Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 243

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.

“PI 101...Building It From Scratch, Part 2”

I spent yesterday in the office I am building from scratch. I will be going weekly for a few weeks. My job, yesterday, was to create a team specializing in musculoskeletal care. Since this is currently a large medical center specializing in mental health with an orthopedist employed 1 day a week and a PT 2 days a week, I need to create a team that works. In order to do that, I had to determine if the orthopedist was amenable to working in an interdisciplinary environment as well as the PT. The first order of business was to assess the current players. The end result, yes for the PT and no for the orthopedist.Here's how I built our team.
In analyzing the most efficient pathway for building a team, I realized that there is 1 common denominator that would know the level of clinical excellence of doctors as well as their personalities and availability. It is the MRI company as they are the common denominator of all musculoskeletal care providers. We all need MRIs and the MRI company is all about schmoozing and knowing the players to ensure success in their MRI business. However, what's in it for the MRI company? You know the answer; it's always about the money.
I contacted an MRI company that I had worked with in the past at 9 AM and sent an e-mail; I didn't even make a personal phone call. Here is what I sent:
"Jeff, I need to meet with you today between 11 AM and 11:30 AM. I am consulting a large multi-specialty group and want to create a relationship exclusively using your facility for all MRI and ancillary imaging needs. Currently, the office does no (zero) musculoskeletal care and I am going to create a huge musculoskeletal component and have gotten all parties to agree to use your facility based upon my knowledge of your clinical excellence. Please confirm."
Within 5 minutes, I received a reply reply: 
"Mark, Myself and my partner will be there. What is the address?"
Whether you are a multi-specialty group or a stand-alone chiropractic office, there is little difference as you are going to be the cause of increased referrals to the MRI facility and you will get their attention immediately. At the meeting, the conversation was simple and lasted for 5 minutes. I said that we needed to create a team of medical specialists and who would they recommend as clinically excellent and EASY to work with? My goal was to create my team and the MRI company's goal was to keep all of the referrals pointed to them.

They instantly gave me a short list of every specialist I needed and then told me to do nothing. They left and called all of the specialists. I spent the day getting phone calls from some of the specialists they recommended and for the remaining specialists that I didn't talk to, the MRI company set up face-to-face meetings for me which will take place early next week. In essence, they acted as my recruiting agents/head hunters and did all the hard work. Your job is to let them know what you want from them; the ability to refer and have a conversation on any difficult case. In addition, you need to gently let them know that you expect all referrals to end back up in your office. Nothing more. As time goes on and the referral process starts in their direction, that is when you sit with them and let them know your expectations for referrals back to you. The moral of this story, let the MRI company create the "easy button" in building your team.
The next task I started to accomplish was to implement a system where all services are "macro'd" for musculoskeletal care. This includes both chiropractic and PT as both have similar CPT codes. This will ensure that the provider, based upon clinical necessity, does not "underbill" because we will have done our homework up-front based upon what specific carriers of different financial classes pay for. This process, which everyone should engage in, will prevent rendering free care for services that carriers do not cover it. If a patient needs care, it is your responsibility to create the treatment plan and implement care. It is the patient's responsibility to ensure that you get paid for your services; it is not your responsibility to give care for free.
Treatment macros help you figure out how to create what can and can't be done by carrier or financial class and ensure an efficient delivery of services. To give a corollary that will help underscore this, my friend's daughter has a congenital heart condition. She is currently 7 years old and had open heart surgery 5 years ago for a fee of $75,000 at Boston's Children's Hospital. She now needs another surgery and the hospital said that everything required is not covered by their insurer based upon the language of their policy and it will cost them $60,000 beyond their policy. They have 2 choices, pay the fee or the services will not be done.
I have heard the argument form chiropractors nationally that if a patient is in pain, how can you not do the service? My answer is, if Boston Children's Hospital won't do the service, this child could die. To give the rest of the story in fairness, they will do a review and offer a financial hardship package and you could do the same. However, if this becomes the rule and not the exception, you will go out of business over time. Pick and choose wisely.
In my formative days in practice, I gave away 30% of all services until my wife came in one day and said, "You know that patient that just left and didn't pay because he couldn't? He couldn't because he just bought a new Mercedes and he has a payment due for his next holiday vacation to France." I then (because my wife made me in 1984) made every free patient pay my fee. I lost 30% of my practice in 2 weeks because these people felt my services were worth what I charged them, ZERO. It took 8 weeks for me to get my volume back to its previous level. However, almost everyone paid my fee with my new financial hardship office policy. 
It's matter of priorities for many patients and it's your job to get them to realize that you are a priority. Create a system that works and that is what I am doing in this office I am consulting for. In this office, we haven't even hired a DC yet. I spoke with one that the MRI company gave me and I will be interviewing him next week. More to come in the next few days on this project as I will keep you posted regularly.

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