investigate every player to see what will give them the greatest advantage. Therefore, from a strategic and business perspective, it is in your distinct advantage to ensure that your associates are not the “weak links” in your practice. In addition to the personal injury aspect of the practice is one of documentation compliance.
Your #1 source of exposure from a compliance perspective are your Associates and you have to ensure that everything they write and do is both compliant and consistent with a level of care you set for your practice. This is where systems and training come into place to ensure both the safety of your patients, your license and your money. Never lose sight of the fact that as an owner and medical director (don’t get hung up on the word medical) you are responsible for everything your associate says, writes and does based upon your supervisory role.
Therefore, your paperwork must be systematized to prevent your associate from cutting corners from being either ignorant to what needs to be done or lazy to ensure they take home a paycheck while doing the least amount of work. In addition, you must be verifying on a regular basis that you are overseeing your associate in documentation fashion. In most states this is a regulatory requirement.
Every one of you should have done a complete compliance review with me looking at your intake forms, E & M new patient evaluation, your first soap note associated with that new patient evaluation, your CV and staff office policy. This is by far, the most important component of our relationship because if you get busier with noncompliant documentation you will be compounding your problems and increasing your exposure significantly for very bad things to happen to you. Therefore, if you have not done a compliance review refer back to your welcome email package, and send me the requisite forms in the appropriate format to set up a compliance review.
I would not have my associates present during the compliance review for documentation as too many have had fraudulent issues and I do not want my associates to witness the problems. I would like an opportunity to independently make all the corrections required and then present those corrections to the Associates to perform in their documentation.
I would however, consider doing a second compliance review purely for the Associates documentation to share with them what they are doing and not doing from a third party who is vastly experienced in compliance reviews (me). This will motivate (if there are errors) the associate to pay careful attention to detail in the future when documenting, which will in turn protect you and your practice. There is a fee for second compliance review, which will be shared with you upon request.
FIXING THE WEAKEST LINK
Fixing the weakest link is a two-pronged solution to many issues and practices with multiple doctors. Although many want to focus on the personal injury aspect to ensure that referring lawyers are happy and defense lawyers are placated, we must never lose sight that our primary focus is patient care. The weakest link in your practice is the Dr. who has the least amount of advanced education or knowledge in spine care combined with the lack of motivation to do anything about. These doctors typically document the most cryptically as well as ignoring necessary triage for advanced testing or collaboration with medical specialists when clinically indicated.
The solution is quite simple. Your associate doctors need to take post – doctoral courses to ensure what I consider the “new minimum” in education for a doctor of chiropractic. You as the owner should be the highest trained expert in your clinic and that starts with being on the trauma team (you will learn about that later). Your Associates should start taking the following courses as a minimum:
- Medical-Legal-Insurance Documentation, Colossus to the Courtroom
- MRI Spine Interpretation
- Stroke Anatomy Evaluation for Chiropractors and Manual Medicine Specialists
- Primary Spine Care 5: Biomechanics Neurology of the Chiropractic Spinal Adjustment Documentation in Collaborative Relationships
NOTE: These courses are formal in that CE credits are rendered and do carry a fee as are all of the continuing education programs we offer.
What these courses do is give your Associates more than the basics in documentation, advanced spine care and triage so that your patients are protected by assuring an accurate diagnosis, prognosis and treatment plan and that the documentation reflects that level of accuracy which protects you and your practice.
This also ensures that when the defense attorney goes through the documentation and billing and sees who was treating the patient they typically will choose to depose or subpoena for trial one of your Associates. You must understand that any doctor who treats a patient can be subpoenaed to testify for any patient. Should an under-educated associate be called by the defense and gets “ripped to shreds” because of lack of knowledge, the plaintiff attorney will hold you personally responsible for your Associates actions and/or documentation and probably will never work with you again because that associates testimony cost them their case.
When having your Associates take these courses they are not optional. The more successful group practices in our program give their associates a course and informs them it’s an additional benefit for their employment and is paid for by the practice AND IS MANDATORY FOR EMPLOYMENT! The associate is then given a timeline for each course to conclude followed by an office meeting with that associate to discuss what they have learned and how it’s going to be implemented into YOUR practice.
There are reasons why some offices are more successful than others and it is usually by the owners of those practices ensuring a strong infrastructure has been created “vertically,” or in simple terms with everything that touches the practice.
As you move on these consultations you will learn more about ensuring a STRONG infrastructure at many levels.... ENJOY the journey…