Frustrated With Health Care

Do you have a presence on the net? 

Even though I was perhaps one of the first chiropractors in my area with an office website, up until recently I didn’t really believe, nor did I notice that we ever got any new patients from the internet.  I always thought of my website as providing information for my patients and the community, if they happened to stumble upon it.  My website is also part of a service that provided a monthly e-Newsletter that is distributed to my email list.  It happens to be a great service, but that’s another story altogether.  The point I am trying to make is that even though I have had an internet presence for many years it wasn’t until about 2 years ago that I started to notice an increase in my referrals from the internet, and it has been increasing ever since.

What do you get when you Google your name?  Are you within the top ten?  Are you on the first page, the second page?  Do you show up at all?  Obviously the higher up you are on the list, the better your presence.  You know I always thought, “this thing is called the www, which stands for the World-Wide Web”.  What good is that to me when most of my business comes from within a 15 mile radius of my office?  However, there are more people going on the net every day and they ARE within your sphere of influence, and they can, and do, search for local business.  So . . . what do you get when you Google your profession and your town together, say, “Dentist Poughkeepsie New York”?  Again, are you in the top 10?    Also, did you know there are “Geo-specific” searches so that in many cases you do not even have to include your location; you can just Goggle “Dentist”.  The results will by different from zip code to zip code. 

Increasing your presence on the net is a great, and often times free, way to advirtise.  All it takes is a little creativity and the know how, and before long your name will appear at the top of the list.  The first step, however, is determining how you want to “Brand” yourself.  So here’s what I want you to start doing.  Think about how you want to be branded, how do you think people will look for you?  By your name?  This is always a good start, but how else do you want to be found?  By your business name?  How about by your profession?  How about by what conditions you typically treat?  Once you have all the searches in which you want to be found try doing the searches to see what comes up.  Vary your searches.  For example, search for your profession with and without your town, with and without your State.  Also, using quotes provides a more specific search so try searching with and without quotes.  For example, “Your Name” and Your Name.  What you want to do is take notes on the total number of hits with each search, as well as whether you come up in the results and if so, where you come up.

Even if we are doing “everything right” in practice to stay the course by keeping a positive attitude, thinking abundance, doing outside talks, and asking for referrals, you’d have to be some sort of “superchiro” not to be feeling the affects of the down economy.  And of course we still have health care insurance companies “beating us up”; it would appear that us New Yorkers aren’t the only ones affected.  So really now, how much of this can we take?!  It would seem that us chiropractors are the new second class citizen.  

The truth is that from my perspective our current healthcare situation doesn’t make me a happy camper.  You see, I have always had aspirations of being wealthy; yes, even in my decision to pursue chiropractic.  Not withstanding this, you know that I did, and still do, have a strong attraction to the science, art and philosophy of chiropractic.  However, when I decided to become a chiropractor, this was just icing on the cake, since I felt that I could make a good living as a chiropractor, which I thought would be parlayed into “fame and fortune”.  Let’s face it, as a self-employed chiropractor we are taking risks, which we are supposed to be rewarded; the question is, are we?

Early in my chiropractic career I dreamed that the money would begin to roll in, which would give rise to investment opportunities.  Then of course, at the end of the trail, I’d have a great practice that a young and aspiring chiropractor would purchase from me for at least $250K . . . my how times have changed?!

Again, not withstanding this, I still dream . . . you see, I happen to be one of those crazy people that believes that while money may not bring me happiness, it is a whole lot easier to be happy with money than without.  In fact, for the most part, I don’t believe you will find too many rich people saying that money doesn’t bring you happiness.  Think about it for a minute, if money was not a consideration, how would you live your life; how would your life be different?  Wouldn’t you be happier doing the things you enjoy doing?  Well . . . I’m sorry to say, but to live the life of your dreams it takes money.  In fact, wouldn’t you agree that as a rich person you would be a much bigger asset to society, to your community?  You bet you would; I know I would!  Not only would I contribute greatly to the local economy, but I would have more time and resources to give back to my community.  I happen to be an active member of our local Lion’s Club; they would benefits dramatically.  Historically, I have given unselfishly to our church; they would also reap the rewards of my good fortune.  Think of the civic organizations you can help; how about your church?  This is something I have thought about for quite a while, and I still do.

