by Mario Fucinari •
DC, CPCO, CPPM, CIC
Many would argue that chiropractic colleges did not prepare us properly for the business side of chiropractic. Likewise, many would say that none of us were ready for the hardship and strife we faced last year. The pandemic, staff shortages, inflation, rising costs, and decreased reimbursement have also taken their toll. One fact that has emerged now more than ever is that you must work smarter, not harder, to survive.
Businesses have been affected by the pandemic. FEMA statistics tell us that 40% of companies have never reopened, 90% will close within two years after the disaster, and 56% of businesses have no contingency plan. Hopefully, you remained open through the pandemic. Now is the time to not only ramp up your practice but have a clear sense of how your practice will adapt to the coming trends in healthcare for the next several months, and yes, even in the coming years.
Step One: Have a Vision
Gather your most trusted advisors, including family, staff, and consultants. A certified compliance consultant may give you insight into regulations and rules on such issues as discrimination practices, CDC guidelines, Occupational Safety and Health Administration (OSHA) guidelines, and most significantly, HIPAA. HIPAA and OSHA requirements require forming an Emergency Mode of Operations Plan and the ability to grant access to patients of their health records and health care. Weather-related emergencies, power outages, sickness, fires, and water damage are a fact of life.
Step Two: Have a Communication Plan
Communicate your vision and goals for the future. Even though many people are vaccinated, others are not vaccinated and do not plan to be vaccinated. We have all experienced the “cold and flu season,” but now add the COVID season onto the list. At the time of this article, there is evidence that the Delta variant of the COVID virus is gaining prominence throughout the United States. The vulnerable individuals include patients, doctors, and staff over the age of 60, immune challenged, and experiencing pre-existing conditions. Although the chiropractic philosophy plays a part in your thinking, your business decisions need to be based on sound objective principles. How is social distancing in your reception room, check-in, check-out, and treatment rooms going to look in the future? What type of personal protection equipment (PPE) and cleaning policies and procedures will continue? No matter what, you should consider monitoring CDC guidelines for such protocols.
Communicate with staff, patients, and your referral sources what is new within the office. Have you added in services such as wellness care, orthotic evaluation, or rehabilitation? You are the captain of your ship and must chart the course of your future.
Step Three: Design the Office to Maximize Efficiency
Although you are an administrator, you are also the doctor. It is difficult to wear two hats at the same time. You have to have administrative time and doctor-patient time. Time is the one commodity we can never have enough of. To work more efficiently, ask yourself, on patient care, as the doctor, what are my job duties? The doctor’s responsibilities are to examine the patient, render a diagnosis and treatment plan, and perform the manipulation. All other duties may be delegated. Use technology to make your life easier! The staff may collect information, and the patient or authorized representative may supply information directly by portal or questionnaire. The health information is then reviewed by the physician or other health care professional. The extent of the history and physical examination is not an element in selecting the office or other outpatient services code.
Use technology to reduce time in the office. Reduce patient time in the office by emailing intake forms to the patient or having them available on your website. When updating their information, encourage patients to use a secure online email or portal to process their forms on your website, complete questionnaires, electronically sign documents, and process payments.
When a patient initially calls the office, the front desk staff should triage the patient, get all insurance and financial information, and schedule them for a virtual consultation either that day or the next day. Processing information immediately reduces no-show patients. Consider using telephone or video conferencing to pre-screen patients (pre-consultation). Clinical staff will call the patient, update the chief complaint(s), history, mechanism of injury, surgeries, medications, and COVID history. The time the clinical chiropractic assistant takes to do the consultation is not charged for directly but aids in reducing the doctor’s valuable time away from other patients. When the patient arrives in the office for their examination, the doctor reviews the information contained within the intake forms and the consultation notes. The doctor can then ask the patient any follow-up questions and perform the examination. Any information gained on the examination day would constitute elements of the Medical Decision Making (MDM). The doctor will examine the patient, but the days of patients sitting in the office with a clipboard filling out forms are over. Under the new evaluation and management guidelines, consultation is no longer an element used to determine the level of examination. Medical decision-making is the preferred element to determine the level of the examination and management code. Time may be used instead, but indications are that insurance companies will audit your documentation of time if they think it is excessive.
Step Four: Expand Your Wheel of Services
Like a bicycle wheel, the axle of the practice is manipulation. Each spoke entering into that axle is another stream of income. Diversity of income streams will benefit the patient and provide you with other sources of income. Examination, x-rays, orthopedic supplies such as pillows, custom-molded orthotics, nutritional supplementation, and rehabilitation are examples of other services and income sources. All of the services, when medically necessary, will ethically be used to treat a patient, thus providing a win-win for the patient and doctor.
As outlined by Medicare and other insurance companies, a service will be considered medically necessary if utilized to improve the patient’s function. Consider tools that you may offer in the office to improve function.
Step Five: Document Everything
Documentation is the key to risk management. It is required for compliance, but you risk the backlash of possible litigation for negligence without it. Cases have been brought forth by employees of companies such as Target and Walmart, alleging that the employer did not adequately protect their staff against the COVID virus. When brought into question, your compliance manual will establish the record of your good faith effort to meet compliance requirements.
Your documentation should include your policies (your intent) and procedures (step-by-step actions to accomplish the intention). After establishing and conducting training, make sure to document and have the staff and doctors sign an attestation of their knowledge of the policies and procedures.
It is no doubt that the Coronavirus pandemic will shape our lives, activities, and memories for years to come. Proper preparation, accomplished by training, will ultimately lead to a successful stable practice. Learning to work smarter, not harder, will ensure a thriving practice for years to come.
Dr. Mario Fucinari is a Certified Insurance Consultant, Certified Professional Compliance Officer, and a Certified Physician Practice Manager. For the HIPAA Manual and Corporate Compliance manual or personal coaching on office procedures, you can check his website at www.Askmario.com. Dr. Fucinari is also on the speaker’s bureau for ChiroHealthUSA, NCMIC, and Foot Levelers. If you wish to have him speak for your group, you can contact him or one of the speaker’s bureau for availability and class content. For further information, you may email him at Doc@Askmario.com.
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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.