http://www.trigram.com/blog/ Trigram Blog en support@trigram.com Copyright 2008 2008-05-06T01:33:00-08:00 http://www.trigram.com/blog/post/from-complaining-patient-to-enthusiastic-referral-source/ http://www.trigram.com/blog/post/from-complaining-patient-to-enthusiastic-referral-source/#When:00:33:00Z By Honora Lee Wolfe, Dipl. Ac. (Reprinted by permission).  Honora’s bio may be found at the end of this post.  She may be reached through her website, Bluepoppy.com. Every business gets complaints. People are people; clear communication is difficult, and there are misunderstandings even among the best of friends. In running any business, there are items that fall through the cracks, no matter how hard you try or how good your intentions.  In addition, when people are sick, their patterns of disharmony cause them to filter what they hear in certain ways - not to mention the fact that some people are complainers by nature.  It is an unfortunate truth that someone unhappy with your services is 10 times more likely to be vocal about his or her dissatisfaction than a happy customer is likely to be about his or her satisfaction. None of us can afford too many "bad-mouthing" ex-patients running around spreading bad news. So, do you have to lose a patient because he or she is unhappy about something? Of course not (unless you choose to "fire" the patient on purpose, which is also an acceptable option). Here are some hints on handling unhappy patients and turning them into loyal, enthusiastic cheerleaders for your clinic. Listen carefully and attentively. Let the person blow off some steam. Don’t become defensive. If possible, make it clear to the patient that you are on his or her side (even if you think some of the patient’s issues are unreasonable). Try to avoid an adversarial posture.Ask the patient for details. Ask the basic questions: who, what, where, when and why. This lets the person you know about his/her concerns while allowing you to clarify what really happened and what you might do about it. This also allows the patient time and perspective to move from the position of simple anger to one of rationality.Propose one or more solutions. If you give people an either/or proposition, they are in the driver’s seat. They get to choose how the situation may be rectified. Another possibility is to ask the patient how he or she would like the situation handled. Most people will be more reasonable than you might think. In fact, statistics show that if you let the complainant choose the solution, it often saves you money (or time) in the long run. If the patient’s request is unreasonable, you can come back with, "Well, here’s what we can do."Get it over with and move on. Make sure your patient is satisfied with the solution that is agreed upon. Make sure the patient knows you appreciated him or her brining the problem to you directly instead of letting it fester, or just disappearing without contacting you. Also, if there are any fundamental problems in your clinic, you need to know about them or they cannot be fixed. After you’ve done this, take the following three steps: Make sure you apologize for the patient’s inconvenience or discomfort. Make sure whatever solution(s) is agreed upon is acted upon promptly. Make sure every phone conversation, e-mail message, fax or letter is documented and in the patient’s file. This is of vital importance if there are any legal or insurance ramifications. Of course, taking these steps may not work every time (but let’s hope you don’t need to use this technique very often). You may lose the person as a patient anyway, but he or she will be far less likely to speak ill of you to others, and there’s always the chance the patient may remain an enthusiastic customer. Finally, you also will know that you have treated the patient fairly, and that you did the best you could to deal with any problems or mistakes made by you or others in your clinic. Since it is ourselves we have to live with, knowing you did your best ultimately is the most important issue. Honora Lee Wolfe has been involved in professional health care education since 1976. She helped found the Boulder School of Massage Therapy in Colorado, serving as the school’s director for the first five years of its existence. She then went on to study tui na at the Shanghai College of Traditional Chinese Medicine, completing her acupuncture training in 1988. Ms. Wolfe has taught at numerous national and regional acupuncture colleges throughout North America and Europe, and has authored or co-authored more than a half-dozen books related to acupuncture and Chinese medicine. She currently maintains a busy practice in Boulder, Colorado which specializes in musculoskeletal and nervous system pain and sports medicine. Ms. Wolfe currently lives in Boulder, Colo., and is the author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists.  She is also a principal at Blue Poppy Enterprises, Inc.  Check out http://www.bluepoppy.com for more from Honora. Practice Management 2008-05-06T00:33:00-08:00 http://www.trigram.com/blog/post/dont-undercharge-for-your-services/ http://www.trigram.com/blog/post/dont-undercharge-for-your-services/#When:00:25:00Z By Honora Lee Wolfe, Dipl. Ac. (Reprinted with her permission).  Honora’s bio may be found at the end of this post.  She may be reached through her website, Bluepoppy.com. Undercutting the pricing of the practitioner down the street is a great way to get his or her patients into your office, right? Wrong. There are actually several reasons why this is a bad idea, and in this article, I will do by best to convince you of this assertion. First – and possibly most important at the present time - is that a wide variety of third-party payers are trying to determine the customary and standard charges for the services provided by practitioners. If someone researching the subject for Blue Cross hears that practitioner #1 is charging $80 per treatment, practitioner #2 is charging $50 and practitioner #3 is charging $35, that person will probably conclude that $55 is an acceptable reimbursement amount. It also is illegal to charge patients who pay you with cash more than those who pay you through insurance. What message do you want the insurance researcher to pass along to the people who make the "customary and standard" decisions? Second, no one wants cheap health care. What people want is reliable, trustworthy, effective, low-risk health care – but I’ll discuss these points a little later. The truth is, only a few people base their buying decisions solely on price, no matter what commodity or service you are discussing. You can verify this by noticing something as simple as, say, the fact that most people are not driving around in Hyundais. Similarly, it’s a fact that at the supermarket, name brands such as Coke and Pepsi always outsell the "Brand X" cola by a margin of about 12-1. I could go on with examples from industry after industry. Why is this true? It’s because people don’t want low price; they want low risk. Big K Cola, for example, might just taste fine – or it could be terrible! I don’t know, but if it’s only 85 cents more to buy the Coke, the "trusted source" feels like a great bargain. I know exactly what it will taste like, and there’s