While I love serving my community with quality chiropractic care, I no longer have the delusion that it will fulfill my financial dreams.  This is why I have diversified.  This is why I have pursued network marketing over the years, and this is why I have turned to the internet to study Internet Marketing!

Since I no longer feel the need to continue venting, which just perpetuates negative energy, I feel the need to transition this blog to a more positive direction of solutions to the healthcare frustration.  In this vain, it would be my pleasure to share internet marketing ideas that I have learned that would benefit you in any product you would like to market, including chiropractic.

What are your ideas?  Are you more into venting or solutions?  Certainly I can continue with the occasional bitch session, but I think this blog would be better served with constructive solutions.

Just when I think I’ve gotten it all out of my system and I’m ready to start talking about some positive, constructive stuff another article comes across my desk that I feel compelled to discuss.  This is yet another article that adds to my frustration, and yet, supports my moving forward plans.

The newest article was in this past weekend’s Parade; “Don’t Let the Economy Endanger Your Health”.  This hard-hitting story reports some sobering facts about how people are reacting to the economy relative to their health.  In fact, based upon conversations I’ve had with many other doctors these figures come as no surprise. 

Startling results of a survey from the American Heart Association reveal that 57% of those surveyed report that the economy has affected their ability to take care of their health.  The impact is obviously greater amount those with lower incomes, although 33% of those earning $75,000 or more say that they also feel the squeeze.  People are forgoing lifesaving care; 10% have reportedly stopped or reduced their medication for chronic diseases such as high cholesterol and asthma.  13% have elected to not get a flu shot, while 18% have avoided getting needed exams like mammograms. 

However, in reality the state of our economy may not be completely to blame for this; health care has just gotten to be so freakin’ expensive.  In 1970, Americans spent approximately 7% of their budget on health care.  At 17% for 2008, this represents a 2.4 trillion dollar outlay, which exceeded our spending on housing or food.  The truth is that the U.S. leads the world in advanced specialty care; as such, we spend more money on health care than any other nation in the world, and what do we have to show for it?  In spite of our huge price tag, the World Health Organization reports that the U.S. is ranked 31st in over all health as compared to all other industrialized nations; a very sad commentary!

So, what does the author, George Anders, recommend us to do?  He suggests that prevention must be our priority and that we should find creative efforts to encourage wellness; sound familiar?  To me, this sounds like it is right out of a chiropractor’s mouth, after all, isn’t this what chiropractic is?  All we need to do is demonstrate that our care is wellness orientated and that we are a great health care option; that’s all it should take, right?  Well, actually, I believe that because of the economy another part of this puzzle is to demonstrate affordability and possibly re-think our fees in these tight economic times.

Like most chiropractors my desire has always been to help as many people as possible.  In fact, in my career there have been times where it was not uncommon for me to see upwards of 90-100 patients a day in my practice.  Today, I’m lucky if I see 30-40 a day; clearly a significant drop.  So what happen?  Did these patient’s condition get better?  Do they all-of-a-sudden no longer require my services?  Obviously not!  The solution?  We just have to find newer more modern ways to communicate with our patients to bring them back in.  Lightening bolts in the Yellow Pages doesn’t work.

You know, I really don’t like to beat a dead horse, but I do think that something else needs to be said about the direction our “health care” system is going.  I don’t know, maybe it’s because I’m a chiropractor and I am concerned about how chiropractic services are going to fit into the whole health care picture.  Or, maybe it’s because I see health care continuing along the path of an ever increasing dependence on drugs to cure all our woos. 

It would seem that the push now-a-days is for national health care and what they call “preventative care”; you know, early detection through expensive testing procedures and early intervention through expensive drug regiments.  As previously mentioned, this is sick care and it is LESS cost effective.  Where in this plan is true health care?  Where in this plan do you see chiropractic care fitting in?  As many chiropractors will tell you, it does not!

