Do you remember the Head and Shoulders Shampoo commercial slogan, "You never get a second chance to make a first impression?" That was a very powerful slogan then, and it applies now to every new patient that walks through your door. That all important first visit will determine whether that patient is just trying you out, or will want to enroll into your practice and become a great referral source.
As a provider compliance consultant, this is one of the first things I teach my DC & PT clients. Your new patient's first impression of you is your only chance to become their doctor.
Day One: Three Critical Things
First, never accept the patient until they accept you. You need to listen to the patient FIRST. Then you need to know what is their chief complaint and what do they expect? And, they need to know that you have listened to them and you understand their problem and will focus your attention on their condition. You will know they have accepted you when they ask, "Can you help me?"
Second, you must ask this question: "What have you tried that hasn't worked?" The last thing you should be doing is duplicating the services rendered by other doctors that have failed to resolve the patient's condition.
And third, if they have been treated for the same condition elsewhere, you must contact the previous provider and ask which diagnostic code(s) were they used for billing. I have seen many instances where a new patient was diagnosed with the same diagnostic codes from the previous provider, and the services were denied because the diagnostic code was previously used, or the patient had been treated too long for the same diagnostic code. When performing your initial exam of the patient's chief complaint, you must use another legitimate diagnostic code that truly represents the patient's condition. A little later in this article we will be discussing optional testing that will provide for additional diagnostic codes.
These three circumstances will determine whether your new patient stays with you, and whether or not you get paid. The reason nearly 100 percent of new patients that stay for only two to three visits and then vanish, is because you have failed to implement the above. And, you probably never called them to ask why they didn't return. YOU need to make that call personally, not your staff. Had you made the call, they probably would have told you that they had seen two or three other chiropractors and the treatments the received were ineffective. So they came to you hoping to have a different experience, and you performed the same ineffective procedures that the other DCs did (most likely moist heat and electric stimulation).
Most problems occur because of communication errors. Which takes us back to, listen to your patient describe their chief complaint. Call the patients who failed to return and explain to them that you would like to take a few minutes to fully explain the treatment plan for their (chief complaint). You then proceed to explain how passive and active range of motion, stretching, massage and trigger point therapy (ischemic compression), along with focused adjustments to the (chief complaint) followed by exercising and strength conditioning, if necessary, is designed to achieve maximum recovery. And yes, in most cases and in most states, with proper documentation and coding, all of these services are eligible for insurance reimbursement.
I have consulted with hundreds of practitioners, and the vast majority of them begin their treatment plan by applying moist heat and electric stimulation. Really? Everybody needs moist heat and electric stimulation? Or, they may tell you that they came to you looking for help with a painful shoulder, so you performed a complete chiropractic exam, including the shoulder, and tell them about all of their spinal related problems as well. Unknowingly repeating mistakes in patient management has a huge affect on your financial bottom line. You need to know the reasons why your new patients fail to follow through with your recommendations.
Stick to their chief complaint, it's the only reason they came to you. Focus on the chief complaint, and your patient retention and referrals will soar. Perform a E/M 99202 Expanded Problem Focused exam on their chief complaint only! Think about this. No other profession diagnoses and treats multiple conditions simultaneously. When a patient has a problem that is serious enough to see a new doctor, they don't want to hear about philosophy or submit to a complete neuromusculoskeletal exam. Philosophy should not be a component of your diagnosis and treatment plan. The appropriate time for philosophy and wellness care will come when the chief complaints have been resolved.
Too many times, I have seen DCs perform a complete chiropractic exam and list four, five or even six diagnostic codes, and they treat them all simultaneously. This significantly reduces your treatment options for this patient in the near future. Once you submit a diagnostic code to the insurance company, that's it. You can't use that code again until the policy renews for the following year, unless you can clinically document an exacerbation with diagnostic testing. However, when you diagnose and treat the chief complaint only, you have all those secondary diagnostic codes available to you for this patient's future treatment.
[pb]Explain to your patient right now, not on day two, three or four, what your findings are and what treatment you recommend specifically for their chief complaint. Your new patient will appreciate your focused attention and will want to enroll into your practice. The two, three and four day reports are not what your new patient wants or expects. My experience has proven that a multi-day report usually results in a negative first impression.
Getting Patients to Enroll
Due to the recent decision by Blue Cross / Blue Shield of Pennsylvania (and many other states) to reduce chiropractic visit limits from 20 a year to 8 a year, leaves you with only one option that will convince the new patient to enroll into your practice. OPTION: Diagnostic testing that will quantify their soft tissue injury or condition. Explain to them that your practice is UNIQUE from other practices because you have a safe and simple diagnostic testing procedure, right there in your office that actually quantifies their soft tissue injury or condition rather than assuming what the condition is simply based on their pain and symptoms.
Show them a sample report and explain that this is a new and advanced computerized muscle testing system that shows the deficits of the five categories being tested.
- Peak Force Strength – Maximum effort in pounds (left and right)
- Endurance – Timed duration of maximum effort (left and right)
- Power – Peak Force Strength x Endurance
- Work Capacity of muscle
- The number of minutes the injured muscle can be worked without risk of re-injury.
Explain further that all test results have been validated with current AMA Permanent Impairment Guidelines including strength Coefficient Variation. And, the AMA Guides 6th Edition actually recommends computerized dynamometry testing.
Now you say, I have two very important questions I need to ask you. First, ask: "Is this report something that makes sense to you and would interest you?" Actually, all of my patients, and all of my clients patients, have said YES. I continue to explain that the first test represents a baseline study that documents their functional impairment and is approved documentation of medical necessity.
Monthly progress testing is performed to document the positive outcomes that are required to access continued medically necessary treatment. As long as positive outcomes are documented, the insurance companies are obligated to pay. With this documentation, you will have access to all of the medically necessary treatment required to return your patient to pre-injury status or maximum medical improvement (MMI).
When the outcomes show a progress of only ten percent or less, it indicates that muscle has reached per-injury status or maximum medical improvement (MMI), and the treatment to the muscle should be discontinued. However, treatment continues on other muscles that are still showing positive outcomes of greater than ten percent. However, if the answer is NO, you have a patient who is not willing to make a commitment that is in their best interest, and will not be a good patient or a good referral source.
The second thing you ask is, "Are you committed to maximizing your recovery?" Most always the patient says YES. Again, if they say NO, you have a patient who will not follow your recommendations and will most likely complain about the lack of results. However, on occasion they will say I can only come once a week. This can be a problem because most rehabilitation guidelines state that rehabilitation should be performed a minimum of three to five times a week. Less than three times a week is considered ineffective and is not eligible for reimbursement. In most cases, three rehabilitation sessions a week can be scheduled if the patient is willing to rearrange and prioritize their free time.
In conclusion, practice management is not just about advertising, screenings, telemarketing and free dinners. It is more about the management of your patient's condition from their initial examination and diagnosis, to their diagnostic testing that documents their functional impairments and establishes medical necessity, to their passive and active treatment protocols that stabilize their condition, then onto the rehabilitation and strength conditioning phase of care. And finally, yes, now is the time to discuss philosophy and wellness care if you choose. As Leonardo da Vinci said, "Simplicity is the ultimate sophistication."