no risk. In your professional world, there will always be practitioners who offer lower prices than you do. But if you can make your services reliable, effective and low-risk, patients will not care what you charge them. As long as you are not fleecing people, but are giving good service and value, price can be quite irrelevant in relation to the size of your practice. In fact, a slightly higher price can even enhance your reputation, rather than hurt it. So, how do you lower your prospective patients’ risk? There are many ways to do this. The best, of course, is when someone uses your services, gets a good result, and tells their friends you are wonderful. However, if you are new in practice or moving to a new area, you have to offer people something to lower the risk of coming in to see you the very first time. What could this be? Become a local expert. That means writing articles, speaking in public, getting on television or the radio, or better yet, all of the above. You’d be surprised how many small, local publications are looking for writers on health care subjects, and how many organizations need regular speakers. There are opportunities in both areas, if you go out and create them. If you’re the one writing about acupuncture and Chinese medicine and a particular disease or diseases in the local media, people figure out you are knowledgeable on that subject. Teach a class. This class could be on tai qi; qi gong; feng shui; diet; cooking; stress management; or whatever subject you can credibly offer to your community. I guarantee that unless you are a total jerk, people in the class will become your patients because you are credible, approachable and knowledgeable. Join a service or volunteer organization and get involved. I do mean "get involved." This type of activity puts you in contact with a lot of people, but you may as well put in the time in your community, because if you don’t have enough patients, sitting around your office studying treatment books won’t bring them in; building a network of people who know you and consider you a credible, participatory member of your community will. Talk about your practice with everyone you can. You believe in this medicine, and you have been trained to perform it well. If you engage people in a conversation about their health and let them talk to you, they will be drawn to you. Active listening is tremendously powerful. It builds your credibility and creates more referrals. The above activities will help you build a network, gain credibility, and get referrals. If your prices are fair and your payment policy is easy to understand, people will begin to seek you out. If your prices are too low, your services will probably not be respected, and may even by suspected as not being that great. You get what you pay for, right? I also suggest that you don’t offer free appointments. My experience is that you will get mostly "tourists," who don’t come back once there is money involved. Once you have people coming to see you, you must transfer the risk-lowering activities to the inside of your clinic. Keep it clean, tasteful, simple and conventional. You are operating a medical facility, and whether your services include acupuncture only or other treatments, people need (and expect) your office to look like a medical facility. Are your front desk staff dressed appropriately, and do they behave in a professional manner? Do your offer superbills, receipts, and appropriate release and intake forms? Do you keep your charts in a professional manner? Do you wear clean, new shoes? In other words, if a patient comes in believing you to be an expert, will that patient go out believing the same thing? Is your "inside reality" the same as the way you portray it when you’re out networking and marketing? You want people to feel and believe that you are reliable, credible, trustworthy and effective, right? The inside feel of your office, treatment rooms and building, and the entire experience of coming to see you, is part of creating that impression. All of these things go into the low risk factor. Always Put Yourself in Your Prospect’s Shoes By this, I mean a prospect who has never heard of you, but takes a quick look at your office, advertisements, and brochures or business cards. Here are some questions to consider: What will he or she think? What’s his or her risk in calling you? What can you do to lower the risk? Is there some way you can get the prospect to experience your service before committing to treatment? Is there more information you can provide ahead of time to help the prospect make an intelligent decision? Can you give any guidelines as to what to look out for when seeking acupuncture treatment? Remember: You don’t need to lower the cost of your treatments; you need to lower your prospective patients’ risk in trying your services. People don’t want low prices. They want low-risk, effective medical care. Honora Lee Wolfe has been involved in professional health care education since 1976. She helped found the Boulder School of Massage Therapy in Colorado, serving as the school’s director for the first five years of its existence. She then went on to study tui na at the Shanghai College of Traditional Chinese Medicine, completing her acupuncture training in 1988. Ms. Wolfe has taught at numerous national and regional acupuncture colleges throughout North America and Europe, and has authored or co-authored more than a half-dozen books related to acupuncture and Chinese medicine. She currently maintains a busy practice in Boulder, Colorado which specializes in musculoskeletal and nervous system pain and sports medicine. Ms. Wolfe currently lives in Boulder, Colo., and is the author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists.  She is also a principal at Blue Poppy Enterprises, Inc.  Check out http://www.bluepoppy.com for more from Honora. Practice Management 2008-05-01T00:25:00-08:00 http://www.trigram.com/blog/post/how-to-set-fees-for-your-practice/ http://www.trigram.com/blog/post/how-to-set-fees-for-your-practice/#When:00:12:00Z By Honora Lee Wolfe, Dipl. Ac. (Reprinted with her permission).  The article below is excerpted from Points for Profit: The Essential Guide to Practice Success for Acupuncturists by Ms. Wolfe, Eric Strand and Marilyn Allen. We believe this article applies to practices of all stripes, not just Chinese medicine practitioners, which is why we have put it here in our blog. Honora’s bio may be found at the end of this post.  