It is completely understandable that the average Chiropractor prefers to avoid PI in their practice. Why? Oh, so so many reasons.
Time for a wake up call!
I'll start with the last one first. Really? You're going to deny patients who need you more than ANY patients? Those injured in auto accidents, with the most serious of soft tissue injury..that thing you are absolutely best at treating your skilled hands? Forget about the fact that you have more latitude in how often and for how long you see PI patients, but the fact that you as a doctor are needed, and don't feel obligated to help is kind of a way of ignoring your most important oath.
Why is PI perceived as a "dirty game"? Because it has always required we do things which we know are unethical for the purpose of obtaining patients. Some pay for a list of DMV accident records. Some spend time and money taking attorneys to dinner. There are all kinds of "tricks". The best trick of all, is to have tools which prove your value to attorneys. This way you don't have to chase them down, but they chase you down.
Change the game from opinion vs opinion to data vs. opinion.
Attorneys tell me all the time, that they prefer to work with MD's over DCs. I started to ask. "Clearly the public perception is that the MD has more credibility over the DC" is what I heard. Is this the case for the DC armed with objective data? Not at all. As a matter of fact, doctors that used to fear being before a jury or even in a deposition now gladly accept such challenges, as they have their trusty DynaROM Data to protect them and their patients.
Focus on the data, and opinion means nothing. Literally.
Many Chiropractors find their way into the profession because they have had a positive, life-changing experience with Chiropractic. It is a profession where miracles, great and small, happen on a daily basis. Few Chiropractors, however, take the time to identify, plan and build their niche practice and instead accept what comes their way.
Most Chiropractors have dabbled with accident recovery, but only a small fraction of the Chiropractic profession has chosen to become experts in the personal injury arena. Personal Injury practices flourish regardless of the economy. In 2011 alone, an estimated 2.22 million people were injured in motor vehicle traffic crashes.1 This astounding number does not include those people who do not report injuries at the time of filing an accident report. Those who reported a traffic accident experienced an 84% increase in the likelihood of new onset chronic widespread pain (2).
Furthermore, according to the Bureau of Labor Statistics (BLS), more than one million workers suffer back injuries each year, and back injuries account for one of every five workplace injuries or illnesses. In addition BLS states that one-fourth of all compensation indemnity claims involve back injuries, costing industry billions of dollars on top of the pain and suffering borne by employees.
Personal Injury provides Chiropractic with an abundance of injured patients in need of treatment and guidance. The complexity and diversity of injuries sustained as a result of a motor vehicle or work-related accident can be intimidating to the victim. While these types of accidents are a common occurrence, few people understand the importance of seeking qualified expertise in both the medical and legal aspects of the case. Getting proper care from a qualified professional in a timely manner and, as important, following through with that care to full recovery is essential.
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. 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.3,4 Objective data leads to an objective Doctor, creating clinical competence.
There are no shortcuts to success in the personal injury industry. The skills developed by mastering this evidence-based, patient-centered field create a solid foundation for a sustainable, financially lucrative practice.
It takes more than clinical competence to thrive in the personal injury industry. As a Chiropractor, you can’t just rely on injured patients to find you. You need to validate and align yourself with attorneys who also specialize in personal injury and who can partner with you to achieve the best results for your patients.
In the past this endeavor has been daunting, however, when armed with indisputable objective data that will solidify an injury claim, attorneys will seek to work with you. Previously, attorneys had reservations about working with DCs, as most cases come down to credibility of a DC’s vs. MD’s opinion. Objective data levels the playing field, as data trumps opinion 99% of the time. 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.”
The rules of personal injury case management may be simple, but they are not necessarily easy. There is a definite process to follow to maximize your reimbursement potential. These simple guidelines will help streamline the legal process, leading to prompt and consistent payment for your Dynamic sEMG testing.
Adhere To Testing Protocol: It is essential to learn proper testing technique, as good data is crucial to your success. Proper technique insures accurate data. Without this your credibly may be in jeopardy, and your clinical conclusions open for dispute.
