Academy of Chiropractic Personal Injury & Primary Spine Care Program

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From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"How do I shift lawyer referrals away from the PI Mills and to me?"


Dr Studin: so the issue is, and the question you brought up, and it's a really, good question, how do you compete with the Cairo mills who undercut everything by taking two, three, $4,000 settlements on every single case and you're dealing with these big pie firms who take 10 grand, who churn them in Burnham? Did I miss anything?

Guest Doctor: No. That's what they do. They settle everything for 10, $15,000 total for the buck. Yeah.

Dr Studin: They churn them and burn them. I love that one. And just like, just like some of those Kairos, a Pi Mills, the lawyers, a pie belts, this is a very common theme for a larger firm across the country. the first thing I want to share with you, which we talked about prior to reporting this is I dealt with a large firm in, in New York, a years ago. And they're the biggest on long island. They did billions and billions of dollars a year, they were big, but I met with them and they said to me, no matter what you do, Dr Student, and I took me two years of wanting and dining to get in there. It took me two years to get them to refer. And I finally got in and what they said is, Dr Students ask that you treat for everything. And remember we only got paid $33 and 70 cents no matter what we did a visit because our fee was set by the state. After you get paid the most, your link could be as 1000 bucks and that's it. And that's it. So your, your, your place at least paid two or 3000 your guys, the thousand bucks and I would get 15, $1,800, you know, total from the carriers and then 1000 bucks at the end. So, I was walking away with 22, 2124 per case, and I was losing money. Two years of wanting and dining and all that politics and all that crap down the tubes because it was then that I realized, and in addition, I had two other firms that I work with. three firms actually just prior to that that would send me, each of them would send me, you know, between 15 and 20 cases a month. So I was getting on average, a little bit less than that on average, about 40 new pi cases a month. One of them went to work for the insurance carrier, lost him, my practice dropped the third, the next one moved out of town. And the last one hated me because that was prior to my being knowledgeable, like the Old Cairo one step two step. And on the witness stand, they cost them the case and they never want to even look at me. And today, even though today, he won't even look at me cause he thinks so a piece of crap. you know, regardless of, of how much I've evolved. So my practice went to nothing that I went to this big firm and then I realized what a, what a schmuck I was because I don't want 20, 30, 40 cases from one firm. I want one case from, from, from 40 firms because that insulates me from anyone moving, flipping, or hating me. Now with that being said, here’s what's going on the carriers right now, and I can tell you that factually has increased their Rico Division for falls, which means that they're looking to take you to federal court. Now it's interesting, you and I had this previous conversation where, you know, the carriers can do whatever they want to take you to court, whether you're right or wrong, you understand that, right?

Guest Doctor: Yeah. Oh yeah.

Dr Studin: Yeah. I mean it's kind of sick. So, um, but what they're doing is they're really gearing up now, here's what they're doing to those mills. The carriers are now profiling those mills. And, um, were you on our webinar yesterday?

Guest Doctor: Yes.