She may be reached through her website, Bluepoppy.com, from which you may also purchase Points for Profit--needless to say, a book we highly recommend. Setting your fees can be just as important as your location, business name and style of practice. If your fees are too high for your locale, it may deter potential patients from considering your services. On the other hand, if your fees are too low, you will not survive long or at least not thrive in the world as we know it. So, how do you figure out your rates, especially when opening your first clinic? There are a number of factors you must consider when making this decision: the lifestyle and income level in your area; the going rates of other practitioners in your area; the amount of money you need (and want) to make to be comfortable; and what you think the value of your products and services actually is. What’s the Going Rate in Your Area? Before you do anything else, find out the going rate for acupuncture in your area. This is an easy task that can be performed in an afternoon. With pen, paper and the Yellow Pages (or an Internet connection), jot down a list of all of the practitioners in your neck of the woods and call them. Don’t be shy. There are more than enough patients out there for all of us to share. One new practitioner only increases the number of potential converts to our wonderful medicine. You should therefore be up front about what you are seeking. Tell the acupuncturist you are trying to figure out your own fees and ask what they charge; are their patients easily able to pay and continue with treatment; or do they notice that sometimes patients balk at rescheduling for "financial reasons"? If this is too scary, get a significant other or friend to call and simply ask for the rates at each clinic. Other practitioners’ numbers may be a factor in how you set your rates, but you need to know this information. If nothing else, you have introduced yourself to everyone else in the area. These practitioners are your colleagues, and you may come to rely on them in the future for referrals, for covering your practice when you are out of town, or for a bottle of herbal medicine you need for a patient (but which your clinic has run out of). How Much Is Too Much? How Much Is Too Little? So what do you feel comfortable charging? If you are charging more than what you believe your services are worth, it will come through in your body language and voice, and patients or potential patients will think them too high as well, even if the rates really are quite fair. However, if you charge extremely low rates and undercut all of the local competition, or you provide no-cost treatments, you may find your patient load slowly decreases into nonexistence. Why? People assign worth and value to things based on what they cost. It is logical to believe that something more expensive must be better. Take, for example, the experience of purchasing a new vacuum cleaner. There you are, standing in the aisle, staring at 20 choices. Some of the vacuums have extension wands; some of them are bagless; others have a cool little light on the front or hypoallergenic filtration. Of course, the first thing we do is whittle down our choices to include only those vacuum cleaners that have the features we need and believe to be valuable. The next step in the process is price. At one end is the least expensive vacuum, at the other the most. Most people involved in any buying decision will at this point start discarding choices based on the price. Do I really want to buy the cheapest one? Why is it so inexpensive? Maybe it will break quickly; will I be back here again paying for repair services? Away go the one or two choices from the bottom of the list. Those will be discarded first, before the vacuums that are too expensive! At the other end of the spectrum are the Mercedes and Lamborghini of the vacuum world. They are sleek and shiny, have huge sucking power, and boast not just one light, but three. Do I really need all of those bells and whistles? That red one won’t make me vacuum any faster or better. Plus, it’s so expensive. Away go the top two or three choices. What we are left with now is a realistic selection of comparable items, all within a few dollars of each other. We can pick the one at the low end, the high end, or the one right in the middle. It won’t matter, because now the playing field is relatively equal from the point of view of price. The point here is that if you are the vacuum at the low end, you are likely to be immediately discarded as too cheap or possibly ineffective. Of course, there are some people who will gladly accept the cheap services you provide, but if a new client who has never heard anything about our industry calls around and considers several practitioners, they may decide that your fees are so low, there must be something wrong with your services. They will assign less value and worth to you and your services, and ultimately chose a higher-priced practitioner because of the perception of value. In the end, most people will make purchasing decisions based on perception of value and trust, not strictly on price. Consider another example. Most of the people we know do not drive the least expensive cars on the road. They buy a car based on a complex set of perceptions and beliefs that include a wide variety of issues. Price may be among those concerns, but it may not be that high on the list compared to many other issues. The same is true of how we purchase health care services. People don’t want cheap health care; they want trustworthy, caring, reliable and effective health care. There are two other things to consider. First, it is well known that your personal income will be the same as that of your average patient. If your patients all make $25,000 to $40,000 per year, that’s what your income will be, as well. That is one of the reasons why we suggest you check the financial demographics of any town in which you plan to set up a clinic. It may be wise to pick a town or area in which the median annual income is $75,000 to $100,000 if that is how much you want to take home. Second, it is a proven fact that people who are not charged at all, or who are charged very low fees, rarely get well as quickly and completely as people who are charged more. That means there is some relationship between the placebo effect and the amount of money paid for services rendered! If your clinic is lovely, your treatments good, your customer service better than adequate, and your bedside manner compassionate, you may actually get better clinical results if you charge a little more for your treatments than if you are charging too little. It bears repeating: People don’t want cheap health care; they want effective, compassionate health care from someone they trust. How Much Money Do I Need? Set aside any of the numbers you have come up with to this point, and let’s look at how much you need to make to live the life you want. We’re going to start with the desired end result. How much money do you need, or want, for personal expenses per month? What’s your number? $4,000? How about $10,000? This has to at least cover your expenses at home, including student loans, car payments, bills, and the like. Take your desired monthly income and write it down at the top of a piece if paper under the words Personal Budget. Now, consider all the costs of running a clinic. While the numbers vary depending upon what part of the country you live in, we have found $4,000 a month to be about average. This includes 30 hours per week of front desk help, rent, business and malpractice insurance, CEU costs, phone service, heat, marketing expenses, some computer and accounting help, and office and practice supplies. Decide if your costs are a little higher or lower, and put your total under the title Monthly Business Budget. Add the total business and personal budgets together to get your total monthly budget, then multiply that total by 12. The resulting number is your overhead for one