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Is Patient Education Worth the Time?

Is Patient Education Worth the Time?

by Dr. David Bohn, DC

Chiropractors will talk about educating patients and never question that an educated patient is more likely to begin care and then stick with a recommended care plan. When many chiropractors elect to educate their patients they usually fail to do it in a creative way that attracts and holds attention, answers the questions that really need answered, yet do not nag or annoy their patient.

People today are not like the patients of the 1980’s. Attention spans are shorter, information on any topic is available with just the click of a mouse, and the competition to be noticed and heard is fierce.

This presents a dilemma. If we all agree that if our patient is educated about their problem and the solution we are offering results in a less stressful practice for us and a better outcome for the patient why isn’t this happening?

Perhaps I can offer an example from my own life to help illustrate. 

As an undergraduate college student I drank and apparently enjoyed low cost beer, sometimes to excess. I knew very little about how beer was brewed and really wouldn’t have cared to have it explained. Beer was important to me for the same reasons it is to all 21-year-old men. In chiropractic school a friend of mine introduced me to home brewing. I read every book I could find, spoke with people in the local shop that sold home brewing supplies and eventually mastered understood the importance of understanding the importance of balling degrees and terminal gravity. As the years past my interest and understanding in beer grew to the point that I cannot bring myself to drink a can of mass produced swill that many people find so satisfying.

Well enough about beer, here’s the moral to the story. The more you learn about something, the more interested you become in it and the more of it you begin to buy. You buy more and become more loyal to it until you become a valuable lifetime customer of the product. I will admit to you, I am now a loyal lifetime Samuel Smith’s Oatmeal Stout raving fan although I still enjoy experiencing fine microbrews as I travel. Applying this to chiropractic means that the better you educate your patient, the better client they will be, the more loyal they will be to your practice, the more money they will spend, and most importantly the better they will be able to explain your practice and what you do to their friends and family. This means you will get more referrals and have a better, less stressful practice.

It all comes down to increasing the value of each patient. Not just for 18-24 visits but for the lifetime of that patient, for the referrals and the new problems they may have over their lifetime.

Patient education;

1.   Increase the number of internal referrals your practice receives.

2.   Increases the PVA (patient visit average) of each patient because educated patients comprehend the value of chiropractic.

3.   Educated patients understand the value of maintenance.

4.   They are more likely to remain long term patients in your practice and educated patients are less concerned about fees.

My personal favorite example of quality, creative patient education is the take home report of findings. This would include copies of the patient’s x-rays with lines drawn on it demonstrating the patient’s biomechanical faults. Pictures of the patient preforming each range of motion. A posture analysis showing the patient the abnormalities. A listing of their subluxated segments with the corresponding effected organs and muscles, and a financial case presentation. I also like to provide the patient a copy of their first visit note in narrative format. This take home report allows the patient to fully understand and share their problem and my solutions will everyone.

Dr. David Bohn, DC is the founder of http://www.chiroconceptions.com and has been practicing chiropractic since 1988. For more information on software and other tools to increase your practice visit our website or call 301-777-3710 for more information.

Still Using Handwritten Notes?

Still Using Handwritten Notes?

I get several calls a week from doctors who are still using handwritten travel cards or antiquated computer technology because they either have very little computer knowledge or do not like to change. Well, let me be the one to break the news, computerized notes with EMR/EHR technology is here to stay.

If you are one of those chiropractors who has been putting off moving into the future of documentation then QuickSOAP Notes is the program for you because at www.chiroconceptions.com we specialize in “technophobes”.

Moving your documentation into computerized touch screen technology will increase your compliance, decrease the time you spend doing new patient notes, and can even increase the number of referrals you get from primary care providers and attorneys. Even with these potential benefits many DC’s hesitate on moving forward.

When you buy QuickSOAP Notes we will “hold your hand” and help you get set up. This includes helping you get you computer set up and running and connecting your iPad if that is the way you want to go. QSN’s is intuitive and help videos are available on every screen so you can learn as you go without constantly turning to a manual to find out how something works.

Over the years I have discovered that doctors have a strong interest in updating their practice and their patient management with computerized documentation but have doubts about their ability to learn the software and work on a computer. We have had many self described “older” doctors update to QuickSOAP Notes and adapted to the technology very quickly. The biggest barrier to purchasing and upgrading seems to always involving expanding your headspace first, after that it is all downhill.

It will take a few weeks to become completely comfortable with the program and then it will seem as if you had it made just for your practice.  All of our screens can be customized to fit your practice and you have the option of adding unlimited template screens meaning that you can finally create a documentation that is uniquely yours for less than $2000.