Practice makes perfect and mastering proper test protocol requires actually performing tests. Testing theory will not provide you with the skills required to flourish in this industry.
Clinical Interpretation: Unfortunately, accurate data is not enough to win cases and get paid. You must make clinical sense of the data, presenting it in a clear, concise manner. Receiving a bill without the required report is a red flag for insurers. Not only does it lead to claim denial, but possible disciplinary action.
It is imperative that you get proper training regarding accurate and thorough interpretation of the test findings. Relaying these findings, combined with the test graphics and your clinical recommendations is mandatory if you wish to gain professional respect and receive consistent payment for your services.
Prepare For Deposition: There is nothing worse than having solid data, and not being able to defend your work. Both patient and attorney are relying upon you as the Expert Witness. Take this responsibility and obligation seriously, and garner the respect you deserve as a doctor. Ultimately your income will abound.
Doing your research and educating yourself on the pertinent sEMG studies is a key component to deposition mastery. Take the time to learn from each attorney encounter to bolster your confidence and become the Expert Witness that you are.
Follow Up: It is imperative that proper follow-up and follow through is made with insurance carriers and attorneys. Most payment delays or denials occur from incomplete information or lack of documentation. Initially it might require diligence and tenacity, however as you persevere the process becomes streamlined.
Be proactive and utilize the power of FEDEX and Certified Mail. Insurers will claim they did not receive bills and reports, a common first attempt at denial. Insurers “learn” quickly who perseveres and who does not. Those who persevere get paid.
Retesting: Initial testing should be performed 4-6 weeks after a motor vehicle accident or workplace injury. The test and interpretation with written report must be included in insurance and attorney billing. Do not take this lightly. An important part of being paid for this service depends on the presentation and interpretation of the data.
Dr. Gregg Friedman, Chiropractor and personal injury expert, recommends performing Dynamic Surface EMG with simultaneous computerized ROM testing every 30 days of care to document progress and establish necessity for continued treatment. The additional test and written report, including a comparison of results should be included in the billing.
The key here is to practice, practice, practice. The more you do , the more confidence you will develop. And, as is true with any competent case management, refer out if necessary. A second opinion from a medical doctor or specialist helps to build your case, and your reputation. Working with a network of diversified practitioners solidifies results and strengthens the claim.
Attorneys want to see consistency in your testing and interpretations, case management, and ability to discriminate between those truly injured and symptom magnifiers. Objective data is the key element in being able to defend your diagnosis and justify your treatment recommendations.
Being a victim of an auto accident or workplace injury is both inconvenient and intimidating. Navigating the medical and legal aspects can be daunting. Dr. Allen Fraley, Chiropractor and personal injury expert, strongly urges other Chiropractors that are interested in becoming personal injury experts to acquire the proper technology, seek education to master the unique aspects of a personal injury practice, and gain confidence and expertise in the interpretation of sEMG. This mastery and confidence will be conveyed with patients, attorneys and judges. When combined with indisputable, objective sEMG data, you can’t lose.
1. National Highway Traffic Safety Administration. “2011 motor vehicle crashes: Overview” NHTSA’s National Center for Statistics and Analysis, 9313-120612-v3, December 2012
2. Jones GT, et al. “Road traffic accidents, but not other physically traumatic events, predict the onset of chronic widespread pain: Results from the EpiFunD Study” Arthritis Care and Research 2011.
3. Geisser M E, Ranavaya M, Haig A J, Roth R S, Zucker R, Ambroz C, Caruso M. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. Journal of Pain 2005; 6(11): 711-726.
4. Gerhardt, John. “Utilizing sEMG in the medical-legal arena to prove presence or absence of soft tissue injury”, White paper: 2011.
Businesses across the board are changing their marketing strategies to focus on utilizing technology and social media platforms. The apparent benefit is that they can read the minds of their customers and study the specifics of consumer behavior, this leads them to provide high-class products and customer services. In essence, with the help of advanced social media tools, it has become easier to access data and make better, smarter decisions. Business optimizations can be made more quickly and accurately.
