Kathy Mills Chang, MCS-P, CCPC
Chiropractors know how to diagnosis and treat patients to free them from pain and get them back to functioning to their full potential. Even those of us in the profession aren’t immune to the magic; from the infants to the infirmed, we’ve witnessed firsthand what chiropractic can do, and it’s nothing short of jaw-dropping. What’s also a bit jaw-dropping, however, is how many chiropractors struggle with identifying and diagnosing the cause of their own practice’s pain and dysfunction. Just as DCs wouldn’t recommend a patient ignore symptoms, we urge doctors to address symptoms of problems, both big and small, in the office when they first appear.
You know when’s something’s off in your practice. Your numbers may be down. Patients may be disappearing midway through treatment. Your records requests are up. You’ve got a lot of staff changeover. But you may not know why. One way to begin looking for the source of the problem is to identify those areas of your practice that need attention and correction using the same techniques that you use to approach a new patient:
- Take an appropriate history
- Perform an examination
- Diagnosis the problem
- Formulate a treatment plan
The History
When you sit with a new patient and explore his or her history, you ask questions that will direct you to the cause of the problem. The four components of history according to the Evaluation and Management Documentation Guidelines are; identifying a Chief Complaint, taking a History of the Present Illness, completing a Review of Systems, and probing Past, Family, and Social History. Read on and see how easy it is to apply those same principles to getting to the bottom of your practice headaches!
- Identify the chief complaint by discussing with your team which programs or systems are creating backlogs, difficulty, or other concerns. You may be able to get to the bottom of it by asking, “If you could wave a magic wand and change something to make your job smoother and easier, what would it be?” A compilation of these concerns will usually lead you to your chief complaint.
- Once you identify this area of focus, get to the bottom of the history of this concern. Gather your team and find out how long it’s been going on by asking questions about the evolution of the problem. Has it been a problem in the past, and how did you deal with it? Has there been a time when this problem didn’t exist? Use assessment techniques like “O, P, Q, R, S, T,” just as you do with a patient, to get to the bottom of things.
- Now you want to review your systems. The systems of your practice should be thoroughly reviewed to see which ones are causing the problem. Systems like documentation, billing and collections, patient finances, Medicare, compliance, patient communication (and others), and the lack of order and/or standard operating procedures in any one or more can certainly cause practice headaches.
- Finally, take a look at your own personal history with this problem. What broken processes or other accidental shortcuts have been going on in the practice that may have lead to this “chief complaint?”
The Exam
The next step is the physical examination. You’ll use the information gathered in the history to perform tests and measurements that will help you diagnosis the problem. Since this is the quantifiable portion of the assessment, take the historical information you’ve identified and perform appropriate tests to lead you to a differential diagnosis. Reviewing statistics in the area of your chief complaint will often uncover the breakdown of processes. If increasing missed appointments are the problem, the statistic will reveal that, and you can then review the procedures for appointments and follow-up calls. When collections are the problem, a review of your CPT code usage, your total of production, or income could be the indicators that lead you to identify potential compliance issues or money left on the table.
Diagnose the Problem
Now that you have all the data from the first two steps, it’s time to name the problem. Once the problem is identified, you can begin to recognize what it will take to treat the problem. Often, just being able to identify the broken system or procedure will shrink the problem down to a manageable size. It’s easier to wrap your arms around the solution to a problem when you clearly know the cause of it! Just ask all those satisfied chiropractic patients.
The Treatment Plan
Now it’s time to treat the problem. Just as you would with a patient, lay out a plan that you can execute to achieve your desired goals. Like any complete treatment plan, know what measures will evaluate the effectiveness of this plan. What statistics will be pushed upward because of this plan? What new systems will replace those you’ve identified as ineffective? Consistently implement new procedures by starting first with the ones that cause the biggest delays and interruptions of patient care. Have regular team meetings or daily huddles to discuss, plan, and better prepare for the correction of the identified problems. Include your team members in this process! You will encourage teamwork and cooperation when changes are implemented by making sure everyone has a voice in the decision and agrees on the changes that are necessary for improved patient care and efficiency. Just a few little improvements here and there over a period of time will yield tremendous gains in the quality of patient care, provider and staff satisfaction, not to mention your bottom line!
The process of indoctrinating new patients into your practice, including all the steps necessary to get to the cause of their problem, is such a great model for getting to the cause of practice challenges and inefficiencies. Commit to using this process to get to the cause of your practice headaches and create solutions that will give you the practice ease you desire.
Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. Kathy leads a team of 14 at KMC University, and is known as one of our profession’s foremost experts on Medicare and documentation. She or any of her team members can be reached at (855) TEAM KMC, info@KMCUniversity.com or www.KMCUniversity.com.
▶︎ 
Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.