Back in 1998 chiropractors may have won the battle with the AMA to cease and desist their anti-trust practices, but it would seem that the AMA is getting the final word.  Think about it, what three organizations run the health care industry?  I think you might agree that it is the AMA, the pharmaceutical companies and the health insurance industry.  So, let me ask this, do any of these organizations even consider health care from a wellness point of view?  From a chiropractic point of view?  Not on your life!  It is just not in their best interest!

Medical costs continue to sky rocketed and chiropractic services have been prevented from keeping pace.  Why?  Simple, the allowable fees are also set by the health insurance companies and they do not value chiropractic services.  The result is that with higher overall health care costs the health insurance industry has raised their co-pays, obviously to save money by precluding them from having to deal with what they consider to be nuisance claims; aka, chiropractic services.  One obvious solution is for chiropractors to fight for higher fees, but you know that along with that we would also have to compromise by accepting a cap on care.  OK, great you say, we’ll take $75-$100 per visit with a 12 visit cap.  Then we all know that 12 visits isn’t enough so we’ll just convince our patients to continue care at a cash fee that is much less, right?  Depending on your area getting the full fee might be an unrealistic expectation.  Aaahhhhh, but is it legal to charge less than the established fee schedule?  To answer that let’s take a look at our current model of “national health care”, Medicare.

As a chiropractor in the Medicare system we have three codes that are covered; 98940, 98941, 98942; all chiropractic manipulation codes.  These codes are only covered when there is an active treatment plan with an end result in mind; on going preventative, maintenance care is a non-covered service.  All services, covered or not, are supposed to be properly documented and properly billed.  This means that for all care, covered or not, a claim form must be submitted to Medicare; a special modifier is used to tell Medicare when care is active when it is not.  In either case, your patient is supposed to pay their share, which means that for covered services they pay their co-pay and for non-covered services they are supposed to pay the full fee.  Anything less and you run the risk of having to answer questions of the National Government Services.  It would seem to me that these same rules would apply to any new government plan that comes down the pike.

Now the questions one might have is, why do we need to submit a claim to Medicare for non-covered services?  That’s a good question, but I might speculate that it is because “they” want to keep on eye on us to make sure we are not taking advantage of Medicare patients by convincing them that they require more care than they actually “need”.

The questions abound: Who’s rules are we playing by?  Who says that a patient can’t make their own decisions regarding their need for care?  Since care that is not active is considered a non-covered expense, then why are we bound to the established fee schedule?  Whose to say that we couldn’t give it away for free, and if we did would they still be concerned?

Today while listening to a popular talk show host I was inspired to discuss their comments on my blog, but I wasn’t sure which blog would be most appropriate, this one or my other one, www.HurryUpAndSlowDown.com, which is devoted to the Chiropractic Lifestyle.  I decided to post it on both.

While listening to him speak today his comments were much like those of a chiropractor.  He was saying that our government’s plan to cut costs by pushing preventative health care are misguided efforts that will not save money.  He went on to say that real preventative care is getting regular exercise and watching what you eat.  The government’s thrust and the focus of the medical profession is not prevention care, but rather it is based upon early detection and intervention.  Their goal is to get people into their system of taking drugs as early as possible.  On the contrary, their cost-saving efforts will significantly increase cost simply because of all the expensive tests and early intervention drugs they will dispense.  I wanted so much to call the station just to give him a big thumbs up.  Unfortunately, I did not have the time to hang on the phone; so I did the next best thing, I sent him an email.  Here is what I sent him.

Holy cow!  When I tuned in today you were talking about how preventative care, as the government sees it, is all wrong; that it is NOT about prevention, but rather early detection and treatment.  This is called “sick care”, NOT health care, and this model of care will never save money!  As you so eloquently put it, preventative care is about exercise, and a good diet, which definitely cuts cost.  This is the exact message I have been preaching for the past 20 years.  In fact, when you combine it with a periodic tune-up of your spine and nervous system with a chiropractic adjustment, this is what we call a chiropractic lifestyle.  And, now that the government has gotten themselves involved they are further spending excess money by supporting medicine and big pharmas message that all you need are drugs, a whole bunch of expensive tests, and perhaps a little surgery.  Nothing could be further from the truth.  This is NOT health care and people ARE better off staying as far away from them as possible.  By doing this they will not be required to poison their bodies with expensive drugs, AND they will save lots and lots of money.

