Academy of Chiropractic
Quickie Podcast 1195
Compliance 61 CA
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
Dr Studin: I just got a call from a doctor, who told me that he just left a meeting with state farm and his criminal defense lawyer and he has collected over $2 million in direct payments and since the beginning of time of his practice, he has $3.6 million in paper in addition that he did not collect on nor does he expect to collect that. But state farm wants all $5.6 million to be paid back to them. And this is happening in real time, They're claiming that all of his notes pretty much look alike. It's the exact heat stim adjustment exercise on every patient. He's not re-evaluated the majority of his patients. He works with the same orthopedic surgeon on a regular basis, and he only works with two or three lawyers and that's it, of which he sees their cases and they see his, and that's the basis of their claim, he's got some kind of pig ponds, ping ponging scheme with those few providers since the beginning of his career. So now what do you feel about all of that?
Guest Dr: That makes me a little bit nervous for him. But, I mean, I'm not looking at his records, but I would hope that each patient that arrived at his clinic that they would have different findings associated, different diagnoses. And treatment that he provided would be appropriate for the condition that they had.
Dr Studin: that's 100% correct. But, it's interesting that most of our patients get similar care. I mean, you have one technique, you do that technique over and over and perhaps you might go spineless left on this one or spine is right on the next one. But are you going really deviate much from heat STEM, adjusting, therapeutic exercise? Those are all modalities.
Guest Dr: No, I think as a general rule, you kind of have a general parameter for what you do. No different than a spine surgeon has a real similar routine of things that he does. I mean, maybe the surgery that a different level or what have you, or there might be a little bit of a difference here or there, but for the most part they have a standard operating basis that they do to get the best outcomes.
Dr Studin: And that's where documentation comes in and EMR macros, which state what you're doing and why and have the treatment order for everything. That's specific to that finding, and the other thing, Listen, I always worked exclusively with dr. Shabby He is a neurosurgeon. My patients all went to him cause he had great apples clubs, but I did hundred percent have more than two or three lawyers I work with and then I work with dozens of lawyers and I work really hard to expand that platform. So I guess what you're saying is it all comes down to documentation and also his records almost every visit on every patient looked almost identical. So which is another problem. And yet if you don't reevaluate regularly, it all looks cookie cutter.
Guest Dr: And to have things that we can, you can't do that. So, you've got to make sure that you're assessing the person as they come in on a day to day on the interval basis, meaning between re-exams and a document and all that.
Dr Studin: Well, I'm not in the pits anymore. You are, I mean, you're still seeing patients on a regular basis and you're going through that. I mean, but you've got your standard operating procedure of how you adjust patients and, and what you've document, if state farm came to you with the microscope and said, and by the way, they had a whole PowerPoint about his treatment trends, what percentage of cases got this adjustment and that adjustment and what percentage saw this orthopedist and they really had an all on graphs and PowerPoints, everything over the past like 10 years, Their algorithms are designed to be able to ferret these things out. How would your practice do with that? Do you think you're vulnerable? Just as he is?
Guest Dr: I think anybody could be, if there were going at that kind of a level, if they were trying to question somebody running on a standard operating basis, I mean there's obviously variable within my office about the various symptoms and things. I have a reasonable protocol that I run on people it's not necessarily everything is the exact same every visit and but there's a very similar theme that I work with on people and I don't think that that's much different across the board with anybody across the United States.
Dr Studin: So therefore, it comes down to one thing and one thing only documenting the Sesame. Right?
Guest Dr: Yeah, I think you would have to do that and justify what you're doing.