Stay, pay or refer. It’s the golden rule of growth. It’s that practice rule of thumb that guides doctors in their practice decisions. The rule, of course, is this: Every decision you make in practice should be related to patients staying in your practice, paying for your services, or referring friends and family. If it isn’t somehow related to one of these three things, don’t do it. (Of course, referring a patient to another provider or discharging them is still an event that can result in patients respecting you for that effort and referring others to you because you demonstrated professionalism in managing their care.)
So, how does electronic clinic management hold up against the golden rule of growth? Remarkably well, especially when you find the right technology for your practice. In fact, I think if you’re going to invest in electronic clinic management, that decision shouldn’t just have to meet one of the golden rule’s criteria, but all three. Your use of clinic technology, particularly digital documentation and electronic clinic management, should help patients stay, pay and refer.
To Stay
As a young doctor in the late 1980s, I quickly learned the economics of practice growth. New patients are an absolute practice necessity, but they are also a large investment of time and money. It’s cheaper to keep current patients happy and active in your practice than it is to be a new-patient magnet 24/7. Unsatisfied patients lead to erratic and unsustainable practice growth spurts and a life of stress.
What factors determine if a patient stays or goes? Good results are the two words on the lips of many chiropractors. But even more important than good results is the patient’s understanding of your treatment objective. The right kind of clinic management should help you help patients understand what you do on the most important front: the patient plan of care.
There is a particular problem in patient management that limits chiropractic practice growth. It is the tendency for chiropractors to rely on grids of visit frequency as care plans. Clear objectives of functional improvements, outcome measures or adaptations to activities of daily living are all absent. “Decrease frequency and duration of pain” is a great objective, but one that often comes quickly and temporarily with chiropractic care.
Patients without a care plan have no reason to stay when their pain is gone. They can’t know what your functional goals are if there’s no care plan written down and no re-evaluation on the schedule. If their understanding of why they’re in your office goes no further than “getting checked,” they are going to check out and manage their own care by seeing you “when they need you.” And if they don’t understand when they need you, only severe pain will drive them back.
The patient who stays knows your rationale for everything you do, from the nuts and bolts of their treatment plan to why you recommend exercises or nutrition, to your other value-added services. It may be layman’s understanding, but it’s still an understanding.
What would it look like to have the help of the digital clinic? Digital documentation and an integrated scheduler can help you plan, organize and follow through on a true plan of care; technologies that help your patients understand and help you and your support staff manage them through key, reaffirming milestones. Every scheduled appointment has a reason supported by your treatment plan.
Together, these technologies encourage a level of patient understanding that helps you become more than just the “back pain guy” or the “headache lady.” Your plan of care covers more than just their spine, and your treatment plan talks about more than just their symptoms. Your patients have reason to stay beyond initial relief because they know you have their goals in mind. Your clinic technology supports your contention that chiropractic is more than pain management, and your patients respond by maintaining and keeping appointments.
To Pay
The second major component of the golden rule of growth has to do with payment and collections. To get paid as a chiropractor isn’t the easiest thing to do, and therefore any ethical strategy that increases the ease of payment is a good thing. Just as with encouraging patients to stay, you can encourage patients to pay, or at least grease the health-care payment wheels, with the right clinic technology, especially technology that reduces billing errors and proves the necessity of your intervention.
It’s obvious to any doctor who has had a stack of 100 claims returned because of one unreadable digit that billing errors hinder payment and cost money. Errors, from confusion over coverage to mismatches in service and diagnosis codes, delay payment and force the practice to spend money to recoup revenue that was already earned. When things go wrong on a consistent basis, it strains the doctor-patient relationship and causes patients to reconsider their commitment to their care.
If your clinic-management technology is going to help you get paid, it should have a near zero tolerance for billing errors. Simply moving to electronic claims submission should increase turnaround time, but there must be a system of checks and balances in place to make sure you’re getting paid on the first submission of a claim. Technology that doesn’t speed payment and reduce your average time in creating and sending claims doesn’t meet the standards set by the golden rule of practice growth.
Besides billing errors, there’s another aspect to encouraging payment that must be dealt with by electronic clinic management: documentation compliance. If your digital clinic management is going to help you get paid while you encourage your patients to stay, it should be helping you document the pages of relevant data that supports your initial intervention and continued involvement. Exacerbations, comorbidities, noncompliance with home recommendations and re-examinations are going to help you build your case (So is evidence that you actually have a plan of care and are talking about more than just adjustments.) Many of our patients have complex case presentations and benefit from our help for longer than six to 12 visits, but that means we need to have the data on hand to continue to have them in our practices; data that is going to help us earn a better and more consistent reimbursement.
Your electronic clinic management should have a safety valve to reject billing and coding errors at the instant they are prepared for submittal. However, it also needs to support a stronger and deeper documentation standard in your office without placing any more demands on your time. As the health care world changes and we transition to a third-party pay system that requires notes submitted with every claim, documentation is going to determine your ability to get paid.
To Refer
In the world of business referral builders, Bill Cates is legendary. Though he focuses largely on financial planners, his advice is valuable to any professional, especially service professionals such as chiropractors. One golden piece of advice he gives is to remind us that while people will shop around for the cheapest service they can get, they will always seek out professionals who build experiences for them and thank those professionals by referring friends and family.
You can choose to sell your patients a service or you can choose to offer them an experience combined with great service. To build a patient experience means operating at the highest level of service for your profession; becoming a high-tech doctor who has the latest practice technology is a sure way to do it.
No matter how we try to understand it, doctors are perceived to be more knowledgeable when they have the latest technology, regardless of skill and ability. It may not be fair, but it just is. Patients want a high-tech doctor with bedside empathy who can streamline the annoyances of health care (paperwork, long waits, etc.) encountered with other providers. It’s not hard for patients to make the leap from modern clinic to best-treatment standards and greater quality of care.
The power of this perception is at its peak when the doctor is running a completely digital practice. Technology plays a role in all major patient contact: scheduling, billing, documentation and record storage. These powers are at their height when the technology includes digitally based patient education and digital presentation of X-rays. When the patient is ushered through an incredibly convenient and smooth visit that includes high-tech multimedia presentations for their condition and demographics, you’ve created an experience that surpasses the average chiropractic service. Furthermore, you’ve given the patient information about your practice (value-added services, common conditions and the like) that helps them recommend you to family and friends.
Your electronic clinic management should have the kind of tools you need to deliver a superior health care experience. Completely digital patient management, including patient education, is a great way for your technology to help you build referrals.
Remember the Golden Rule
Stay, pay and refer. If you’re running a successful practice, then more often than not, most of your patients are doing at least one of these three things. But there’s always room for improvement, and the digital clinic is a good way to help you improve in each category. Just make sure you’re getting quality clinic technology by applying the golden rule of growth to any potential electronic clinic management. If your new software isn’t helping your patients to stay, pay and refer, make sure to find out how it can or find the kind of electronic clinic management that does.
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