Episode 000 – The Ups and Downs of Starting and Growing a Successful Chiropractic Practice
No one ever said growing a successful practice was easy, but if you work hard enough for long enough it will eventually pay off. Listen to Dr. Tabor Smith, the host of Practice Growth Strategies, as he walks you through the ups and downs of growing his practice. You’ll discover how he almost lost it all, but out of sheer determination, re-built his practice from the ground up and turned it into a thriving Chiropractic office. Practice Growth Strategies is the official podcast of Genesis Chiropractic Software. Subscribe to us on iTunes and stay tuned for more Practice Growth Strategies! Transcript Text: Announcer: Welcome to Practice Growth Strategies, bringing you tips and strategies from the best in the business. To find exclusive work flow, scheduling documentation, billing and all of the tools your practice needs in one easy-to-use platform visit GenesisChiropracticSoftware.com. Here’s your host, Dr. Tabor Smith. Tabor: Hello and welcome, ladies and gentlemen, to Growing Practice Strategies. I’m your host, Dr. Tabor Smith. On this first episode, I just wanted to really welcome you here. I wanted to share a little bit about myself and also what we’re going to be doing with Growing Practice Strategies. I have been very privileged over the course of my career. I’ve been a chiropractor for eight years now, and for the last few years I’ve been privileged enough to be able to do a lot of webinars. I’ve done well over 100 webinars with some of the brightest, some of the smartest and some of the most gifted people in our profession, the wonderful profession of chiropractic. I’ve also been privileged and blessed to do webinars for an amazing company called Genesis Chiropractic Software. If you haven’t checked out GenesisChiropracticSoftware.com, I highly recommend you do that. I use Genesis in my office. It’s an amazing software. I know some of the biggest offices in the world and some of the best chiropractors in the world use Genesis as well, so I highly recommend you look into it. Let me just mention a name. One of the big guys at Genesis is Brian Capra. What a great guy. He is a good friend of mine. He has asked me to host this podcast on behalf of Genesis. He has lined up an amazing list of speakers. As these episodes unfold, I want you to subscribe. I want you to make sure you’re listening to every single one because there’s going to be some tips, some jewels, that you’re going to get out of these episodes that could literally spring your practice forward years in advance. I think you’re going to find huge value in these. Let me start off by telling you a little bit more about myself. I graduated from Parker Chiropractic School. When I first got out, I actually went back to New Mexico and worked for a little while back in New Mexico for about six months. I was going to buy the office that I was working in. That office was for sale. I decided to go back and get a job there and then I would work into buying that practice. It fell through. I believe in our life that failures matter just as much as successes, and I think if you probably looked at your life as well you’d probably see that there are some failures there that you’d look back and say, “Thank God that it didn’t work out.” It’s the same thing with me. I was so glad that I wasn’t able to buy that practice. What happened then was I was able to get another job as an associate chiropractor in Amarillo, Texas, for an amazing chiropractor. Some of you might even know him, Dr. Shane Hand. At the time, we had probably one of the biggest chiropractic offices in the State of Texas and I got to work for him. That’s where I learned the principle of chiropractic. I learned just the power in the adjustment. It was absolutely amazing when I saw life change in front of my eyes. I think it’s okay to say this. We were part of WLP, Dr. C.J. Mertz was a coach there in that office. He’s a great guy. I think it was about after three months of care the person would come back for a group re-exam, basically. It’s where you get the group together and you do another mini doctor’s report just to kind of set those people back on the path of understanding their care and understanding why they are getting adjusted at that office. At that three-month mark there would always be four or five people in this little group re-exam, this group report of findings. What Dr. Shane would do is he would ask each one of these patients what their experience was so far in the office. In front of everybody, in front of the whole group, he would say, “What is your experience? What have you noticed in your three months of care?” I remember 99% of the people in there would have some kind of improvement. Something was better. Some of them would even be absolutely miracles and amazing. I remember sitting there as a chiropractor, just a year out of school, thinking, “Wow.” I had an amazing experience where I could barely walk. I had numbness and pain shooting down my legs, and chiropractic changed my life when I was a teenager. That’s what made me want to go to chiropractic school. When I was able to see that happen in so many people’s lives in such a large practice, that’s when I realized that chiropractic was an amazing thing and that I was extremely blessed to be a chiropractor. I worked in that office for two years. I loved it. Dr. Shane is still a mentor of mine. Then my wife and I, Dr. Gina Smith, moved from Amarillo to Houston, Texas. We decided to open our own practice. We’ve been practicing here in Houston
Chiropractic Philosophy
Learn how to strengthen your chiropractic philosophy and become a more principled chiropractor with this short webinar.