The main thing is don’t be afraid of expanding and growing. All of our staff from our graphic artist to our senior programmer will be glad to help you get the most of your software. You get 30 days of support when you buy and if you would like unlimited support and updates we will be only a phone call away, year after year, for only $295/year. We are happy to take suggestions for new screens or improvements from our support subscribers.

Stop being afraid, we’re here to help. Call us at 301-876-4565 if you would like to move forward and add QuickSOAP Notes to your practice today.

Reminder about your invitation from David Bohn

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Reminder about your invitation from David Bohn

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Invitation to connect on LinkedIn

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A GUIDE FOR LIVING IN 2011 

A GUIDE FOR LIVING IN 2011

 

Health:

1. Drink plenty of water.
2. Eat breakfast like a king, lunch like a prince and dinner like a beggar.
3. Eat more foods that grow ON trees and plants and eat less food that is manufactured IN plants..
4. Live with the 3 E’s — Energy, Enthusiasm and Empathy.
5. Make time to pray.
6. Play more games
7. Read more books than you did in 2010 .
8. Sit in silence for at least 10 minutes each day
9. Sleep at least 7 hours.
10.Take a 10-30 minute walk daily.  And while you walk, smile.
 
Personality:

11. Don’t compare your life to others. You have no idea what their journey is all about.
12. Don’t have negative thoughts on things you cannot control. Instead invest your energy in the positive present moment.
13. Don’t over do.  Keep your limits.
14. Don’t take yourself so seriously.  No one else does.
15. Don’t waste your precious energy on gossip.
16. Dream more while you are awake.
17. Envy is a waste of time.  You already have all you need.
18. Forget issues of the past.  Don’t remind your partner of his/her mistakes in the past, that will ruin your present happiness.
19. Life is too short to waste time hating anyone.  Don’t hate others.
20. Make peace with your past so it won’t spoil the present.
21. No one is in charge of your happiness except you.
22. Realize that life is a school and you are here to learn.  Problems are simply part of the curriculum that appear and fade away but the lessons you learn will last a lifetime.
23. Smile and laugh more.
24. You don’t have to win every argument.  Agree to disagree…
 
Society:

25. Call your family often.
26. Each day give something good to others.
27. Forgive everyone for everything.
28. Spend time with people over the age of 70, and under the age of 6.
29. Try to make at least three people smile each day.
30. What other people think of you is none of your business.
31. Your job won’t take care of you when you are sick.  Your friends will.  Stay in touch.
 
Life:

32. Do the right thing!
33. Get rid of anything that isn’t useful, beautiful, or joyful.
34. GOD heals everything.
35. However good or bad a situation is, it will change.
36. No matter how you feel, get up, dress up, and show up.
37. The best is yet to come…
38. When you awake alive in the morning, thank GOD for it.
39. Your Inner most is always happy. So, be happy. 
 
Last but not the least:
 
40.    Consider forwarding this guide to those you care about.

EHR Stimulus Funds for Chiropractic Note Programs

On July 16, 2010 the “Final Rule” regarding Meaningful Use criteria and EHR (Electronic Health Records) Financial Incentives was released and has generated  lots of questions and a lot of confusion for many chiropractors about how to obtain stimulus dollars for documentation software (EHR/EMR). Several times a week a chiropractor will ask me if my program QuickSOAP Notes (www.chiroconceptions.com) meets the requirements.

Here are what I believe are the key points regarding EHR eligibility for those of you who don’t care to read the original documents or fact sheets on Meaningful Use and EHR Financial Incentives in their entirety:

• Meaningful Use Criteria which establish eligibility for financial incentives are for EHR Certified programs only. Translation: if your EHR is not certified, you may not receive any financial stimulus.  Many EHR companies are advertising that they are “eligible” for certification, although this is not the same as being certified.  Buyer beware!

• You know only need to complete 20 of the 25 Meaningful Use Objectives/Measures as defined in the Final Rule issued by CMS.  Even though you may “defer” 5 of these requirements, this is still an ambitious list for most practitioners in order to qualify for the funds.

• The completion of these Objectives/Measures fulfills Stage 1 requirements only (which make you eligible for the financial incentive portion).  Stage 2 and Stage 3 objectives exist, but the exact requirements and penalties are not as well defined.

• Chiropractors are Eligible Professionals that may qualify for the EHR financial incentives

• Chiropractors may be eligible for EHR financial incentive payments as early as 2011; payments can proceed for up to 5 years.