year. Pretty high, isn’t it? Don’t panic yet; we’re going to break this down into manageable bites as we go down this form. The next step is to divide your yearly overhead by 50 weeks. I say 50, because you do want some time off for a vacation, don’t you? If you are planning to take more time off, then use the remaining number of weeks to divide into your yearly overhead. Next, you need to decide how many hours per week are you planning to work, or write in how many you presently work. Are you a part-time practitioner, working 20 hours per week, or do you work full-time at 35 to 40 hours? Divide your weekly overhead by the number of hours you work per week. The number you have before you is the amount of money your clinic needs to produce each hour. This may be produced from treatments, product sales, rent income from other practitioners, or classes you teach. Where does this number fit when compared to the results of the previous questions in this article? Is this required income per hour higher or lower than the average treatment price of other practitioners in your town? Will you have to see two or three patients per hour to get there, or can you meet your hourly overhead with one patient every hour-and-a-half? The answers to these questions also will have a lot to do with how many treatment rooms you have available and, therefore, how many people you can see per hour. If you perform lots of massage or tuina, you may only be able to see one person per hour. Also, if you have access to only one room, you are definitely limited in the number of people you can see, and your cost per treatment may need to increase (or you may need to consider moving). Remember, however, that your clinic can and should generate income in other ways besides just the treatments that you give. You may have a room to rent out one or more days per week or during the evening. You can, and probably should, have product lines that you sell in your clinic, such as Chinese herbal medicine, skin care products, orthomolecular products, books, or other items. Just as it is difficult to balance on a chair with only one leg, your clinic and personal budget will be easier to balance with more than one source of income. What About a Sliding Scale? Many public clinics like Planned Parenthood or other social service-style clinics base their fees on a sliding scale related to patient income. This is usually tied to the federal guidelines for what is considered above and below the national poverty line for the size of your family. It is legal to use a sliding scale, but you may want to require some type of verification of people’s assertions about their income, such as tax returns or a few months’ bank statements. You need not offer these discounts to people for whom you are billing insurance. What Feels Right? This is the last step. If you have done your research, asked your questions and added your personal figures, you should have a few numbers in front of you. Just by scanning them you will get a feeling for your personal comfort level with your treatment prices. Feeling comfortable with your pricing is extremely important. When you tell a new patient that he or she needs to come in twice per week for the next three weeks, that patient needs to sense that you are comfortable with your prices and believe you are worth that amount of time and money. If you have checked the local competitors, and your pricing is someplace in the middle (neither too high or too low) and allows you to meet or exceed your clinic’s hourly income requirements, you can rest assured that your prices are fair for your market. Being fair means that the people you serve will not feel taken advantage of or gouged by out-of-control medical costs. By setting your fees based on a combination of facts as well as your feelings, you are more likely to feel and behave comfortably with the financial policies of your clinic. The knowledge that your pricing will meet your personal needs without gouging your patients will give you confidence that you are doing what is right, fair and needful for both yourself and your patients.Honora Lee Wolfe has been involved in professional health care education since 1976. She helped found the Boulder School of Massage Therapy in Colorado, serving as the school’s director for the first five years of its existence. She then went on to study tui na at the Shanghai College of Traditional Chinese Medicine, completing her acupuncture training in 1988. Ms. Wolfe has taught at numerous national and regional acupuncture colleges throughout North America and Europe, and has authored or co-authored more than a half-dozen books related to acupuncture and Chinese medicine. She currently maintains a busy practice in Boulder, Colorado which specializes in musculoskeletal and nervous system pain and sports medicine. Ms. Wolfe currently lives in Boulder, Colo., and is the author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists.  She is also a principal at Blue Poppy Enterprises, Inc.  Check out http://www.bluepoppy.com for more from Honora. Practice Management 2008-04-22T00:12:00-08:00 http://www.trigram.com/blog/post/four-powerful-steps-for-practitioners-to-attract-more-patients/ http://www.trigram.com/blog/post/four-powerful-steps-for-practitioners-to-attract-more-patients/#When:23:48:00Z By Honora Lee Wolfe, Dipl. Ac. (Reprinted with her permission).  Honora’s bio may be found at the end of this post.  She may be reached through her website, Bluepoppy.com.Attracting new patients. Admit it: that’s what running a successful clinic is all about - getting more people to know about you and purchase your services. The more people, the better. Why else would you work so hard and spend so much to learn this medicine, create a beautiful, welcoming clinic, and offer the best possible services? I don’t believe you went through all this to languish in obscurity or poverty. You work so hard because you know you have something of value to offer - and you want to reach as many people as possible with this medicine, because it can help them live a healthier life. Marketing is what helps you reach your goal of a busy, prosperous clinic, but it’s also a subject that confuses of a lot of practitioners. We all know we need to promote ourselves and our medicine, but some of us may not know where to start, or how to continue regularly and effectively. A Sample Scenario Let’s say you live in an average U.S. city, and that you get 1,000 people in a room and give a talk on acupuncture/Chinese medicine. You would talk about your services and about the history of Chinese medicine, or you would discuss research on specific medical conditions. You might have literature to pass out; books for sale; business cards to distribute; slides or photos of a recent trip to China, etc. After this direct exposure, chances are at least 1-4% of these people would call you for a treatment, or to discuss the possibility of treatment. That’s 10-40 people. "But how," you ask, "will I get that many people to know about me? I can’t get that many people in a room." Since you probably don’t have the budget to create the kind of advertising that would get that kind of response, you must find creative, low-cost ways to go directly to those 1-4% and bypass those that are not interested. It’s not worth promoting yourself to people who will most likely never embrace your words. Here are four steps to reach potential new patients: 1. Define Who You Are and What Sets You Apart You have a clear idea about what Chinese medicine and acupuncture are, and what they can do. You know what services you do and don’t want to offer. Can you also delineate what makes you and your services unique? Is it your specialty (gynecology; mental-emotional disease; children’s care; sports medicine); the beauty and healing environment of your clinic; better parking; a special sub-group of people that you serve, etc.? 2. Describe Your Ideal Patient and the Conditions You Want to Treat Sets You Apart After step one, figure out what kinds of problems or patients are your "ideal." Do you only want to see patients over age 21? Do you only want rock climbing enthusiasts with musculoskeletal problems? Whatever it is, be as clear with yourself about these two items as possible. 