Traditional marketing concepts have been completely outshined by these more advanced and effective channels of marketing. The business card is dying, as are other print materials used for self promotion. If someone wants to know who you are or locate your phone number or your address, they will Google you. In addition, direct mail is being used less and less. The associated cost is higher, the return on investment is lower, and it is difficult to track the results accurately.
From Facebook to Twitter, social media platforms have truly transformed the landscape of marketing. Innovations in technology are driving powerful changes in the way individuals engage in health care delivery.1 These marketing mediums, combined with industry innovations, provide the Chiropractor with the ultimate power of engaging patients, which deliberately involves them in their health recovery process and builds a stronger, long-lasting relationship with the Doctor.
Social media has placed the patient at the center of the Chiropractor’s business objectives. This has enabled Chiropractors to cater to the needs of their patients rather than trying to mold patients to fit the practice.
A patient-centered care environment inspires causal motivation that results in patients that WANT to comply with treatment programs and be the best they can be. People will work their hardest for something or someone they believe in. Patients who are causally motivated tend to be advocates for their Chiropractor and are great referral sources.
According to Constant Contact, attracting new customers, engaging existing customers, and getting referrals are the top concerns for small businesses surveyed. Respondents were asked to identify which strategies they find most effective. Here’s a quick recap:
Email marketing – 83%
Website (content and SEO) – 71%
In-person interactions – 68%
Social media – 49%
Outbound calling – 33%
PR – 22%
Direct mail – 21%
Traditional advertising (TV, radio, print, etc.) – 17%
Pay-per-click – 17%
Of those using social media, Facebook is far and away the most effective.2 Given this information, it is extremely important for the Chiropractor wanting to keep pace in this new healthcare environment to embrace this change and embark on this new marketing strategy.
Not all social media channels are created equal. They all have their primary focus and functionality. While YouTube and a Blog are great at delivering patient information, Facebook is the premiere choice to provide patient reminders, support for wellness and recovery and responding to patient questions. With limited time and budget, it’s important to spend resources on activities that will yield the greatest return – it’s important to select the ideal social media channels for the job.3
One of the positive outcomes of an economic slowdown is the innovation that can come out of it. Many of our industry leaders are responding to this social media marketing trend by creating products and services that mainstream Chiropractic into our high-tech, smart phone, connectivity-dependent society.
These products and services are geared toward Chiropractors and patients alike. John Cox, CEO of Visible Health, notes that “somewhere around the order of 80 percent of all information communicated between a physician and a patient is lost when a patient walks out of the room.” Social media venues allow the Chiropractor a more effective means to manage the doctor-patient relationship by providing a strategy for communicating pertinent and appropriate information, consistently.
Patients benefit greatly from this communication technology, whether focused on general patient education, sEMG findings, specific condition information or health and wellness topics. These tools reinforce the “why” of seeking Chiropractic care and put this information in the hands of your advocates so they can easily share the information with others. Mobile devices present a tremendous opportunity to provide patients with even greater access to these powerful tools that support the current dynamic in healthcare delivery.1
To dominate your digital space invest the time and resources to implement the following:
The good news it that you don’t need a big bank account to go viral or create an outstanding promotion. You just need a unique and different idea. Tell a simple, bold, forward thinking creative story that is brief and memorable. People respond well to freshness and new ideas. A solid social media strategy should not be driven by social media itself, but rather your Chiropractic business objectives – social media is a tool to help you achieve your goals.
1. O’rourke, K., Heckman, J., Elwood, D. Development and Exploration of a Multifaceted Social Platform to Improve Patient Education, Communication, and Activity, Medicine 2.0 ‘12:Boston, USA, September, 2012.
2. Dornaus, Erika The Health and Wellness of Small Business, Constant Contact White Paper, May 2012.
3. Berg, Dean. Healthcare Social Media: How to Choose the Best Tools for the Job. Annica Media, September 2012.
Designer of the MyoVision and experienced expert witness.