Dr. Josh Wagner has created easy to follow communication for any DC to convert new patients’ mentality from: “Can this chiropractor help me?” to "When Can I Begin?” All without heavy education or force. On the webinar he shows you how to easily frame yourself and your care as “The Prize” in your new patient’s mind. All while making your patients feel completely listened to. And it’s easier than memorizing long scripts.
By Nancy Miggins, DC & David Marcarian, MA
The current healthcare ecosystem mandates efficiency and objectivism. The requirements to document, bill third party payors and actually get paid are becoming increasingly more rigorous and laborious. It is no longer enough to properly document and code what you do in your examination and treatment of a patient, it is essential that you can prove medical necessity and substantiate your clinical decisions with objective data.
Chiropractors believe they are immune and can fly under the radar of insurance audits and fraud investigations. Unfortunately, you can’t avoid the radar. Insurance companies have been establishing utilization profiles for years and they know your every move.
Emphasis and focus should be placed on strict compliance, meeting normative standards and employing proper testing and technology to generate objective, clinically relevant data. Even well-intentioned outliers get audited.
Today’s successful Chiropractors are empowered with real data, not dogma, and are embracing evidence-based practice. Evidence-based practice incorporates objective data; data that is factual, unbiased, and unchanged by personal feelings or interpretations, to help determine the best course of treatment.
Unlike previous paradigms which relied heavily upon patients’ blind faith in their doctor, evidence-based practice seamlessly blends the doctor’s clinical expertise with research proven diagnostic technology. Evidence provides peace of mind for the patient and the third party payer.
Objective data bolsters your clinical opinion and provides a means to monitor patient progress and effectiveness of treatment. Adjustments to the patient’s program of care can be made efficiently, resulting in improved outcomes and more cost-effective treatment.
Technology is the answer to cover your assets. One size does not fit all, however, so it is important to use the right tool for the job.
Static sEMG provides information about muscle firing while in the neutral posture. Taking only a minute or two to perform, this is the ideal quick screening tool. It shows the effect of subluxation on the muscles of the spine, along with postural influence, short leg, and head forward position. At minimum, Static sEMG is a form of electronic palpation yet unlike palpation, has great inter-examiner reliability. It displays an easy to interpret graphic to enhance patient awareness and education.
New University research has validated Standing Static sEMG studies as clinically valuable.1 Even more important, the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress (2).
Dynamic sEMG uses EKG electrodes attached to the skin, measuring muscle response continuously as the patient moves. This technology boasts over 7500 research papers published to date. It’s ability to determine presence or absence of soft tissue injury was established in a major Superior Court decision in the State of Florida (3). The AMA has recently provided a specific CPT code for billing.
Dynamic sEMG has recently evolved into a more effective and efficient technology known as DynaROM sEMG, in part due to a meta-analytic review from The University of Michigan. Researchers found the clinical value of Range of Motion was significantly enhanced by incorporating Dynamic sEMG. By measuring and graphing ROM and Dynamic sEMG simultaneously, one can see if muscle guarding and bracing accompanies limited range of motion. If it does not, the patient is most likely magnifying symptoms.
Dynamic sEMG coupled with simultaneous computerized ROM is the only truly objective testing available to Chiropractors for determining the presence or absence of soft tissue injury (1,4).
Brandon Casey, partner at Casey Law Offices, states “Attorneys like evidence, and by that I mean actual evidence-based treatment, not opinion.” He goes on to say “sEMG studies are the best proof of soft tissue injuries. In this day and age of skepticism, they are essential in a litigation case.”
With the latest in evidence-based technology, the process of providing insurers and attorneys with objective, physiologic data is simple and quick, requiring only a small time investment by the practitioner or trained assistant. Objective data leads to an objective Doctor, creating clinical competence. The doctor who embraces and integrates such technology will sleep better, knowing the burden of proof lies in the insurer’s hands in an audit, as data wins over opinion 99% of the time.
1. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
2. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain. Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg,WV Zucker, Robert MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV Caruso, Marianne RN,VA Medical Center, Martinsburg, WV. PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
3. Richard W. Merritt vs. Florida Dept. of Health et al (Case No. 04-1149RX)
4. Gerhardt, John. “Utilizing sEMG in the medical-legal arena to prove presence or absence of soft tissue injury”, White paper: 2011.
Written by David Marcarian, MA and Nancy Miggins, DC
As the original Chiropractic “Technogeek”, I feel obligated to make the lives of Chiropractors easier and more productive through the use of technology. One age-old issue screaming out for a technological solution has piqued my interest. It is well known that patients retain only 5-20% of what the doctor communicates; even less at a screening. Without being able to reinforce the message we convey, and do so quickly and effectively we lose our patients’ attention. Traditional solutions have relied upon everything from general pamphlets and videos espousing the value of Chiropractic, to expensive celebrity endorsements. We have struggled for decades attempting to “sell the invisible” and still only appeal to 8% of the population.
The emergence of Static sEMG in the early 90’s attempted to provide a user-friendly technology that produced patient-friendly graphics, but was limited by technological and reliability issues. This technology not only forged the way for evidence-based practice, providing objective data that Chiropractors need and patients want, but also provided an effective tool for internal marketing and spinal screenings, a mainstay for generating new patients. Yet the problem still persists.
What does a NASA researcher do? Seek out data, and observe. So that is what I did. Instead of interviewing doctors, I spent four months interviewing patients.