3. List the Ways/Places You Can Get Access to People with These Conditions Think about what these types of patients do: what they buy; where they shop; where they hang out; what publications they read; what radio stations they listen to; what websites they visit; what e-mail newsletters they subscribe to; what their habits are; and where you can find them. For example, if you want to treat rock climbing enthusiasts (because you are one, too), go to your favorite search engine and type in "rock climbing." Also go to the Yellow Pages for your city or region and look up everything to do with rock climbing that you can find, then analyze the search results and compile a list of every company, organization, store or other entity that has to do with this subject. Evaluate the results and compile a list of every avenue of potential marketing you find. 4. Think of Inexpensive Ways to Network and Promote Yourself to (and with) This List Now that you have a list of possible allies and patients, it’s time to get busy. Contact everyone on the list and offer them something that would be a "perk" for their members, customers, readers, etc. Write articles for Web sites, magazines, e-mail newsletters, and club and organization newsletters about the benefits of acupuncture for climbers. Contact outdoor gear stores, rock gyms, climbing clubs and associations, and ask to give free talks about the same subject. Use the same material you just wrote up in an article. For example, you could have the local rock-climbing gym sponsor a talk, with you as the speaker. Make sure there’s something in it for the owner or manager of the store - maybe a free treatment, for example. Everyone who comes to the talk, which is about the benefits of acupuncture for climbers (increased stamina; less hand and finger pain; fast injury healing; etc.), receives a free article about climbing and hand pain (or whatever the subject is). You might also have some personalized items on hand, such as caribiners; climbing chalk bags; energy bars; or other small climbing paraphernalia that has your name and phone number to give to the climbers · you get the idea. Bring cards, brochures - anything that you can give out for free. Remember, not all of your efforts will make a "hit." However, concentrated efforts such as these will bring you new patients. Also, remember that these people know, talk and climb with each other. If you have success treating a few people, the entire regional climbing community will hear of you. The same holds true no matter what your specialty is. Through these efforts, you will create a brand name for yourself: the local "acudoc" who treats climbers. You will become the "in" practitioner to visit in these circles. This is exactly what you want. Always remember to ask your climbing patients for referrals, so you can build a practice that allows you to get very good at one specialty - which is much easier than knowing everything about everything. The message here is, don’t try to market yourself to everyone. Find your ideal patients and market yourself doggedly to them. Why spend money on a newspaper ad to the general public when you only want to treat a certain segment of the population? Save your effort and money and be more effective by going directly to those valuable 1-4% you really want to serve and who want your services. Good luck! -----Honora Lee Wolfe has been involved in professional health care education since 1976. She helped found the Boulder School of Massage Therapy in Colorado, serving as the school’s director for the first five years of its existence. She then went on to study tui na at the Shanghai College of Traditional Chinese Medicine, completing her acupuncture training in 1988. Ms. Wolfe has taught at numerous national and regional acupuncture colleges throughout North America and Europe, and has authored or co-authored more than a half-dozen books related to acupuncture and Chinese medicine. She currently maintains a busy practice in Boulder, Colorado which specializes in musculoskeletal and nervous system pain and sports medicine. Ms. Wolfe currently lives in Boulder, Colo., and is the author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists.  She is also a principal at Blue Poppy Enterprises, Inc.  Check out http://www.bluepoppy.com for more from Honora. Practice Management 2008-04-15T23:48:00-08:00 http://www.trigram.com/blog/post/red-flags-for-insurance-billing/ http://www.trigram.com/blog/post/red-flags-for-insurance-billing/#When:02:33:00Z The following was an article written by Kevin McNamee.  Trained as an engineer, Kevin also trained in Chinese medicine and chiropractic, getting a Master’s Degree in Traditional Chinese Medicine and a Doctor of Chiropractic--simultaneously.  Having survived that, he now runs a successful medical practice in Los Angeles, as well as managing a medical supplies company (check out The Supply Center). When not overworking, Kevin may be found traveling the country giving seminars on medical billing and practice management, marketing one’s practice, and doing orthopedic medical evaluations.  Dr. McNamee is an expert in most practice management disciplines, and many more of his articles, resources, and access to medical supplies may be found on his website by clicking here. Red Flags:Why You’re Not Getting Paid   There are many errors that can cause your insurance forms to be rejected and/or denied for payment. The following are some common mistakes that can occur in insurance billing. 1. Billing for more than three to four modalities/procedures per visit. The therapeutic encounter for a patient is to be 30 minutes based on the insurance company’s perspective. In that time, three to four therapies is more than adequate. There is also a phenomenon called a diminishing return of the therapies given to benefit the patient. Therefore, anything above this will have questionable value. Similar therapies given on the same visit may also be questioned. For example, a patient may receive a hot pack, moxa and infrared on the same visit. The question asked by the insurance company could be, "How much temperature heat to be placed on this patient before he is well-done?" 2. Billing an evaluation and management (E/M) on each patient encounter in addition to the therapy.  