The purpose of this article is to discuss where to start to ensure you have a good infrastructure within your practice. I am going to refrain from talking about COVID, there is plenty of that going around. The term infrastructure gets tossed around quite often, however, all too often we don’t know what it really means. For me, whenever we have a growth spurt or we have a reverse growth spurt, those are always times to be able to examine where your weaknesses are and take the time to fix them. Some doctors shy away from weakness and put effort into building on their strengths, I do the opposite. The strengths will always take care of themselves, the weaknesses are what need attention.
When it comes to growth spurts in particular, it’s really important that you don’t stop doing the things that got you there in the first place. Those things that got you there in the first place were a combination of a good patient report of findings, creating clinical notes that are compliant, then using your documentation sharing system within your practice to communicate with the providers that are relying on those notes. That’s the most important thing, understanding that your work is being RELIED upon within your community, and ultimately, you have an obligation as a doctor to provide that information for your patient. Being conscientious of that concept is the key to continued growth. From a starting point, number one, we want to make sure that you have a compliant note template and your process of examining patients and reporting follows CPT guidelines is in place. That is where a compliance review is critical, you need to know where your practice stands so that we know where the strengths and weaknesses lie.
The second step is to have an annual review of multiple randomly selected charts ensuring that you are not slowly drifting away from your compliant note over time. That process should be a normal course of doing business for your practice. You are looking for “aggregate compliance”, that is for your own protection. Those charts will be from different patients and include their evaluation/management [E/M] reports. We want to make sure, number one, a single note is compliant, but then we also want to make sure that you’re not forwarding canned notes from case to case. What you don’t want to see is the exact same diagnosis over time, particularly when there were diagnostic tests ordered, you MUST modify your diagnosis as more clinical data becomes available. I don’t want to always see three to four spine regions being treated. We don’t always want to see the exact same “canned” treatment plan, regardless of the patient’s clinical presentation, comorbidities, and history. We have to show that there’s been some sort of reasonable level of medical decision-making that is dedicated to that individual patient. That’s what patient-centered care is about, diagnosis and treatment plans that are organized around that particular patient’s examination and imaging findings. Your paperwork must be examined initially in a single note format. Then, you want to examine your paperwork in a group or a conglomeration format over time, that is how the insurance carriers determine whether to file accusations of fraud.
"When it comes to growth spurts in particular, it’s really important that you don’t stop doing the things that got you there in the first place."
Once that is accomplished we get to the third step. You will need to work with your staff, your staff is going to take that compliant paperwork and make sure that every week the reports on your initial evaluations and your re-evaluations are being sent to all of the providers and attorneys that are working with your patient. That’s a system that really doesn’t have anything to do with you and should be automated. The rate-limiting step of that process is your ability to have a compliant note that is ready for that type of distribution.
Now the practice building phase goes into full gear, once your compliant notes are set up and you have a system in your practice to share those documents, you need to communicate with the medical and legal offices that are involved in that patient’s care. You are then going to reach out to them with the clinical information of their client or patient in a HIPAA-compliant manner. If people have Schmorl’s nodes, preexisting conditions, myeomalacia, spinal cord compression, abdominal aortic aneurysm, kidney tumors, bladder tumors, all of those things that are important to identify prior to treatment are a critical part of interprofessional communication. It is proper protocol that we communicate what we found and use that as a platform to educate the medical and legal professionals in your area. The anatomical and internal medicine findings are the talking points for the medical community to handle. The diagnosis and functional losses are for the legal community. That’s where you start. Each night when you go to bed, remind yourself, that’s the basis of your practice, whether you’re busy, getting busy, getting slow, or are already slow, it doesn’t really matter in chiropractic and in healthcare, the process is ALWAYS the same. In the football world we call it “getting back to fundamentals” so when teams are struggling, they regroup and focus on the punt, pass and kick. Always go back to fundamentals, particularly when you struggle, and NEVER lose sight of eliminating weaknesses in your practice.
Dr. Owens is presently in private practice Chiropractic practice in Buffalo NY and generates the majority of his new patient referrals directly from the primary care medical community. He can be reached at [email protected] or 716-228-3847