In the process of interviewing patients, an issue with significantly greater impact on the profession was exposed: Those in pain easily garnered the support of friends and family members in choosing Chiropractic as the treatment of choice. Those not in pain seeking Chiropractic care for general health and wellness, clearly expressed one common challenge: Each and every one admitted they found it extremely difficult to justify their Chiropractic visits to family and friends.
More important than this was the emotional response I received from patients who had taken home their Static sEMG test as it validated their complaints to cynical family members. One patient actually cried saying “My husband didn’t believe me until I showed him my print out”. You go to the doctor when you’re sick. You see the Chiropractor in pain. Why would you possibly go if not in pain?
We’ve been attempting to implement the dental model of “preventive care” for years with little success. But to a Technogeek, this is just another fun problem to solve.
In reviewing the literature on patient communication, I found some clear trends (1, 2, 3, 4).
In the days prior to objective data, we would pleasantly say “thank you”, and go off to get several opinions potentially putting off fixing the problem for months or even years! Sound familiar?
We in the Chiropractic Profession share the mechanics dilemma, and may learn a lesson from their approach. We live in a data driven society. Show them why with “instant” indisputable, objective data and we overcome not only their objections and reinforce the need for care, but overcome family members objections. In a data driven world, objective data rules, and those with it have the power to convince. Whether it be mass airflow sensors or wellness care. The key is finding a way to transmit this data in an electronic, instantaneous form which is visual in nature for maximum effectiveness.
I realized that it would be most intelligent to meet the patient where they lived… on their smartphone! Nielsen reports that more than 50% of mobile consumers are using smartphones. According to Nielsen’s monthly analysis of cell phone bills for 65,000+ lines, smartphone owners – especially those with iPhones and Android devices — are consuming more data than ever before on a per-user basis. This is an enormous captive audience waiting to be engaged.
It was crucial that this process maximized the use of technology to remove the need for human interaction and labor. Unnecessary labor is proof of a poorly designed system. This tool had to be fast, allow for instant communication, and provide indisputable, objective data which could be easily presented to skeptical family members and friends. Due to the fact everyone has smartphones, it has to be easily viewable on the tiny screen. Allowing the texting of the image via SMS would improve its effectiveness.
With major technological improvements that have tripled the speed of muscle tension measurements, the tool of choice for this objective data would be Static sEMG. Although Thermography was considered, it is too finicky due to sensitivity to environmental heat and cold, making screenings difficult. Additionally, patients can’t feel temperature differences between left and right sides of their spines, making the results less “believable”. Modern, Wireless Static sEMG can be performed in virtually any environment. More importantly, everyone knows the ache of muscle tension, making instant credibility the doctor’s reward when the graphed results reflect what the patient feels. New University research has validated Standing Static sEMG studies as clinically valuable (6). Even more important, a major study by the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress (7, 8).
Impersonal is ineffective. If the patient’s personal Static sEMG results, graphical in nature could be instantly transferred to the patient’s smartphone, that crucial communication between doctor and patient would be reinforced within seconds. Unlike a generic pamphlet on the value of Chiropractic, the patient needing to prove the necessity for care can instantly forward from their smartphone the test results to skeptical family members. Another requirement is for the graphical image to act as an “E-Business Card”, presenting both specific information on the doctor’s office, and an easily customized special offer. The impact on those who’ve received the forwarded, visually appealing graphic would provide powerful advertising for the clinic.
So I built this thing, filed patents and tested it. And guess what else happened. In Beta Testing all of the above conditions were met, and more. The big surprise was how many patients posted this graphic image on Facebook, and did so while still in the doctor’s office! Imagine the impact of your office information marketed by your patients at no cost to you? With the average person having 120 Facebook friends (5, 9), the value in terms of marketing alone is quite significant.
The tool proved invaluable at screenings where not only did the patient walk away with an instant personalized message, but also knew exactly how to reach you to take advantage of the special offer embedded in the graphic. Even better, the doctor stored the prospective patient’s email address for instant follow-up and future email marketing.
The term “Viral Growth” is an understatement when it comes to the impact of these visual images flying around the internet. The biggest surprise of all is that each and every patient tested said, and without exception (after saying “Cool”, that is): “Now I can show my _______ why I need my Chiropractor.” It is unknown if this can get us beyond that 8% of the population we’re seeking. Considering the massive proliferation of Smartphones, it at least takes advantage of a new form of high-tech, low cost marketing with potentially powerful consequences.
Technology can be your best friend or worst enemy. By finding the best product and support for your needs, you will have a great partner in building your practice. Follow the simple guidelines above, and you will enjoy all, the advantages of technology without the stress.
1. Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.
2. Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953-5.
3. Osborne H. In Other Words…Actions Can Speak as Clearly as Words. Boston Globe’s On Call Magazine. Jan/Feb 2006. www.healthliteracy.com/article.asp?PageID=3763 (accessed Mar 3, 2006).
4. Osborne H. In Other Words…Teaching with Pictures. Boston Globe’s On Call Magazine. Nov 1999. www.healthliteracy.com/ article.asp?PageID=3822 (accessed Mar 3, 2006).
5. Dunbar, R.I.M. (June 1992). “Neocortex size as a constraint on group size in primates”. Journal of Human Evolution 22 (6): 469–493. doi:10.1016/0047-2484(92)90081-J
6. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
7. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain. Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg,WV Zucker, Robert MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV
8. Caruso, Marianne RN,VA Medical Center, Martinsburg, WV. PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
9. Marlow, Cameron: “Maintained relationships on Facebook” 2009, March 9, www.facebook.com
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