This looks like the provider is trying to inflate the bill. If one were to look at the components that need to be present in the history, exam and medical decision-making to bill and E/M, the typical daily progress notes do not rise to this level. The daily progress notes are included in the therapy codes like acupuncture, etc. 3. Total charges for daily treatment are not reasonable in the area. Your charges for workers’ compensation, personal injury and health insurance should be the same.  Just because a case is a personal injury case does not mean you can inflate the bill. This is a red flag to the insurance company; besides, it is illegal to have multiple fee schedules. 4. Treatment for soft tissue injury exceeds three months. If a patient with a soft tissue injury such as a sprain and/or strain is not treated, the condition will reach maximum improvements in three months. Therefore, if a patient is being treated for a soft tissue injury for more than three months, the question arises: what therapeutic benefit are you offering to the patient’s recovery? If the patient has not been afforded Oriental medical care during the previous treatment, it may be worth trying a short therapeutic trial to see if there is any improvement. Continue if there is measurable improvement; discontinue if there is no change. 5. The records do not support the diagnosis or treatment plan. If the history and examination findings do not support the diagnosis, the treatment is not supported. This is why tongue, shen and pulse diagnosis is not adequate. A more thorough history and examination needs to be performed so the patient’s progress can be monitored objectively through re-examination. 6. The patient is seeing multiple doctors and has duplicate services on each day. Be careful when you are treating a patient being seen by other providers. What may happen is that other providers are giving the same therapy (ice, heat, massage, etc.) as you on the same day. The question of diminishing therapeutic benefits arises. 7. Diagnostic tests are not supported by the chief complaints, exam findings or diagnosis. Diagnostic tests such as MRI, x-ray, laboratory tests and bone scans must be supported by the history and examination findings. These two components lead to the type of diagnostic tests. It is inappropriate to order an MRI of the neck, midback and low back when there was only an injury to the neck, with no radiation in the extremities, muscle weakness or other reasons indicating such a test. It could look as if the final bill has been inflated. 8. The property damage to the car is not proportional to the medical treatment given. When evaluating a personal injury case, look at the dollar damage to the car: sometimes, it indicates the severity of injury sustained by the patient. For example, if the patient was in a vehicle that had $1 damage, but the patient received $10,000 in medical care, is this appropriate?  Conversely, a patient is in a vehicle that sustained $5,000 in damage, and the patient received $3,000 in medical care. The second situation appears more reasonable. There are always exceptions and, if so, each case can (and should) be argued. I had one case in which there was $200 in damage to the cab of the patient’s pickup truck, but the patient had $5,000 in diagnostic tests and treatment. On the surface, this looks inappropriate; however, the pickup truck had 2x4 lumber handing a few feet out of the back. The car behind the pickup truck did not stop in time and hit the lumber, forcing it through the truck cab where it impacted with the patient’s lumbar and sacral regions. The cost of fixing the hole in the metal cab was minimal, but the physical and financial impact to the driver was severe. These are a few red flags that may get your claims denied. Remember, there is usually some logic behind the denial. Try to put yourself in the insurance company’s shoes. This can help you anticipate and avoid potential claims denials. Practice Management 2008-04-14T02:33:00-08:00 http://www.trigram.com/blog/post/how-to-get-started-using-acubase/ http://www.trigram.com/blog/post/how-to-get-started-using-acubase/#When:05:32:00Z  What follows is a run-through of how to set up and use AcuBase Pro from the get-go.  Follow these directions to get up and running and optimize your AcuBase experience in a hurry.There are many ways of approaching the use of a practice management system. We’d suggest you do the following, in order:1. Start by reading through the AcuBase Pro documentation, provided as an Adobe Acrobat (PDF) file. The AcuBasePro.PDF file may be found in the AcuBase Pro program folder on your computer, as well as on the program CD (in the Documentation folder), and/or on the Trigram.com website under the Demo section. You may also download it by clicking here. Follow along in the program and play around a bit before getting too serious in order to get comfortable.2. When you are ready to use the program, start by going to the Settings/Preferences section (the wrench icon on the top-right side of every screen) and fill out as much Preference information as you are able. You may always go back and change these settings.3. Once you have filled out the basic Preferences, add some patients and fill in their billing preferences under the "Cases" section for each patient. Then, when you begin creating invoices, your patients’ preferences will show up properly. 4. Jump in! And remember that your program will expire in 30 days if you are an unlicensed user. Contact Trigram Software when you are ready to purchase a license, or to renew your license at the end of each 12-month period. Once the program is licensed, all data already entered into the program will continue to be accessible--you do not need to reinstall anything. To purchase a license, go to the Purchase link; call us at 1-888-4ACUBASE or US +1.510.654.3268; or e-mail support@trigram.com  Getting Around in AcuBase ProThe five main topic tabs at the top of the screen are Patients, Invoices, Reports, Inventory, and Calendar. These tabs represent the core subject areas of the program, and each is given its own chapter in the user’s manual and on-screen help. Back and Forward buttons at the top-right part of each screen will allow you to move backward and forward through previously viewed screens. The Settings button (which looks like a wrench in the upper-right hand side of the screen) will take you directly to the program preferences. The Settings section of AcuBase Pro is the central repository of your preferences for the way your practice interacts with the many different functions of the program. We recommend that you fill in as many of the Settings options as possible before you begin using the rest of the program, as options set up in Settings cascade down through all aspects of AcuBase Pro. Click on the wrench icon to go there first after viewing this Welcome screen. A Help button is available at the top-right of every screen, and looks like a question mark (?). This button takes you to context-sensitive help for whichever screen you are looking at. More detailed help may be found in the AcuBase Pro User’s Manual, which was installed with your program and may also be found on the AcuBase Pro Installation CD. AcuBase Pro also employs "mouse-overs" to assist you. Simply leave the mouse pointer over a field or button to get more information about that field or button.  