Here’s some sick stats: 

            80-90% of all disease is related to lifestyle stress.

            Years ago when the doctors went on strike in Canada, the death rate went down!

            The medical profession kills nearly 100,000 people each year; that’s like 500 fully loaded jumbo jets crashing every year!

A great prescription for preventative care: 

• Take responsibility for your health
• Watch your diet, and most people knows what that means; see item 1.
• Get moving. Exercise is NOT a 4-letter word!
• Get appropriate rest.
• Stop your stinkin’ thinkin’. A negative attitude will kill you and all those you touch
• Get your spine and nervous system checked by a chiropractor.

Think about it; taking responsibility for your health = fewer symptoms = fewer visits to the MD = fewer expensive medical tests = less need to take expensive drugs = a more efficient, cost-effective, productive member of society.

 THIS is the chiropractic lifestyle; THIS is true Health Care!

It seems that I am not, and chiropractors in general are not the only healthcare provider frustrated with the healthcare system. 

Just the other day I heard on the radio that across the U.S. something like 35% of Medicare patients could not find a General Practitioner who participates in the Medicare system.  While this is a sad commentary, it is just representative of the bureaucratic nightmare that goes along with taking care of Medicare patients.  Across the board providers are pulling out of Medicare, as well as out of other insurance company provider panels simply because the excessive control prevents them from “being a doctor to their patients”.

Unfortunately at least for Medicare patients and for us as providers is that it doesn’t matter if the provider is Participating or Non-Participating, all the same rules apply.  As a Non-Par provider the only advantage is that you do not have to wait for payment; presumably your patient pays at the time of service.  HOWEVER, as long as you are accepting and careing for Medicare patients, even as a non-par provider, you are still bound by a fee schedule, you still have to bill, code, and document your services and level of care accurately and appropriately, AND you still have to be able to provide this documentation to Medicare upon request; the nightmare continues.

To the best of my knowledge, the only way to avoid this nightmare with Medicare patients is to not accept Medicare patients for care.

And actually, the same would hold true with most other patients who have any type of health insurance.  The only difference is that other insurance companies do not have a non-par fee schedule; presumably you can charge whatever your usual and customary would allow.  But again, if your patient has insurance they are going to want to submit a claim for your services.  As such, as the provider you are required to document and code your services accurately and appropriately, and you must make your records available upon request.

The day of the family doctor where a patient comes in, they get a consultation and examination, you jot down a few notes, give your treatment, and the patient pays . . . , those days are long gone thanks to the controlling eyes of the insurance industry.  Justified???

Just another source of frustration as a healthcare provider.

Trading time for dollars is not necessarily a challenge exclusive to chiropractors or healthcare workers; any service oriented business has the same problem. 

For those who provide a service and are not bothered by this exchange they either really like what they are doing or they are making a lot of money doing it; maybe both.  If I had to be trading time for dollars I can’t think of a better vocation to do this with; I love being a chiropractor.  My challenge is as the business of healthcare continues to be more absurd with each passing day, the infamous “Burn Out” becomes more and more imminent!  With burn out comes depressing thoughts of trading time for dollars.  Actually, as much as I DO love chiropractic, burnout has occurred for me.  It actually started to rear its ugly head at about year number 17 or 18, 2002 or 2003.  Not too bad; I lasted about 18 years!  For the many chiropractors I have spoken with, burn out can come as early as after 3 or 4 years.  The question I have is, is burn out a by-product of length of service or is it just a sign of the times?

Are you burned out?  I suspect that if you are reading this that you maybe, in fact, at least on the verge of burn out.  What is your precipiting factor, or factors?  Heck, just the thought of needing to be in the office to actually be making money could be a factor for many.  You know in years gone by a chiropractor, or any other healthcare worker for that matter, could make a decent living.  No question that there maybe some who may still be doing that.  However, I dare say that the vast majority are making less, BUT the big second question is where are you putting your money to create that “nest-egg”?  Investment are clearly challenging, risky, and often times much less fruitful than they once were.