The New Chiropractic Technology I Found That Changed The Way I Practiced Forever
I have told you the story of how losing a patient led me to focus on the patient experience. We’ve talked about how Big Business is using technology to manage and improve their customer’s experience and why Chiropractors have fallen behind, unable to compete without the same enterprise level technology used by the Big Boys. Now, I would like to explain how I was able to gain access to that same enterprise level, multi-million dollar software and implement it not only in my own practice but to begin offering it to other chiropractors who want to quantify and improve their own patient care experience. As I was searching for ways to improve our patient care, I tried implementing the other chiropractic technology that was available. What I found was that it was antiquated in its processes and impossible to use to keep track of any real metrics that would allow me to make improvements. We would still lose a patient and I would go to one of the reports available in the software, find no-shows, expired care plans, or one of the dozens of other reports I would have to search through to discover what went wrong. Then, my staff and I would focus on the reason that patient was lost until we lost another patient for a different reason. It was basically management by fire and it is not how real businesses operate at a high level. That is when I had the good fortune to meet a former CIO of a top-five financial firm on Wall Street and his son who was a Princeton grad with a computer science degree. They were building chiropractic billing software for insurance billing and as soon as I saw what they had accomplished, I knew we needed to deploy it in my clinic. We implemented it in my office alone and my collections doubled. Even more important, it actually leveraged web-based technology and artificial intelligence, learning over time to find necessary billing tasks and delegate them automatically to the right staff member. This meant that my staff and my billing team no longer had to search through piles of reports to find out what work had been done and what had fallen through the cracks. This new technology was allowing us to use the workflow methodology. The system could now find patients who were at risk of being lost. A no-show would become a task assigned to one of my staff members. An expired care plan would be delegated to the appropriate person. A daily SOAP note that was not signed by the doctor would create a task assigned to be handled. That meant that at any moment, my staff and I could see exactly how many tasks were outstanding to manage our patient care experience at the highest level. Now remember my patient Chris. When I saw how this technology drastically changed my billing departments results, I knew I had the answer to helping other doctors with the same patient experience problems that resulted in losing Chris. We began building upon the billing workflow methodology and expanded it to the overall patient experience. The reality is there are three main categories of work every practice has to perfect to improve the overall patient experience. Not just insurance billing. Insurance billing is a subset of main category number one which is Revenue. Other subsets of revenue workflow include cash collections/recurring payment and inventory management for example. The three main categories of the patient experience are Revenue, Retention, and Compliance. I will go into each of these in more detail in future posts. Our new enterprise level technology was automating these three main categories and boiling it down to a single number. The number of tasks that needed to be completed by the end of the day for the perfect patient experience. It was no longer management by fire. Instead it had become single-metric management. Either the number of tasks left to do was zero or it wasn’t. Either every task to make our patient care experience the best it could possibly be had been done or they hadn’t. And, if a task had not been completed, I could immediately see what the task was, who it was assigned to, and follow-up. No more digging through reports. What does this mean to the average practice? Today hundreds of practices across the country are using this new Single Metric Management Methodology and seeing the same benefits I did. Specifically, an average increase in Revenue/visit of 62%, an average increase in Patient Retention of 26% (Average visits a patient is seen before leaving the practice), and an average increase in Compliance of 32% (Documentation and Billing). In future posts, I’ll go over in detail the data analysis we did that proves these numbers. Some “side effects” of Single Metric Management include a drastic reduction in wasted staff hours looking for work, an overall improvement of staff satisfaction, and conversely, a decrease in staff turnover, a decrease in management hours since many meetings are now eliminated, and an increase in a provider’s free time to do with what they wish. Most importantly providers are able to deliver a patient experience that rivals the customer experience seen in the best businesses in the world. The operations of my office had become efficient, effective, and scalable thanks to the implementation of this new single metric management workflow methodology. We had moved from being reactive, trying to fix the problems after losing a patient, to being proactive and making sure everything was done in real time to keep our patients. It became crystal clear that leveraging enterprise level technology to quantify and improve the patient experience had the power to completely change the way chiropractic offices function, decrease the stress of management, enhance patient retention, and above all, improve the care or experience patients received.