Dr Studin: Okay. So for those of you who weren't on the Webinar, we had a slide up with 16 items and I'm sure you pay careful attention to those 16 items. But on those 16 items, it was then what modalities do you use? What diagnosis these with number of diagnosis use, how many treatments do you do per patient? And what they do is they're no longer trying to say, does he have a diagnosis for this treatment region? They're looking at all of your cases and coming up with a profile on average and how far off averages. Every patient gets 22 to 25 visits, whether they're, whether they're six years old, 26 years old, or 86 years old. Every patient has more than 15 diagnoses. Every patient has this every, and they're coming up and every patient where you all work with the lawyer on every single one, you know, and it's just, they're really profiling. So what the carriers are doing is they're looking at these Tyro mills and MD mills, and they're not singling at current practices. It's the same thing across industry, but what they're doing is they're sitting down with the doctor. Now tell me how chilling this would be. They sit down with the doctor and they first, they send you a letter that you're being audited, for potential felony or improper claims practice. We urge you to bring a lawyer with you. They sit down, that's the first thing you get in the mail right away. You spend the rest of the night in the bathroom. Okay. Then you sit down with them when they start profiling you and your practice and they know more about you than you, you know about you. And they pull out spreadsheet after spreadsheet of everything you're doing and say, listen, we have 16 items against you. We've paid you $1 million in the past. You know, we paid you a million or $2 million directly and you've got about five or $6 million in receivables out there because you've had a busy pi practice or it doesn't with 3 million, it doesn't matter. We want 100% of it back by the end of the month or we're going to go to federal court. We're just giving you a courtesy of letting you know and an opportunity to get out of this. That's what they're doing. So you see [inaudible] that's how they're profiling. So the lawyers you work with, you should be telling them and here's this strategy and this is factual. It's not inflammatory, it's factual that you know for a fact that the carriers have increased their Rica. And I know about this for state farm and Geico because I met with them. The carriers have increased their Rico division for fault and they're going around the country and profiling all of the Cairo mills that churn and burn them. Looking at the lawyers they work with, they are looking at the medical doctors they work with. They are looking at all the things. Do you work with the same medical doctor for medical validation? Because that's only the pump up the settlement. The only reason it's there. So all of these things are happening. So if you work with these types of mills, you've been for Warren because you're going to be swept in with ups. You've got to be very careful now. So I don't think that, I don't think that that's an inappropriate strategy and I don't think that that is being disingenuous. Now ask me your questions.

Guest Doctor: One of your clients. How can I as a, as a practicing chiropractor, protect myself or insulate myself from being swept up in some, some sort of, you know.

Dr Studin: situation like two separate issues. One is this strategy, so you're not, you know, part of the Schema on number two. It's simple. Reevaluate your patient every 30 days. If you have an MRI and there's a, a positive finding, change your treatment plan, update your diagnoses regularly. Don't do the same treatment modality on every single patient for the same number of visits. Change your treatment plans, have treatment orders for x-rays. If you're, if the hospital took x rays and you have to retake them, you need a macro in there explaining [inaudible] you know, while you're retaking the x-rays you need, you need clinical rationales for everything you do. See that's the problem. And that's what occurs is when you don't have clinical rationales, when you don't have reasons, especially if they're evidence, if they're evidence-based, you know you're golden, but your opinion, that's fine too. But if you don't have these things, then you become low hanging fruit for them. The other issue is you know carriers, well they're looking to make money and get money back. But if you're out there and you're documenting appropriately, your documentation is your armor. Carry it in, listen, I don't think, no one in my world that I know of in all the years of doing this nationally, I have one client that I spoke with one at a California who said, listen, you know, I did a compliance review and I looked at his notes and his billing of it didn't add up. And I said, you know what, just send me a spreadsheet of all of the bills that you for, you know, for these, for this patient and the net. And then the at two patients send me, send me your, your Hickson's, your claim forms. And all of the sudden I'm looking on there and I'm seeing things that weren't done. And they said, you know, you've got things on here that weren't done. Yeah, I've had that happen before. And the doctor said, I made a mistake. I said, well, what you need to do is send the money back to the carrier immediately, voluntarily. You get ahead of it. And they say, I can't wait to write the check. This guy said, You know, I'm not going to do it anymore. He's full. I threw him out of the program. (I W?) and to this day he hates me because I won't work with him. I mean, I just threw him out of the program. So the point is, is that most doctors are honest, have a level of integrity, and not that they're looking to the fraud, the system, the issue is, is that do you document what is your armor and that's it. Your documentation is your armor, it's your shield. And without that you can get screwed. That's how you bulletproof yourself. and they usually won't sweep up people who they can. And you know that darn well. I mean, you've been in the game long enough to realize that, you know, crappy things happen to good people, but you're also in the game long enough to know that there's good and bad documentation and the bad ones usually go down first

Guest Doctor: you're easier.

Dr Studin: No, that's it. Okay. I know you want me to look at an MRI with you, you and your authorship

Guest Doctor: and I'll be there in minute and I'm outside

Dr Studin: All right? Go inside. Call me and I'll catch you in few minutes.

Guest Doctor: Good bye.

Dr Studin: Okay. Bye. Bye.

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