New Directions: Trends Changing The Profession

Do you ever feel like you can't keep up with how fast the health care industry is changing? History can be your practice's worst enemy. The rules of the game have changed. It's as though for 117 years we've been playing according to the rules of basketball and that within the last five years they have changed to the rules of football. Think about the equipment that a basketball player uses. It's as though you are on the playing field dressed in a pair of silk shorts and the team facing you is suited up in football gear. They're wearing helmets, shoulder pads and mouth guards and you're wearing silk shorts!

In order to stay in the game, you're going to have to change your gear, leave your silk shorts in the locker room and suit up with shoulder pads. A review of the trends of the new health care economy will help you suit up your practice for success.

Consolidation & Diversification

The facts don't lie: less than 30 percent of medical physicians remain in private practice. The group medical practice has become the most common model for the practice of medicine. This trend is now becoming the prevalent trend in the practice of chiropractic. Chiropractors across the country are finding safety in numbers. They understand that consolidating services in the form of joint practice is a more cost-effective, stable manner in which to deliver health care to the maximum number of patients.

The chiropractor of the future will be a member of a group practice.

With student debt running well over $100,000, the financial resources required to open a new practice from scratch are beyond the means of most new practitioners. The trend of the group practice – a senior practitioner with associate team members – is a win/win for both parties.

The new practitioner benefits from the confidence, experience, and patient base of the seasoned doctor. The senior physician benefits from the up-to-date knowledge, energy and enthusiasm of the younger doctor, who is a candidate for future partnership.

In addition, overhead costs can be shared, vacation coverage is assured, and often "two heads are better than one" when it comes to strategic planning and decision-making.

I have seen many articles on diversification as a strategy for practice success. (I've even written some!) But, too often chiropractors simplify the concept of "diversification" to "different."

Just adding other products or services to your practice is not diversification. At best, it's a waste of time and money. Worse, it can damage the profitability of your core practice by taking your time and money away from what you do best.

Rather than diversification for the sake of being different, the trend of practice consolidation is diversification at its most effective level. Practice consolidation is visible in the increasing prevalence of providers from multiple disciplines joining together in practices that respect the scope of practice and autonomy of each individual provider.

Creating a practice that provides one-stop shopping, where patients can receive multiple types of health care services at the same location, is an important trend to recognize.

The trend of multidisciplinary practice consolidation extends beyond the combination of physical medicine services under one roof. Multidisciplinary practices include multiple healing modalities, including nutrition, therapeutic massage, acupuncture and other disciplines. This trend is most appropriately referred to as diversification. The diversification of services requires a mastery of the next trend by the chiropractic practitioner, the trend of specialization, otherwise referred to as outsourcing.

Specialization Means Simplification

In the past decade, the chiropractor was a jack-of-all-trades and unfortunately at times a master of none. A diversified, consolidated practice will require the chiropractor to take on a greater entrepreneurial and administrative role than ever before in the past. While the chiropractor of the past decade focused primarily upon patient care, today successful chiropractors focus upon the effective orchestration and delivery of patient care in a cost-effective manner.

This means that the chiropractor must surround him or herself with highly effective coaches and consultants to support this endeavor. In the past, this meant possibly utilizing the services of an attorney and an accountant. In the future, it means outsourcing all of those functions that are not directly in line with the chiropractor's roles of healer, administrator and entrepreneur. Employing professional coaches and consultants such as a practice management consultant, a financial planner, a billing specialist and a marketing specialist, allows the chiropractor to most effectively assume his or her new role.

The Personal Benefits of Simplification

By simplifying those priorities that you focus on in your practice and delegating or outsourcing those activities that are not in line with your core competencies, you free up more time to enjoy your life and those things you love to do. It sounds simple, doesn't it? But how many people actually do it? Human beings are, by nature, hunters and gatherers. We instinctively go on adding things. "Pack rat" behavior is a part of the same gatherer instinct deeply rooted in us. This is true in both your life and your practice.

