The Loss that Led Me to Focus on Patient Experience in Chiropractic
In chiropractic school, we are taught to examine, identify problems, create care plans, and to adjust patients. A lucky, or more prepared, few of us may have taken outside seminars to learn about strategies to bring more patients into our office, billing tactics to increase revenue, or practice management techniques. Yet, for all that we learn, the hours and years we put in to become Doctors of Chiropractic, we are never taught the most important part of having a truly successful business. We’re never taught to focus on the patient experience. Just out of chiropractic school, I was no different. I was running what I believed was a successful practice. I was helping a lot of patients and making a lot of money.. At the same time, I was trying to wear too many hats – business owner, staff manager, doctor. Things were falling through the cracks without me knowing until it was too late. I will never forget the day one of my patients came in and told me he was thinking of killing himself. No doctor is every really prepared to hear something like this, much less, a young doctor, still learning. My patient’s name was Chris and he had come to see me for low back pain, something chiropractors see every day. He had received his report of findings, had proceeded with care, and was getting great results and relief from the pain. At his words, I felt shock. I asked what had happened. The story he told me was incredible. After coming to the class that I held for new patients, he had decided to turn his life around. Hearing the chiropractic message and learning how his health affected every aspect of his life as well as his family’s life, he had made a life-changing decision. He quit drinking. He quit drugs. He was going to get healthy for his wife and children and he was going to do it cold-turkey. But now, he felt like taking his own life. After listening to Chris’ story, I was amazed that he had been affected so deeply by the chiropractic message and thankful that he had truly understood it to the point that he was determined to change his health to improve the future for himself and his family. And, I’ll admit, I was proud that my class, my words, had been good enough to change a man’s life. Yet, how could someone who had understood the message on such a deep level now think of killing himself? Chris and I spoke about what he was feeling and how, after the years of punishment his body had been through, it was natural to have difficulty trying to achieve homeostasis again. I explained how the chemicals in his system had been affecting his whole life, including his thoughts and how things were now trying to balance out as his body fought to move toward health. He understood. He got it, just like he did the chiropractic message, and we continued care. Then came the day when I realized that Chris had not been in for a visit in a while. Chris had understood the chiropractic message so completely that he should have been a patient for life. I pulled his chart to find out what had happened. That is when it became clear that once again, something important had fallen through the cracks. Chris had missed appointments, yet we had not followed up with him. His care plan had expired and his billing was not in order. These things that are so vital to patient retention had been missed. I immediately called Chris to find out how he was and to set up an appointment for a follow-up. That is when I found out that Chris was dead. He had taken his own life, just like he had talked to me about. That is when I knew with complete certainty that the systems we had in place were not enough. We tried to call patients who missed appointments, follow-up on care plans, pre-arrange billing with patients, and so many other tasks every single day. Yet, sometimes, my staff became overwhelmed or simply forgot. Other times, they would give up calling a patient who had not responded. And, so many of our systems relied on memory, leaving my staff and I to juggle all of the responsibilities, hoping no one dropped the ball. We only knew to follow-up with patients when I or one of my staff realized someone had not been in to see us for a while. We only knew to check on insurance claims when someone remembered we had not been paid. I knew that other industries used different technologies and software to manage the customer experience. Yet, the Chiropractic profession had no software to manage the Chiropractic patient experience effectively. There were many chiropractic software companies and practice management softwares available. However, not a single one broke down the patient experience into manageable tasks. And, not one offered one simple daily report to let the doctor know whether the necessary tasks had been performed. Instead, they all forced the doctor to wade through piles of reports, to check each individual aspect of the practice, an ineffective and time-consuming chore, at best. To find a solution, I had to go outside of the chiropractic profession, to find out what big businesses use to manage the customer experience. Since that time, I have dedicated myself to finding a better technology to break down and manage every aspect of the patient experience and making it available to chiropractors. And, so that I would never forget the man who first opened my eyes to the necessity of managing the Chiropractic patient experience, I named my son Christian in his honor.