Enabling (Licensing) Your ProgramAcuBase Pro is packaged as a fully-functioning program for up to 30 days; after 30 days, you are required to enter a license code, provided by Trigram Software. AcuBase Pro is licensed and renewed on a yearly basis, with different license fees depending upon whether you are using the program on only one machine or on a network. Upon registration, you will be given a license code, which may be entered on this Getting Started screen, in the program Settings, or when the program expires and pops up a licensing option. Simply click on the License button to enter the code. Expiration information appears in the Settings section of the program. To purchase a license, click here; call us at 1-888-4ACUBASE or US +1.510.654.3268; or e-mail support@trigram.com. AcuBase and Trigram Stuff 2008-04-13T05:32:00-08:00 http://www.trigram.com/blog/post/trends-in-medical-reimbursement/ http://www.trigram.com/blog/post/trends-in-medical-reimbursement/#When:02:32:00Z The following was an article written by Kevin McNamee.  Trained as an engineer, Kevin also trained in Chinese medicine and chiropractic, getting a Master’s Degree in Traditional Chinese Medicine and a Doctor of Chiropractic--simultaneously.  Having survived that, he now runs a successful medical practice in Los Angeles, as well as managing a medical supplies company (check out The Supply Center). When not overworking, Kevin may be found traveling the country giving seminars on medical billing and practice management, marketing one’s practice, and doing orthopedic medical evaluations.  Dr. McNamee is an expert in most practice management disciplines, and many more of his articles, resources, and access to medical supplies may be found on his website by clicking here.  The Great Insurance Experiment From the Great Insurance Experiment to Managed Care of Today. How Did We Get Here? By Kevin McNamee, DC, LAc  In the 1960’s and 70’s, the "great insurance experiment" took place. Insurance companies wanted to determine which payment schemes were the most effective for healthcare dollars spent and medical services delivered. The insurance industry contracted with RAND, a healthcare research organization in Santa Monica, California to study this. Several medical plans were studied. At one end of the spectrum was the plan in which patients paid 100% of their health care expenses; at the other end was the plan in which patients’ employers paid 100%. Within the range were various combinations of deductible and co-payment plans. For example, some plans had a 20% co-payment by the patient and 80% by the insurance company.  The study determined that when patients paid a deductible prior to the insurance company paying, services were delivered efficiently and in the most cost-effective manner for patients, employers, doctors, and insurance companies. The insurance companies then adopted the deductible and co-payment method as suggested by the study findings, and for a while, things worked as planned. Healthcare was delivered and cost was manageable. An Experiment Gone Wrong Over time, healthcare dollars became more competitive. No one had expected doctors to search for ways to make their practice more affordable and desirable to their patients. Originally, doctors received 100% payment in full from the patient, and the patient then submitted the bill to the insurance company for reimbursement. For example, if a patient was scheduled for three weekly visits over four weeks at $50 per visit, the cost amounted to $600 per month. Paying for medical services up front meant that patients needed a large cash reserve while they waited for the insurance company’s partial reimbursement. This could be a heavy financial outlay, especially for patients under continuous care. To entice patients, doctors offered to bill the insurance portion if the patient paid the co-payment amount. The doctor saw more patients because services were more affordable to the average person. It was easier for the patient to pay 20% of $50, or $10 per visit ($120 per month for three visits per week), while the doctor waited 30 days to be paid for the 80% balance or $480 in accounts receivable. As more doctors did this, competition for patients increased. To further increase their attractiveness, some doctors waived the co-payment and accepted the 80% insurance reimbursement as payment in full. Thus, the patient’s only financial obligation was the deductible. Eventually, doctors began waiving the deductible as well as the co-payment and accepted the insurance portion as full payment.  Without patients paying the deductible or co-payment (a built-in cost containment method), doctors made up the loss by over treating and over billing of services. Thus, the cost of health care escalated, and a vicious cycle ensued. Doctors billed for unnecessary and/or unperformed services; an increasing incidence of malpractice lawsuits caused a dramatic increase in the number of sophisticated, costly (but sometimes unnecessary) diagnostic tests; and the cutting edge technology required for such tests was expensive. As a result, insurance companies began to pay more for their members’ care. Hospitals and doctors purchased the "latest and greatest" technology to try to keep their patients, only to discover that they were unsuccessfully competing against each other for patients’ healthcare dollars. Soaring costs were the result of duplicate technology and ever-increasing malpractice insurance. This increased cost of healthcare was ultimately passed on to the patients.  The insurance industry’s "great insurance experiment" had gone awry and administrators were hard pressed to find the answers. In Comes Managed Care In the early 1980’s, approximately 80% of the health insurance available was indemnity insurance, which means that the insurance company paid upon demand with no limits. During the 1980’s, managed care companies began organizing and marketing their new healthcare delivery designed to reduce costs and curb over-utilization. By the end of the 1980’s, 80% of the health insurance overage was delivered through some form of managed care, including Health Maintenance Organizations (HMO’s), Preferred Provider Organizations, (PPO’s), Independent Provider Associations (IPA’s). 1999—welcome to managed care. Due to the factors mentioned above, managed care is here to stay. However, a re-evaluation of the benefit of managed care relative to quality of care delivered has begun. There seems to be an evolution towards something like indemnity insurance, yet due to economic pressures, it will never fully reach that point. How it ends up is anyone’s guess.  Today’s Insurance Trend The current trend in healthcare insurance is giving patients the option for a traditional indemnity plan with a deductible and co-payment or the managed care option. If a patient stays with the HMO providers, he or she patient can pay the $5 or $10 office visit fee with no deductible.  