• The total financial payments that chiropractors are eligible to receive is a maximum of  $44,000 over a 5 year period or equal to 75% of Medicare allowable charges for covered professional services furnished by the chiropractor in an eligible year.  This is perhaps the biggest criteria EHR companies fail to mention.  In other words, in one given year, you can receive up to $18,000 IF (and only if) you provide at least $24,000 worth of covered services (based on allowable charges) to Medicare patients.  On the other hand, if you have a small Medicare practice, your eligible financial incentives will be reduced accordingly and capped at 75% of the allowable charges for your covered services (which, in chiropractic, is CMT only).  Do the math to see if your practice qualifies for anywhere near the $44K amount.

The Bottom Line

My feelings have not been changed by the “final rule” criteria.  I would highly recommend that most offices switch to some form of electronic health records.  However, this advice is NOT based on the presumption that you are doing so to capture any potential financial stimulus incentives.  Rather, migrate to EHR because of its potential to improve your documentation, level of care and overall record-keeping. I would add that you should search for a program that you WILL USE and not for the best deal or all in one package.

Have You Recieved Your Medicare Audit Letters Yet?

I am hearing from many of my clients and some billing and coding professionals that I know that Medicare has stepped up its audits and reviews on chiropractors.

Medicare carriers around the country are sending out these audits as part of President Obama’s Executive Order # 13520, “Reducing Improper Payments and Eliminating Waste in Federal Programs.”  The goal of this order is to eliminate payment error, waste, fraud, and abuse in Federal program and requires federal agencies to conduct semi-annual studies to identify and reduce vulnerabilities in high risk areas.

This is happening right now, it started in mid-August 2010, Medicare carriers will begin increasing their recovery efforts and sending piles of CERT (Comprehensive Error Rate Testing) letters aimed at chiropractors. Although the program is not targeting chiropractors specifically (all Medicare providers are under similar attack), they have made the chiropractic targets public knowledge.  Chiropractors who meet the following criteria will be subjected to “random” audits:

• Chiropractors who have submitted multiple claims for the same Medicare beneficiary between April and June 2010
• The CERT audits will focus on determining whether chiropractic services billed to Medicare were medically necessary as acute (active) chiropractic treatment.
• For each claim selected, CMS will review medical records up to 12 months prior to the date of service on the claim.

Based on the “random” criteria listed above, CMS will deny claims for services that the reviews have determined to be maintenance and not active treatment.  Accordingly, the Medicare carrier will then take steps to recoup any over-payments.

From my experience with chiropractors I would guess that these CERT criteria will apply to just about every chiropractor in the country.

According to data published by Medicare in the press release for this new CERT launch, Medicare is going after $174.1 million in projected improper payments to chiropractors.   Taken across the board, that $174 million could mean every DC in the country would be forced to cough up roughly $3500.  Since a sizable chunk of DC’s on record are practicing part-time, retired, or not practicing at all, it’s possible that the 50,000 DC pool is much smaller.  In half, that would mean $7000 per DC.  Frankly, some of you don’t have anything to worry about because you see Medicare patients once every blue moon.  This conceivably can chop the available audit pool in half again, leaving all the remaining DC’s to foot a $14,000 bill.

If you are still reading and are concerned, here are a few brief recommendations to tackle this issue with a sober mind and some strategic planning:

• The worst mistake is to ignore the CERT audit request. You have 30 days to comply.  Do it quickly.  If Medicare deems your documentation, billing or coding unworthy, they will ask for money back.  If they don’t even receive your documentation, they will still ask for their money back AND they can pursue the opportunity to charge you with fraud.
• Medicare has stated that the primary causes of the errors were payments for maintenance therapy and missing plans of care. Two recommendations here: (1) if it walks, talks, quacks like a duck, it’s a duck.  When Mrs. Jones comes in like clockwork every first Monday of the month, with no rhyme or reason other than, it’s her scheduled appointment, it’s going to be a long hard road to prove that this visit is not maintenance.  (2)  Include a plan of care!  Some docs mistakenly think that they are flying “under the radar” by not documenting any scheduled visits.  If it’s PRN, say it’s PRN!  If you want them to come in 3x over the next 2 weeks, state that!  And remember, a treatment plan is more than a schedule of care (but that’s another topic for another day)
• Seize the opportunity! Scared?  Some of you should be!  But being afraid accomplishes nothing. Face your fears and fix your shortcomings!  Get help instead of sitting there wondering if the Medicare monster is going to eat you for lunch.  No third party payer – Medicare included – expects your notes to be perfect.  Your documentation should meet standards and if you want to keep yourself out of trouble, it should look better than your peers.  Why? Because, statistically speaking, many of your peers are getting it wrong – which is why we are in this mess in the first place.