Note-Worthy
Staff and Office personnel have to work together to make transition easier. Can Ben’s self-improvement plans cause trouble for his staff? Pam looked up as Ben bustled into the office. “You’re energetic today!” “I’m feeling inspired,” smiled Ben. “We’ve made some smart changes in the practice, and we have more coming up, so I think I’m ready to tackle changes in documentation.” “I’m impressed,” said Pam, “but I hope you’re not going to make too many changes. I feel like I’ve had just about all the change I can stand.” Ben was surprised. “I don’t think this is going to be a problem, Pam. We know that the new ICD-10 codes that go into effect in October are going to require more detailed documentation. I’m just going to get a handle on the new requirements.” “I understand that,” Pam sniffed, “but I feel like I have just gotten to where I can completely understand your notes and pick out the important keywords for coding. If I have to get used to a whole new system… well, if it’s not essential, I’d rather we didn’t make any more changes, that’s all.” Ben took a seat. “You know there are a lot more codes in the ICD-10 system than with ICD-9 codes–” “Don’t I know it! Almost 70,000 total.” “And one of the reasons there are so many more is that the codes have to be a lot more specific. If you don’t have very specific clinical documentation, it’ll be easy to get the codes wrong.” Pam said nothing. “If we have too many coding errors, or inaccurate documentation, it becomes a compliance issue.” Pam frowned. “I see what you’re saying. We could face non-payment issues, or even be audited. That would be a lot more trouble than getting used to a new style in documentation.” “Exactly.” Ben stood and stretched. “Tell you what, I’ll work on my handwriting and punctuation at the same time.” Pam laughed — or, thought Ben, maybe it was a snort. Either way, he was ready to get on top of the new demands for documentation. It felt good to have a clear goal. Can Ben’s self-improvement plans cause trouble for his staff? See our ICD-10 page for more information and more blogs on the diagnosis codes.
ICD-10 | 100x More Complicated | Q&A
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning chiropractic billing procedures and software requirements. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar ‘ICD-10 | 100 Times More Complicated,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that? A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10. Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code. GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA. Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our chiropractic documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do? A: You really want to make sure that how the practice is supposed to document the guidelines for chiropractic documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS. Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10? A: Right now, you have to certify for both, but after October 1, you only have to certify for ICD-10. Q: Are you able to come out and help us train our staff? A: We can give you the tools that you need in order to train your practice. For chiropractic documentation, have them listen to our webinar in March, but they can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you. View our ICD-10 page that has a collection of information about ICD-10.
Something for the Pain
By Kathleen Casbarro Simplifying coding issues can relieve practice tension How can software make a difference in the ICD-10 changeover? “Doctor!” The box on Ben’s desk squawked. Pam always sounded professional, but Ben knew her well enough to hear the tension in her voice. Ben hesitated for just a moment over the stack of paperwork he’d been plowing through, but decided he should respond to Pam’s obvious stress. As he neared the front desk, he heard raised voices. “You’ve already been to the doctor!” a young woman shouted at an older man whose face was set in pain… or perhaps in stubbornness. “He’s already been to the doctor!” she repeated in Pam’s direction. “Maybe I can help,” Ben offered. “I was in a car accident–” the older man began. “My dad has been to the doctor and to the hospital,” the young woman said firmly, “and they told him it was back pain and it would get better in time. They gave him pain medication to take and he won’t take it. Now he’s insisting on coming here, and I don’t think his insurance will pay. I just want to take him home.” Family altercations weren’t as common in Ben’s chiropractic clinic as they were in hospitals, but he recognized the situation. The daughter was worried that her dad wouldn’t be able to pay, the old man was still in pain, and their worries were showing up as anger. “Let me take these good people back and have a little chat,” he said calmly to Pam. Getting the shouting out of his waiting room was the first priority. He’d get them calmed down, explain the situation, and then bring them back to Pam for intake, and the paperwork — well, it looked like he’d be working late again. It was hours later when Ben had a chance to discuss the event with Pam. “I’ve been thinking about the man who’d had a car accident,” she said. “We’re always careful to avoid using the ICD-9 code 724.5 for back pain because it tends not to get paid. We make sure to use the most specific code we can so the patient’s insurance will be able to pay.” Ben nodded. “I realized that I don’t have that knowledge about the new ICD-10 codes,” Pam continued. “We’re always focused on the people we treat, but the paperwork is what allows us to keep the doors open and take care of those people. I’m worrying that the new insurance reporting codes will get in the way.” “I think we may have a solution,” Ben said. “I’ve been talking with the people at Genesis — the new practice management software. They had a really sensible approach to it. Three things: assessment, documentation, and implementation. That’s better than focusing on the 70,000 new codes, right?” “It might be,” Pam said uncertainly, “If I knew just what that meant.” Ben laughed. “Fair enough,” he said. “What I get is that the software will cluster the codes into groups so we can drill down to the right one, instead of trying to memorize everything. We’ll be able to see the relevant ICD-9 and ICD-10 codes on the billing screen, along with which payers are using each set, and we’ll have a crosswalk that will let us learn and train before the deadline.” “All on the billing screen?” Pam sounded excited. “That sounds workable.” “Workable,” Ben repeated. “That’s it exactly. It’s like when we get a patient having a meltdown in the front office — we may feel a little stress, but we have workable systems in place to handle it, and it turns out well.” How can software make a difference in the ICD-10 changeover?