Patients can also go to a non-HMO provider of their choice or doctor’s recommendation and simply pay the deductible and co-payment. This gives patients and doctors a choice and more flexibility. For providers who might be thinking about participating in a managed care panel, here are some issues to consider. First, take a look at the potential benefits and negatives, as it could be a tremendous benefit to your practice or the biggest mistake of your professional life. The primary factor to consider is whether you can make an acceptable living with the fee reimbursement the managed care offers. The answer depends on the actual cost of seeing a patient in your office. If the HMO or IPA is offering a fee schedule you can live with, then sign up for it. If not, don’t sign up for the panel. Practice Management 2008-04-13T02:32:00-08:00 http://www.trigram.com/blog/post/were-giving-money-away/ http://www.trigram.com/blog/post/were-giving-money-away/#When:23:56:00Z The 80/20 rule sure does seem to be working, as our users are fast becoming our #1 source of new business.  There’s no better compliment than to have your existing customers become your best sales people, and we want to thank you, our customers, by making you a part of the Trigram team.  Beginning March 15, 2008, if you know of another practitioner or medical office looking for medical billing, scheduling, or practice management software, you can earn $100 by referring AcuBase Pro. The AcuBase Referral Program is as easy as 1-2-3:1.    Refer us. If you know of another practitioner that would benefit from AcuBase Pro, tell them about us and, if they purchase it, ask them to enter your name as the source of your purchase (part of the Trigram online purchase process) or let us know via emai or phone.   2.    Tell us. Contact Trigram and provide us with the practitioner’s contact information, using any of these convenient ways:Online:  Let us know through our Contact formPhone:  1.888.4ACUBASE (422.8227) or 510.654.3268Email:  support@trigram.com3.    Earn $100. When the practitioner or their organization purchases AcuBase Pro, you’ll earn $100! Take your choice of:A check to you or your organization for $100A credit of $100 toward the purchase of AcuBase software or license renewal.You’ll receive your referral fee within 30 days after Trigram has received full payment from the referred customer or organization. AcuBase and Trigram Stuff 2008-03-21T23:56:00-08:00 http://www.trigram.com/blog/post/faq-for-users-wishing-to-switch-to-networking-version/ http://www.trigram.com/blog/post/faq-for-users-wishing-to-switch-to-networking-version/#When:16:15:01Z What follows are a few common questions about upgrading from the single-user to network version of AcuBase... Q:First, just to be clear that I am getting what I want. With this version one person can be doing billing while another person on a different computer can be using the program and not interfering with the first person yet everything is being saved together. A:  Exactly, the program will actually only be installed on the server computer.  The other computer(s) involved will access the program through FileMaker Pro.  This brings us to the following:  all computers involved will need their own copy of FileMaker 8.5 or higher (FileMaker will not let you install on more than one computers).  Of course all computers involved must already be networking with each other.  Users on different stations can enter their own data without interfering with each other.Q:Second, when I back up Acubase do I have to backup both computers separately to save all the changes made on both computers?A:The server is where Acubase will reside.  This is where you’ll shut down the program and back it up. Q: Finally, I originally purchased Acubase when it was the 2003 version, then I made the transition to the current version, and now to the multi-user. Will I pay for this as an upgrade or a new purhase?A:If you upgrade when your renewal is due, you will simply pay the networking renewal fee instead of single user ($495) and get enter your networking license in the program.  Once you have FileMaker, we will assist you with the transition of files. AcuBase and Trigram Stuff 2008-03-20T16:15:01-08:00 http://www.trigram.com/blog/post/an-important-book-on-medical-billing/ http://www.trigram.com/blog/post/an-important-book-on-medical-billing/#When:19:35:00Z There is so much to learn about the business of healthcare.  One of the ways I try to keep up is to spend a ridiculous amount of time reading anything and everything I can get my hands on.  In fact, I just finished reading arguably the best book I’ve ever read on the subject.  Let me tell you why you need to buy and read this book today.The book is entitled “The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid” written by Deborah Walker, Sara Larch, and Elizabeth Woodcock, three accomplished practice management consultants and speakers.  The book is published by the Medical Group Management Association (MGMA)and Medical Economics magazine has hailed the book as “A bible on the science of reimbursement”.  One of the reasons I originally picked up the book was because I recognized the name of one of the authors, Elizabeth Woodcock, who had given a benchmarking seminar I attended in September at theHealthcare Billing and Management Association (HBMA) fall conference in Las Vegas.Unlike other practice management books, this one focuses exclusively on how you can manage your practice to ensure you maximize reimbursement and get paid for your services.  Most of the book analyzes each stage of the revenue cycle process including previsit, patient check-in, charge capture, claims, payment posting, insurance follow-up, denial management, and patient collections.  The remainder covers special topics including rightsizing your staff, using technology, in-house vs. outsourced billing, reporting, and compliance.Here are a few of the topics I enjoyed most:First, each chapter includes performance benchmarks collected by the authors from a study of real practices.  For example, the authors say the optimal staffing level for all back-office billing functions is approximately one staff member per 10,000 claims.Second, a major theme throughout the book is getting things right the first time.  To drive home this point, chapter 1 provides a worksheet that helps you calculate how much denied claims cost you and shows you how some practices spend more money resolving denials than they collect by resubmitting the claim. Finally, chapter 13 provides a number of sample reports you can use to manage and analyze your revenue cycle.  I’ve seen a lot of report – from customers, experts, even competitors – but I haven’t seen a set of reports that are as concise, yet insightful as those the authors have provided in this book.This book has something to offer for everyone involved in a physician’s revenue cycle.  If you are new to billing, this book will give you a fantastic introduction to the process.  If you are veteran guru, use this book to compare your business to industry best practices and performance benchmarks.  You can pick up a copy of this book at the MGMA store by clicking here for the catalog page for The Physician Billing Process.  It costs $65.00 for members and $105.00 for non-members.   AcuBase and Trigram Stuff, Practice Management 2008-02-18T19:35:00-08:00