Examine what you can cut down in your practice responsibilities. Examine what you can eliminate from your schedule so that you can devote more time to yourself and your family. Regularly examine the processes, procedures and paperwork you use in your practice. Get rid of what you haven't used or updated in the last three years. Think carefully about how you can use your time to generate the most value in your practice. Before you take on an additional responsibility, ask yourself the happiness question, "Can I afford to take on this task/project/responsibility without compromising my ability to nurture myself, my family and my practice team?"

[pb]What's Next? Active Care

The next trend in the years ahead is one of the rise of chiropractic philosophy to the forefront of health care.

Those practitioners that master combining a subluxation-based chiropractic practice with a multidisciplinary setting will become the predominant force in the delivery of non-crisis health care to our nation's population. These practices understand that health comes from the inside out, and not from the outside in.

The primary direction in health care is one away from the traditional passive model of patient care toward an active model of care. The paradigm of passive care with which chiropractors have practiced since the inception of the profession is now defunct. Many practices that were established years ago are closing their doors due to the fact that they have not recognized the need to shift their paradigm to active care.

In the active paradigm, your patients actively participate in the healing process. The passive model is one where patients lie passively and receive treatment modalities applied by a physician or therapist.

Active care means giving therapeutic procedures a role in your patient care plan. The definition of a therapeutic procedure is, "a procedure applied one-on-one by a therapist or physician to improve function." The operative word in this definition is function, the language of the active paradigm, and hence the language of reimbursement, is function. By employing therapeutic procedures and learning the language of function, you will be adopting the most powerful new paradigm.

Active care is outcome driven.

Effectively employing outcome assessment tools helps you establish the rationale for your care. You must systematically deploy the outcome assessment tools of the Oswestry Questionnaire, Neck Disability Index, Visual Analog Scale, Symptom Diagrams and others, in your practice.

It is not enough for you to get your patients well and to return them to normal health; you must prove that you have done so. These tools allow you to effectively establish and communicate functional goals for your patients' care. These functional goals will become the benchmarks for your care.

How you document the improvement of your patients' ability to perform their activities of daily living establishes the medical necessity of your care. In most cases, an insurance carrier's definition of reasonableness and necessity are linked to whether the treatment provided has helped to return your patient expeditiously to a state of well-being. Your documentation drives reimbursement. Effectively employing outcome assessment tools is one method of establishing the medical necessity of your care.

Reimbursement and The Rise of the Machines

Chiropractors practicing in a passive paradigm submit claims to insurance carriers filled with day after day of "MUSH." "MUSH" stands for the passive modalities: Manipulation or Mechanical traction, Ultrasound, Muscle Stimulation and Heat. Visit after visit of "MUSH" submitted to an insurance carrier produces mush for reimbursement!

You must master the tools of reimbursement. A comprehensive understanding and ability to correctly employ CPT and ICD codes is the next vital trend that you must be aware of. When you submit an insurance claim for reimbursement, you are initiating a dialogue with a computer program.

The language in which computers communicate is numbers. A mastery of these numbers will allow you to communicate what it is that you have done and at which level you should be reimbursed, not to a human being but to a machine. You must know how to code for what you do, and how to appropriately apply modifiers to those codes, to receive the level of reimbursement that your patients deserve.

Worst Competition

Chiropractors can be their own worst competition. The mind set that there are not enough new patients to go around limits growth and stifles opportunity. Every man, woman and child on the planet today has a spine and needs a chiropractor. Eliminating the thought that medical physicians, physical therapists, massage therapists, or other alternative practitioners are your competition is the first step to unlimited new patients.

Chiropractors should seek to become proficient in the techniques of their choice and to deliver the highest quality care possible. When you are the best, there is no competition! Focus on polishing your patient communication skills so that you can confidently express your message at every opportunity. Placing the focus on these two important skills will leave you with little time left to worry about the "competition."

To paraphrase Charles Dickens, these are the best of times and these are the worst of times to be a chiropractor.

The trends that are moving ahead at rapid speed are all in alignment with this powerful new paradigm for chiropractic. It's as though all of the planets have lined up at precisely the correct celestial position at precisely the correct time for you to participate in the complete realization of your vision. Opportunities are abundant for those who align themselves with professionals who can support and guide them in achieving their goals. You must focus all of your attention on mastering these new trends.

The future has arrived and the time is now for you to invest in the new paradigm as a part of your over-all success strategy.