Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 117

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.

"Multiple Appointments"

I have spoken to many staff members across the county and very few enjoy making multiple appointments for patients. In previous consultations, I strongly suggested that you make the patient’s re-evaluation at the time of the initial evaluation. This way, you close that hole in your practice of not having all of your patients re-evaluated every 30-45 days. By making the appointment on the day of the present evaluation, you ensure the patient has that appointment and you protect yourself against retrospective reviews claiming you are not treating within accepted standards. Remember, you need an order to do any care, and treatments/adjustments fall under the care category. You need ongoing orders from yourself that indicate all care required in your E & M report. The “M” stands for management for a reason.

Note: You did notice I said E & M report? Don’t overlook the word "report." I strongly suggest you send your reports to the carriers to avoid retrospective reviews. If they have the documentation, what are they going to look for in your office? Let them go elsewhere.

Should you treat beyond 30-45 days without continued orders, as defined by every standard, you are looking for trouble. Most forums will not have an issue if you go up to 60 days, but try not to push it too much. An office that treats beyond 60 days is not looking for trouble, they are asking for it. Don’t worry, as the request will be answered. Just give it time!

Again, as before, I urge you to get an internal audit by Dr. Schonfeld who can be reached at 516-695-7732. Make the audit your choice, not the decision of some third party who is trying to legally extort money out of you. An audit is also very confronting as it will bring out many issues that need to be fixed and is even sometimes shocking. However, when you are in control, it becomes a very comforting experience. It is also the least expensive thing you can do to ensure compliance, save lots of money, reduce your stress level and increase your sleep at night. I can easily name ten people who didn’t listen and are now in the middle of insurance company induced hell and scrambling to raise lots of money to pay for the lawyers and settlements.

As for treatment appointments, you should have your staff make appointments for the entire period between evaluations. Yes, every appointment. Your staff will complain, some more vigorously than others, but IDNGARA (see previous consults for the full text of the acronym). This will accomplish many things. First, it will ensure all patients have appointments for the month and your appointment book will be full. The patients will be more likely to keep appointments already made than they will be to make new ones every week. A national survey taken in May, 2009 revealed that only 17.9% of the profession makes patient appointments for an entire month. That means 82.1% of the profession are “missing the boat.”

When your staff makes the appointments, 80% of the patients will be happy to work within your system, while 10% will be thrilled and the last 10% simply will not comply, but don’t make them. Inform the patient that you are getting very busy and you want to ensure he/she has a time locked in that is convenient for him/her. Create the paradigm shift that makes it about the patient, as it really is.

Again, the primary complaint will be from the front desk staff that has to implement the program and they will argue that they have a better system that has been working for years. Be polite and respectful of the hard work they've done in the past and then tell them what to do. If their system worked so well, then why hasn’t your practice grown to where you want it? I want to remind some of you that your staff works for you, not the other way around!


  1. Make all re-evaluation appointments at the time of the current evaluation, including the initial visit.
  2. Get an internal audit and protect your butt.
  3. Make appointments one month at a time (the entire time between evaluations).
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