Genesis Chiropractic Software Webinar Teaches Three Key Practice Compliance Skills
Industry leaders unveil tested strategies in chiropractic practice management software to increase office compliance and save practice owners time and money in this short new webinar. Genesis Chiropractic’s new short webinar reveals three most effective methods to increase compliance in the office, thus saving chiropractors time and money. The webinar is available online, and can be watched or listened to on a computer here at any time. “Ninety healthcare providers were charged with compliance violations reaching $260 million in billing in May 2014. A growing number of practices are subjected to audits and penalties,” says Reuven Lirov, Chief Practice Growth Officer at Vericle. “Chiropractic practice owners too struggle to maintain compliant practices against a tangled web of regulations from insurance companies, the government, Medicare, and Medicaid.” Each of those unbilled visits would be marked as a “fail” in the audit, with a resulting penalty of $10,000 per line item. According to Lirov, mistakes and oversights in the office are a regular occurrence in most healthcare practices. “Chiropractic office practice managers face difficult problems posed by compliance issues such as the increased risk of audit failure, growing compliance complexity, and lack of time to learn and implement new procedures based upon new rules,” says Lirov. Lack of compliance is a serious issue that can lead to substantial loss of revenue and fines. For example, a chiropractic office might see 100 patients a day, or approximately 25,000 patients a year. Suppose just 0.4% of those visits (100 visits) are undocumented. Each of those unbilled visits would be marked as a “fail” in the audit, with a resulting penalty of $10,000 per line item — or $1 million in audit penalties. “Better compliance liberates chiropractic practice owners from worrying about fines and audits, and lets them get back to treating patients,” says Lirov. “Chiropractic practice management software helps practice owners stay compliant and grow. Our average clients have seen substantial growth in their practices including an average revenue growth of 186% and patient growth of 141%.” [vc_video title=”Dr. Greg Loman D.C. talks about compliance.” link=”https://youtu.be/i0slFN2U1GA”] “We’re in a compliance era in which we must really become compliant,” says Dr. Greg Loman D.C., an accomplished physician, a high volume practice owner, and a co-founder of Maximized Living. “In my opinion it is just necessary that you use Genesis Chiropractic Software by Billing Precision not just a for compliance but for just how amazing their product is.” Continuously increasing compliance requirements and lack of time do not excuse chiropractic practice owner during a practice audit. This short thirty minute webinar teaches the three most important practice management skills to save a chiropractic office and avoid audit failure penalties. The webinar includes a demonstration of Genesis chiropractic practice management software. It contains automated features to discover the most frequent documentation errors that lead to compliance issues, such as undocumented visits, unsigned notes, and late billing. The software is also browser-based, so it can be changed as the law changes without inconveniencing the practice owner. Click here to sign up for the free webinar and find out more information. About Genesis Chiropractic Software and Billing Precision, LLC Genesis Chiropractic Software by Billing Precision, LLC was designed by chiropractic business owners with both patient relationship management and practice profitability in mind. Genesis software provides a complete chiropractic practice management system that supports every role in a busy chiropractic practice, from the owner and practitioners to the front desk and back office. It automates the vast majority of standard tasks, including patient relationship management, revenue cycle management, compliance and office management. Its exclusive workflow functionality continuously improves productivity, control and predictability, fostering teamwork and time savings, which leads to greater profitability and practice growth. Visit https://genesischiropracticsoftware.com for more information.
Monitor Your Chiropractic Practice Health at a Glance
Watch Your Chiropractic Practice Health and Get Back To Your Patients Faster Control your Chiropractic Practice Health! Chiropractic Practices rely on separate reports to understand where they are as a practice and a business. Separate reports require comparison and compilation in Excel or other spreadsheets to stack data and notice a trend over time. Comparison of rows of numbers is difficult without graphics to show trends. Imagine never pulling numbers out of reports to compare where you are and where your business is going. Imagine having a tool that enables you to track your daily business goals at a glance. Imagine the time savings that you can now spend with your patients. Well, imagine no more. The tool is called The Genesis Chiropractic Practice Health Monitor and you can learn about it in this 15 minute webinar.
Is Your Chiropractic Practice Ready for ICD-10?
In this webinar you will learn how to prepare your Chiropractic Practice for ICD-10. ICD-10 codes are unique with a basic five part structure, and there are add-ons. In this case, secondary or supplementary diagnosis codes are required to complete the process. This webinar will cover how to verify if all of your claims are using the correct ICD-10 codes. See the ICD-9 to ICD-10 transition and how easy it is to use.
Audit Proof Your Chiropractic Practice
An Audit Proof Chiropractic Practice is possible! Learn how to audit proof your Chiropractic Practice. Detect your audit risk areas at a glance. Improve your billing compliance by reducing unsigned notes and unbilled visits.