Again, I love what I do, but it would be nice to tap into a program that creates a secondary stream of passive income, money you make while sitting on the beach or while sleeping.  Imagine that!

In fact, over the past 4-5 years I have learned a lot about this industry and I can’t wait to share it with you.  Go ahead and click through MY Dream and My Solutions to see the journey I have had and where I am heading.

And, Click Here if you are really interested in pursuing YOUR dreams.

Thanks for visiting . . . until next time at Frustrated With Healthcare.

With a ”Coding and Documentation” seminar you kinda know going in that you may not want to hear some of the stuff that will be presented.  This is exactly how I felt a couple of weeks ago when I went to one of these seminars in my area.  

Don’t get me wrong, it’s always good to learn about great codes I can use to bill for services I’m already providing.  HOWEVER, it is always disheartening to learn all the rules and the precautions.  It takes all the fun out when in the next breath we’re told to be very careful to use the right code, and the correct modifier.  AND, be extra careful to be sure that you are documenting everything in your notes so you can safely bill those fancy codes.  For the privilege of spending an extra 15 minutes with your patient, you get to bill, and possibly “chase”, the carrier for $17, maybe!  Is it really worth it?

In my book, it hardly is worth it.  I mean, you have to be sure that, according to that particular insurance company’s rules, using a particular code is justified for the patient, and that you do not overuse it for this particular condition.  All this is a headache I do not wish to get involved with!

Why do I chose not to get involved?!  Because I chose to care for my patients based on what THEY need, NOT what the insurance company thinks I should give them based on a code.  If I want to give advice on ADL I would rather do a little on each visit, which might add up to 2 or 3 minutes each time.  But wait a minute, I need to spend 15 minutes in order to bill the carrier!  I know, I’ll just spend my 2 to 3 minutes and when it adds up to 15 minutes that’s when I will bill the carrier.

Let me tell you about the second part of this seminar; the part where we learn about post-payment audits.  Just as it sounds, based on a review of records an insurance carrier can request a refund because of what they consider inaccurate or improper coding and documentation, and the “fun” part is they can go back 6 years!  Based on this, I’m not so sure that I want to play games by billing for 15 minutes of ADL after spending 3 minutes 5 times.  The carrier could contact the patient who would only know that you didn’t spend 15 minutes with them on a single visit, ever.

I know, how often do insurance companies check this stuff and what are the chances you’d get caught in this scenario?  You’re right, slim to none!  I just chose not to get involved.  I chose not to worry about all the little neuances about billing these nuisance codes.  In actual fact, I believe I can make up for any “lost revenue” as a result of not billing for these services by seeing more patients for their regular office visit, which I know I can bill for without raising any red flags.

A cash practice with a “non-barrier fee” will keep you going strong. 

Until next time at www.FrustratedWithHealthcare.com.

O.K., so you want to know the Gods honest truth?  Can you handle the truth . . . ?

When I first decided to become a chiropractor it was not for altruistic reasons.  There, I said it, I feel so much better now.  Are you shocked? 

At the time when I first discovered chiropractic I was floundering around, tending bar for a living; I had no real direction.  After first being introduced to chiropractic, it wasn’t long before I thought, “this could be a respectable, lucrative profession”.

During my first week of classes as a new student at New York Chiropractic College, one of our professors asked, “How many of you have never been to a chiropractor before”.  About 30% of the class raised their hand!  In spite of my decision to pursue chiropractic purely as a business venture, this realization surprised me; these people were REALLY there strictly with the thought of chiropractic as a business.  I mean, if you have never experienced chiropractic before, how could you possibly have a passion for arousing someones innate intelligence?  For me, even though I initially viewed chiropractic as a professional career, I HAD experienced being adjusted before deciding to go to chiropractic school and I was VERY aware of the power of innate.

So what’s my dilemma, you ask?  Well, my dilemma is that now that  I have immersed myself into chiropractic and experienced the power of arousing innate first hand I want everyone to have it!  I wish more people can experience a chiropractic lifestyle and have their innate stimulated.  There are way too many subluxated sick people out there who are stuck on drugs and who have poor habits of daily living.  Just a slight change in direction can get them on the path to improved health and vitality! 

