Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 246

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 3"

I spent yesterday in the office I am building from scratch. I will be going weekly for a few weeks as I have shared with you previously. My job, yesterday, was to interview a few providers and institute front desk systems and paperwork. I interviewed DCs, MDs and a PA.

As for the DC,  I did a phone interview the day prior hoping to get a face-to-face scheduled for yesterday as I never initially sit with DCs or any potential professional candidate for hire. If he/she can't get through me on the phone, he/she will certainly fail the "in person" interview and waste more of my time. This doctor shared with me that he is a diplomate in sports chiropractic and also electrodiagnostics and neurology. Therefore, he is worth more money than the average DC. My response to him was that if is so valuable, then why is he failing in his own practice, necessitating becoming an associate doctor in a different practice? He said he was looking for better opportunities...which is bullcrap or code for, "I failed alone because I can't figure it out and I hope you did so I can get money from you." 
After 5 minutes of listening to him drone on, I simply said to him, "This is a trauma based practice and with your permission, I would like to ask you some clinical questions regarding MRI spine interpretation and triaging the injured patient." I also informed him that I teach this at the post-doctorate level. His answer was, "Dr. Studin, I have patients backing up, can I call you first thing in the morning to finish this?" That was supposed to be yesterday and I am still patiently waiting by my phone. It is amazing when you have the knowledge (power) and can appreciate truth vs. rhetoric.I will not hire this DC unless there is a very good reason that he didn't keep his word and he is the real deal clinically...not to mention...this job carries a 6 figure salary with all of the benefits afforded giving reason for him to want to talk to me.We are still looking for the right candidate.
As for the front desk systems established, since this office has a part time PT, I instituted the calendar and the made up missed systems. As chiropractic and PT are similar in visit frequency and evaluation requirements, I implemented those immediately. The calendar system, as I have discussed in previous consultations, is where you track the visits on the front cover of the chart so the provider can easily see the compliance of the patient's visits. This is critical to increase the compliance of patients as you track the misses. It also gives you the knowledge to know who to spend more time educating vs. who gets it and doesn't need as much time. 

As for the made up missed program, this was the first system I introduced into the practice as my experience has proven that this system increases volume up to 30%. I don't want patients coming in and not having their appointments kept or not getting the requested frequencies of care and resultant poorer clinical outcomes. I spent time educating the staff and picked the sharpest staff member as my go-to person so that everything I institute gets done. This is called building an infrastructure. Without a solid infrastructure, the office will be mediocre and that is a word that is synonymous with cancer to me...I would rather be dead than mediocre.

The next step is to institute a SOAP note system for the PT and evaluations and re-evaluations. I modified the one I recommend to you to use to work for the PT so that I can ensure that the PT is compliant with all requirements for "5" level evaluation as clinically indicated. My biggest concern is not one of reimbursement, although that will automatically increase reimbursements. My concern is setting up systems to force compliance through admissible and complete documentation where the staff has control over the completeness of the forms, affording a series of checks and balances in a very busy office to ensure compliance. 

Until the infrastructure is complete, I will not put 1 new patient in this office. Why bring in new patients only to fail at delivering the best care, the best documentation and the highest level of compliance? Infrastructure, infrastructure, infrastructure is the surest way to ensure success and not having to give back every penny you have earned, plus some!There will be more to come in the next few days on this project as I will keep you posted regularly.

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