Seal Your Chiropractic Revenue Leaks
Learn how to track your Chiropractic Billing Performance and it’s impact on your office workflow, billing workflow and your billing results. The big secret is the Genesis Billing Stats Report. Read the transcript: Jess: Hi, my name is Jess, and welcome to today’s webinar on tracking revenue for your practice. Conducting today’s webinar are Kathy Casbarro, the head of our SWAT team who has 30 years of experience in Practice Management, and Jason Barnes, our Chief Operating Officer who is responsible for the billing performance for 500 practices. Welcome, Jason and Kathy. Jason: Hello, thank you for having us. And we’re really excited about this whole series of webinars that we get to put on. More importantly, Jess, is that we’re more excited about helping the entire chiropractic profession. When it comes to running a practice these days, we understand how many balls that a practice owner has to juggle. And for those of you on the phone today, we get to personally hear those stories. Kathy, who I’ve worked with now for four years, and I get to interact with practice owners on a regular basis, talk to them about their frustrations, about their successes, the things that really drive them. And the fact that the mission that the entire chiropractic community shares for changing healthcare is really the main driver, makes the talk of money seem sometimes misplaced. But we know that without a solid financial backing, that mission will never be realized. So, we want to start from that perspective today and really make sure that by talking about money, we can help achieve that dream, that mission, that we share with chiropractors. And Jess, let’s get to the next slide here. We wanna start out by helping practice owners understand what we’re trying to do. As an organization, we help practices in a number of different ways, scheduling, billing, documentation, and practice management. But today, we wanna focus on the revenue portion of that. We can’t break out just the billing without talking about your scheduling process, the intake process. When you’re talking about sealing revenue leaks, looking at the entire practice as a whole has to be part of the approach. And Kathy and I, working together over the last few years, know that when you’re talking about office workflow or billing workflow, they’re really the same conversation most of the time. We separate them in this context to help people understand that when you’re looking at lower collections than what you’re expecting, that can be a frustration that can be scary because we know practices that can’t last for more than just a few months without writing that chip. So, today, we wanna focus on understanding where in your process their breakdown occurred so that we can specifically identify it and then figure out a plan to solve it. But identifying it is without a doubt the first key. So, knowing where you’re reimbursement gets stuck, as Kathy and I have worked together, Kathy, when you talk to practices, what’s the biggest frustration you get from practice owners when they’re not realizing the collections that they thought they would have? Kathy: It’s when they’re not, you know, they can’t continue to treat their patients the way they want to, you know, being able to continue with their mission, so the frustration is that they need to bring in the money in order to continue that mission to help every patient that they have in their practice and, you know, that can be a problem for them. Jason: Yeah. So, when that frustration happens, maybe their heart is not into treating the patients the way they wanted to because they’re worried about whether or not they can keep the doors open. We’ve actually had those conversations. I don’t wanna be overdramatic about it, Kathy, but it’s unfortunate. We’ve seen people forced to sell their practices and move backwards back to the role of associate while they figure out how to attack the problem again. We wanna help people avoid that. We wanna see the chiropractic profession really explode, and I think we’re in a good position to help there. So, keep in mind, just kind of recap as I go through this, coming up with a process that’s repeatable for your office workflow, your intake process, is the only way that sealing your revenue approach that we came up with works. If you don’t have a set process, then there’s really difficulty in trying to diagnose it. But you have to make sure that you understand the connectors you’re looking at. So, some of the examples that we’re talking about today is CPT codes. Am I in or out of network? Am I gonna get paid a certain amount? Do I know what that amount is supposed to be? We need to ask those questions and then be able to track the data across many months. And we deal with the smaller, you know, one chiropractor, part-time front office practices, and we got 10 locations, I’ve got 22 chiropractors, 6 physical therapists, I’ve got weight loss, and I need to make sure all of that is running together. So, the difference between them is actually really, really small. Because the intake process, the data collection process that you have to follow is nearly identical. But now we have to track whether or not the breaking points are the same. And in our experience, they’ve been really, really similar. So, Jess, can you hit the next one for us? We know that you can’t operate and fix the problem at the same time. So, the amount of time that it takes you to come up with a root cause analysis of where your practice went wrong is critical. It’s critical to you enjoying a family life or work outside of your office. Kathy, with some of the more complex problems, how much time does it take to actually figure out where the process is broken
PQRS – How 4 letters affect your Practice
