Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 743
Infrastructure 170 I
From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.
I have previously shared with you the 2017 Goals and Action Steps, however, there are trends that you must understand in order to achieve those goals. These trends along with the solutions will be detailed in the upcoming annual symposium on January 21st and 22nd in New York.
As far as I am concerned, you MUST be there in person to fully appreciate what is happening in the industry and how to make changes in your practice. There are no 2 practices alike and each practice must adapt according to how you currently function.
I am going to break down the trends into the following categories:
- Carriers Denial Patterns
- Lawyers Increasing Needs for:
- Medical Specialists’ Needs
- Medical Primary Care Providers’ Needs
- Emergency Room Needs
- Chiropractic Research
- Carriers Denials: The carriers are getting bolder in denying your claims “just because they want to” and you are either doing nothing and getting “raped financially” or attempting to render a complaint in the wrong format and end up once again getting “raped financially.”
Unfortunately, too many of you have documentation, so poor that if you render a complaint, you set yourself up for audit which then becomes a windfall profit for the carrier because they are waiting for you. For those of you in this category, it falls under the topic of, “Why didn’t you get an internal audit by me?” This was the starting place for being part of the program and it was FREE!!!!!!!!!!!!!!!!!!!!!!!
I have developed numerous action steps to help neutralize the carriers' latest attempts to deny your claims, but unless you understand what is going on at the “visceral level,” it will be challenging to get the denials overturned.
- Lawyers and 2017 are facing equal or greater challenges than doctors in the courts. Although many of you realize that cases do not often get to trial, it is those that do that help set the policies of the carriers regarding settlements. The better the defense (carrier) lawyers do in trial, the more aggressive they are in rendering “lowball settlements.” Regardless of the Colossus algorithms and how you document, if any carrier is consistently prevailing over a specific lawyer, then regardless of your documentation, it will become increasingly difficult for the lawyer to realize fair settlements in a reasonable amount of time.
Although certain experts in the field of Colossus believe that all you need is the “magic documentation,” there are other factors that help dry settlements beyond simple documentation. As stated above, the courts are helping to drive settlement values. The flip side of the argument is that without appropriate documentation, regardless of court rulings, the settlement values will be consistently lower and the attorneys need to be educated as to why working with the “right doctor” based upon their clinical excellence and documentation skills are critical.
This is where consulting the lawyers is an integral part of the process, where most lawyers don’t even realize what the process is. Out of the last 30,000 – 40,000 lawyers I have lectured to, the overwhelming majority were not even aware of what Colossus is and how it affects their settlement values. Too many simply want to complain with “blinders on” because they do not want to change any policies or procedures out of either stubbornness or laziness. After all, many of this sect of lawyers feel they are the experts and should not be educated by anyone in the medical field. There are, however, others within this sect of lawyers that are open to learning because they want to do better for their clients and themselves. It is here where you practice as the “medical-legal consultant and will build lifetime relationships where it becomes difficult to NOT GET THE REFERRALS…ALL OF THEM because you are the reason they will be prevailing.
I have had numerous meetings with lawyers from both the trial lawyers’ associations and defense lawyers to verify what each side has claimed to be true…It’s true and I have the tactics used on both sides to prevail. Those tactics must be followed and documented meticulously in order for the truth to prevail. Having a Colossus compliant report is no longer enough…It really never was!
#3 #4 #5 fall under the same trend. Managing the mechanical spine patient. You noticed I didn’t say “treating.” In medicine, you do not treat patients, you manage them. This is the medical protocol whether it be primary care or specialty care as patients’ conditions are managed. Emergency rooms historically triage patients out to either primary care providers or specialists to manage what they find that is beyond life-threatening or urgent.
Based upon the current literature, which is where the verification of what we do with mechanical spine is located, this gives you a starting point to be in control of managing that patient from the inception of care. You must not be pigeonholed into being a treatment such as a physical therapist is. Once that has occurred, you have lost. The key to being successful in the medical world in being treated as a peer is to be perceived as an expert in managing the specific conditions within your specialty. Too many chiropractors refuse to be called “medi-practors” and live in this paradigm. To those with myopic vision, you should never lose sight of the fact that we treat 7% of the population while medicine treats 95% of the population and we, as a profession, must live in the “mainstream” healthcare paradigm.
In reality, all it takes is education in spine. It is that education that positions you as an expert based upon both your knowledge base and credentials. If having knowledge of spine and credentials to back it up is all that is required, then the only downside is based upon either a religious dogma or abject blindness. It is my overwhelming experience that the smarter the doctor, the busier the doctor, and once the patient is in your office, you can educate in any way you choose as long as it’s within your legal scope of practice.
6. Chiropractic Research: There is a “treasure trove“ of new research that explains so much and it is this research that will help set the foundation of your future growth and success in all paradigms of practice. Although this is the last item and perhaps the least motivating to some to attend, to me, this is the most exciting stuff I have encountered in our profession and I cannot wait to see the final version as I have not done it yet…but it is like “Disneyworld on steroids” to me. AND guess what? There ARE bones on nerves!!!!!! I have the evidence in current scientific literature!!!!
We will be discussing the trends on all of the above with didactic solutions…There are significant changes in the chiropractic, medical, legal and insurance industries. Learn them and win.
If you want to get busier and get paid…
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
Academy of Chiropractic
US Chiropractic Directory
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