So how is this a dilemma, you might ask?  It’s a dilemma because I still have stuck in my head that I would like to make a professional living at being a chiropractor; if not, then to just be able to feed my family and put a roof over their heads.  Actually, NO, I really want, no, I deserve, more than just eking out a living; EVERY chiropractor should!  However, I can’t even enjoy a modest living if I literally give my services away simply because I believe everyone should have it. 

Part of this, of course, goes back to my feelings about the perceived value of chiropractic.  You see, I believe the value of an adjustment is often times beyond measure, since we are giving health & vitality.  On the other hand, we have to convince our patients of that, which is often times difficult because of their pre-conceived notions about health care, chiropractic, and their own priorities in life.

You see my dilemma?  So . . . with all this in mind, how cool would it be if I/we were able to give our services away?  I think that would be so great!  I mean, if I were independently wealthy and did not have to worry about money it wouldn’t matter if a patient drove up in a Mercedes or a jalopy, it wouldn’t matter if they were rich or poor.  The only thing that mattered is if they came in, regularly, with their family, to receive an adjustment; to have their innate aroused!  To me this would be the coolest thing in the world . . . I can just see people lined up outside my door to come in for their weekly adjustment because they want to get and stay healthy, period!

Well . . . the truth is that I do have plans in place to seriously supplement my income, which I do intend to share with you sometime soon.  But, the truth is also that I believe that totally free care does not work; there has to be some exchange for there to be value to those who receive it.  The easiest system I can think of for this is the ol’ “Box on the Wall”.  In fact, the chiropractors I first worked for after graduation at one time, long before me working there, had a “Box”, but that was before we got insurance to cover our services, which we all are aware has seen better days. 

So . . . that’s it; this is my ultimate goal in practice.  To make enough supplemental income to be able to practice with a box on the wall.  Think of the lives you could change if money was truly no obstacle!

O.K.; so this was a long one; thanks for sticking with it.

Until next time at www.frustratedwithhealthcare.com.

For the past 113 years chiropractors have implemented a form of treatment that we call an Adjustment.  It has also been referred to as “high-velocity, low-amplitude” thrust manipulation to the spine, as well as other joints of the body.  Physical therapists, on the other hand, have used a much lower velocity manipulation.  In the name of public safety, chiropractors have always been criticized by the medical profession for our high-velocity approach, in spite of the HIGH degree of success and VERY LOW incident of injury. 

In recent years however, research in the care of musculoskeletal conditions specifically related to the spine, indicated that of all the therapies used, such as electric stimulation, ultra-sound and hot/cold packs, spinal manipulation has been found to be most effective.  And, not just any spinal manipulation; specifically, it has been the high-velocity low-amplitude manipulation, the chiropractic adjustment.  It comes as no surprise then that those who once denounced chiropractic care in the name of public safety are now taking weekend courses in High-Velocity, Low-Amplitude manipulation. 

The organization teaching these courses is the “American Academy of Manipulative Therapy”.   This is a teaching facility for people who want to learn spinal manipulation, specifically the High-Velocity, Low-Amplitude techniques.  As reported in the March 26, 2008 issue of Dynamic Chiropractor, “this is just one of the many examples of how others who called spinal manipulation ‘quackery’ just a few decades ago have now become the ‘originators’ of this form of therapy.”

Chiropractors have always known the impact (no pun intended) this style of manipulation has on the spine, nervous system, and the human body, and inspite of criticism and ridicule from the medical community we have stayed the course, providing chiropractic adjustments for the past 113 years.

Now, after 113 years of abuse by the medical community who has admittedly attempted to “contain and eliminate” chiropractic, we now face the risk of “the establishment” attempting to take away what we have owned for all these years.

Please don’t get me wrong, medicine has its place, but it is NOT in performing high-velocity low-amplitude spinal manipulation after learning it at a weekend seminar in some hotel.

That’s what frustrates me today . . . until next time at www.FrustratedwithHealthcare.com.