The Final Word

For those of you who are feeling a bit paranoid, persecuted or just plain peeved, take heart: Medicare is not trying to eliminate chiropractic.  What they are trying to do is to clean up errors within their own systems – for physicians of all types – and in the process, reclaim money that should not have been paid out in the first place.  It may not seem fair that they have “suddenly” raised the bar. In actuality, the rules were there the whole time; they have recently taken the opportunity to enforce them.

And yes, it’s about the money.  When a cash-strapped government entity discovers that it can recoup $900 Million in incorrectly paid claims in about three years time, it wants to repeat that “experiment” over and over again.  If you haven’t been paying attention, that’s exactly what happened starting in 2005.  And the nearly $1 billion recovered was not just from chiropractors. In fact, we are only a small piece of the pie.  Unfortunately, the coffers are so empty, the powers that be want to scrape up every penny they can get back.

We do have the ability to defend ourselves here.  First, we can make sure our chiropractic billing, coding and documentation is as bulletproof as possible.  Then, our best defense will come in the fact that Medicare (and every other third party payer) may take a few pennies back from the chiropractic community, but it will cost them a few dollars to do it!

Medicare Publishes Chiropractic Assessment Findings on the first Quarter

The other day, the Medicare service provider (Palmetto GBA) issued the company’s first Quarter findings regarding Medical Reviews they’ve recently been performing.  Although Palmetto is just one of many companies that administer claims for Medicare, their results happen to be highly relevant to doctors of chiropractic as well as, in my own past experiences, reflective of tendencies throughout the chiropractic profession.

The intention of the evaluation process is to decrease payment errors as a result of finding and correcting documentation and billing errors regarding insurance policy coverage and also coding. During the assessments, Palmetto GBA discovered 10 areas of concern for the first quarter of 2010. The top areas of concern from 1-10:

   1. Split/shared visits

   2. Signatures

   3. Labels/Diagnostic Testing

   4. Hospital & Nursing Facility Discharge Services

   5. Chiropractic Services

   6. Therapy Services

   7. Individual Psychotherapy Services

   8. Evaluation & Management Services

   9. Legibility

10.  Teaching Physician Services.

Please be aware that this isn’t an all-inclusive list although it does indicate most documentation concerns uncovered throughout the evaluation process.  On this shortlist, three things happen to be relevant to chiropractic reimbursements in the Medicare program.

Which means that we’ll go over the 3 “Frequently committed errors”:

   1. Signatures.  To explain, Medicare demands an “identifier” for services provided or ordered.  This identifier is your signature – either in handwritten or electronic form.  Signature rubber stamps as part of your documentation aren’t acceptable per Medicare Signaure Requirements (See section 3.4.1.1 B) Really, this really is so fundamental that it’s absurd that it actually makes the top 10. Evidently, in spite of its straightforwardness, most doctors apparently forget about it.

   1. Chiropractic Services.  Being a comparatively minuscule profession as a percentage of total Medicare claims, we should not actually make the top 10 hit list.  But we did, which means that now it’s our responsibility to fix these types of issues as soon as possible as a profession.  Palmetto commonly found chiropractic documentation to be inadequate with regard to Treatment Plans.  They reported that chiropractors were missing treatment plans with specific objective, and measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits was regularily omitted.  Complicated?  Not really.  Documented?  Evidently, not so often.  Are you able to correct this, doctor?  Absolutely!

   1. Legibility.  If this sounds the biggest commercial for EMR, It should!  Once again, there isn’t any legitimate reason a chiropractor should get dinged for this one.  Unfortunately, I’ve looked at plenty of your notes and I regrettably concur, that they’re rarely legible, oftentimes just to the highly trained eye (your own and the eyes of your longstanding office staff) – not to mention that sometimes, even you are unable to understand your personal records.  To put it differently, if your current patient treatment records can’t be quickly read and understood by a third-party then it is now the time to get an EMR (Electronic Medical Record) System that you WILL USE!  

There are many effective programs on the market.  The truth is, ANY program that generates legible records provides great improvements over marginal handwriting.  FYI,  I haven’t yet experienced an EMR program which does not generate legible documentation!

As a profession, chiropractors will need to get our act together right away, not just for Medicare, but also for every third party payer.  The items previously mentioned are certainly not hard to correct, yet I understand that most of you happen to be overcome by the amount of work you need to do to bring your current documentation, billing and coding up to satisfactory requirements.  Other individuals could possibly be so consumed with building your practice that you honestly do not have time to take a look upwards to see the arrow crusing straight at the bullseye on your chest.  And some of you are simply sick and tired of putting out the fires in all these areas because of insufficient reliable methods that equally increase your reimbursements while minimizing your audit risk.

Fortunately help can be found. Check out www.touchnotes.com or www.chiroconceptions.com for QuickSOAP Notes or call me at 301-777-3710