Unless you are billing the right set of PQRS codes on 50% of your qualifying visits, then you will lose 2% of your allowed reimbursement. Learn about the changes that this reporting system brings to your practice. Understand how this reporting system affects your reimbursements plus know how and when to use these codes. Read the transcript: Jess: All right. Thank you everyone for joining us today for our webinar on PQRS. Today’s instructors are Kathleen Casbarro and David Alben [SP]. Kathleen is the head of our Billing SWAT department here at Vericle and she has 30 years of experience in this industry. And she is a certified coder. David Alben helps practices achieve and maintain a culture of compliance. He is alsot he also assists healthcare attorneys in defending their clients who have been audited or are subject to prepayment review. So he has his finger on Medicare’s expectations and when it comes to medical documentation. So welcome, Kathleen and David. Kathleen: Thanks so much Jess [SP], really appreciate that. So welcome everybody. I was told about some of the people that registered, and I’ve seen some familiar names. So I’m really glad you’re able to spend a half an hour with us today. So our focus today is going to be on PQRS. We have a single learning objective for today and that is really understanding the PQRS requirements and, you know, Medicare’s rules and the cost of PQRS to your practice. So there could be several of you on the phone that say to yourself, “Well, what is PQRS? What does it stand for? You know, why do I have to go ahead and report another set of claims to the insurance company? I mean, it just sounds like there’s a lot to juggle.” What we wanna talk to you about is, first off, is what is PQRS? So PQRS stands for the Physician Quality Reporting System. It was actually renamed from the Physician Quality of Reporting Initiative. So it used to be PQRI, if anybody familiar with that, and now it’s PQRS. They changed the acronym. The reason why we have PQRS is CMS is wants to make sure that, you know, the patient is getting the right care, that you’re providing the quality of care to your patient. And they wanna make sure that the patients are getting the right care at the right time. That’s what this system is actually built. It was actually built for reporting outcomes. The other thing that they wanna do, too, and Dave is really here to talk about that, I brought Dave on really for the auditing part of this, is, you know, quantifying how they’re meeting the particular quality measure. And Dave, how do you suggest the practice does that? David: So I think it’s important to, first up, really understand what Medicare is looking for, which we’re talking about today. And the other aspect of it is that you pretty much have to patrol your own house, keep it in order, auditing your own claims to make sure that you’re meeting the standards and the number of claims that you need to report on on a…at least a quarterly basis, maybe a little more frequently at the beginning and that everyone on your team understands the significance of this, and why it’s important to the practice. Kathleen: Right, I agree. So the feedback that CMS is getting from this is they’re gonna compare your performance with other peers in your same specialty. And really, the overall goal here is to make changes to payment structures and implement new rules. So, you know, a lot of times you put things on the back burner but, you know, we’re gonna get into later on why really it’s not a good time to do that. We talked about PQRS and what it is and really what it stands for. So, you know, what’s the problem? Why is PQRS a problem? Well, PQRS is a problem because what’s gonna happen is that right now for 2013, the requirements have actually changed. For 2013, you had to report on 20% of your eligible patients within the year and only report on three measures, okay? If you didn’t do that, you’re gonna be penalized by Medicare in 2015 and that’s based on your Medicare allowable. By the way, nobody knows on this call what the Medicare allowable is going to be in 2015. I wish I had a crystal ball for you but I don’t. So for 2014, the rules have changed. So now we go from 20% of your eligible patients now having to report on 50% of your eligible patients. I know most of you out there are going, “Well, what’s an eligible patient? Is that all my Medicare patients?” And we’re gonna get into that, and, you know, nine reporting measures. “Well, what if I don’t have nine reporting measures? What if I only have three? Will I still be penalized?” And we’re gonna get into that as well. But what I’m trying to show here is that you’re trying to juggle a lot of things right now and things are now changing in the industry. Fifty percent of your eligible patients, nine reporting measures, if you don’t report for PQRS in 2014, you’ll have a 2% reduction on your Medicare allowables for 2016, ’17, ’18, ’19, ’20, and so on until they stop. So just remember that. It’s 2016 onwards, not just 2016. So that’s why this is such a huge problem, because this is not going to affect one year. We kinda then have to talk to why is the problem important? The problem is hugely important for a specific reason. Anytime CMS implements something, and they want you to be part of something because they want to make an effect in your industry. So I represented this by a fish bowl effect. On the left-hand side, we have a couple of fish just swimming around,
The Secret to Understanding Chiropractic Practice Cashflow
Obviously, Cashflow will help your Practice grow! On Cashflow: Practice owners and staff regularly have questions about where their payments are, how they can see which insurance companies are helping them, and/or which patients are struggling to pay their bills. Fortunately, with a single report, practices can now periodically review where their payments are and how well their office is functioning, while comparing the metrics that are most important to their success. Watch this free webinar to learn more.
