Interview with Dr. Ray Foxworth TAC D r. Ray Foxworth's mother and stepfather are both DCs. They are 80 and 81 now. His mom was first, having gone to chiropractic college after working for a DC for five years. She was 26 and a single mom at the time. She worked days as a vet tech, and he would often have to go to school with her in the evenings. So, technically, he was in chiropractic college at the age of 10 in 1966. Dr. Foxworth didn't graduate until 1985, though, from Cleveland Chiropractic College. How long have you been in private practice? RF: Twenty-nine years. I started out as a solo doctor from 1985 to 1990. and then my dad joined me in practice for about 10 years. After that. I had two associates for a couple of years, then back to solo practice. Five years ago. Dr. Andrew Ccfalu joined my practice, and about a year ago. Dr. Neely Bern- joined us in the practice. What type of practice do you have? RF: My practice lias always been neuromusculoskelctal focused, but like most others, we've seen lots of other types of cases along the way. My goal in 1985 was to see my profession more accepted, having seen what my folks went through. I wrote goals in 1985 that I wanted to ultimately be in a multidisciplinary practice or practice in a hospital setting and break down some barriers among the different healthcare professions. I have been blessed that, in just one generation. I have experienced all of that. I spent 12 years on the Mississippi State Board of Health, appointed by two governors, and served as chairman for two years. I was the first DC on the board in the history of the state. I had the opportunity to start the chiropractic department at the G. V. (Sonny) Montgomcn" VA Medical Center and ran that part-time for four years before bringing on a full-time VA doc. Our practice is currently on the campus of a mul-tidisciplinary spine center with 12 physicians, including six ncurosurgcons. one orthopedic surgeon, three physical medicine and rehab docs, two pain management doctors, and a full PT department. What are your goals for the chiropractic profession? RF: I would love to see chiropractic fully integrated into the healthcare system and no longer considered an "alternative" approach. While we have certainly made some progress, there is still much to be done. I think for too long, the public, and pcrliaps some in the profession, have thought of chiropractic as an "cither/or" option. Meaning, you choose medical care, or you chose an alternative, chiropractic care. It makes more sense to me to choose whatever is most appropriate for the problem being treated and to always provide the most conservative, least invasive, least expensive treatments first. And. only when these fail, should other forms of treatment be considered. The problem is that chiropractic should most often be the first place to start, rather than the last place for a patient to end up. For that to happen, all healthcare professionals on the team must have a better understanding of what we do. why it works, and when its appropriate. That will only happen if there is a better job done educating other professions about chiropractic. The profession should strive to not only educate the other professions, but to make sure that during their training, chiropractic is seen as an integral part of the healthcare team. That can onh happen by continuing to pursue opportunities like those that exist with the VA Medical Centers and other training institutions. After starting the chiropractic program for our local VA Medical Center. I saw firsthand what happens when residents who arc making rounds with their instructors in ncurosurgcry or other specialist actually consulted with the chiropractic sen ice. After a while, it became "normal and routine" to request a chiropractic consult, and it had an impact on the residents. We still see mam referrals from MDs I don't personally know, but they were residents at the VA and now that they arc in practice, it is "normal" to refer to a DC because that is what they did during their training. It's no secret, we only do what we learn or arc trained to do. and if we didn't learn it in school, it is less likely to become part of our routine after we are in practice. That is why it is so critical to have other professions exposed to chiropractic during their training. The entire healthcare system is built on this model, and for us to continue to operate outside of the models is part of the reason we remain marginalized. For this to change, we. as a profession, must make it a priority to sec chiropractic fully integrated in all healthcare institutions cither as part of their training or as a rotation for residents. If we were to focus on that one tiling, we could literally change the future of the pro- fcssionand have our greatest impact on the healthcare system. What is the most common problem you see among chiropractors today? RF: Failure to get involved professionally and personally in things that matter and have an impact on the profession. Whether it is politics, association work, or taking steps to personally grow our center of influence in our communities, we need to get off the sidelines. The profession has spent too many years talking to itself instead of talking to others. We arc more comfortable with each other and tend to spend our energy focusing on what divides us instead of focusing on what binds us and how we can have a greater impact by working together. If the profession spent more collective time getting outside of its comfort zone and making a point to integrate with other disciplines, we would be seeing far more than the 10 to 15% of the population that is reported. The book The Tipping Point provides a great study in how any product or sen ice can reach the point of wide acceptance by consumers, and it would be a great model for chiropractic to follow in order to change the public's acceptance and utilization of the profession. We must also stop doing things that drive patients away from us as a profession. It's rarely our clinical care that drives them away. It's more often our business practices and how we recommend care. For example, during a visit to a local physician, the doctor's nurse found out I was a chiropractor and she was really interested in getting in to see one of our doctors for her neck problem. The unfortunate part was that she had already seen a chiropractor who. on the "first date." tried to get her to sign a yearlong contract for care. While that may be exactly what she needed, the failure to realize that the rest of the world doesn't know what we know, so they don't do what we do. literally ran this woman out of the chiropractor's office and may have run her out of the profession for good. Fortunately. I had the opportunity to try to explain w hy this chiropractor may have thought that was the best course of treatment for her based on her history. Patients don't understand the need to accept "lifetime care" on the first visit. This combined with other poor business practices has done more to harm the profession than help it. This is not to say lifetime care is inappropriate or not a laudable goal, but it is a timing issue for the patient. A better approach I've heard described is the concept of meeting people where they arc. and then taking them where you want them to go. Earn the patient's tnist by delivering the best chiropractic care you can. and then when they are a raving fan because of your results, you have earned the right to have the conversation about wcllncss and lifetime care, which is not typically on the first visit. We know what we think of surgeons who recommend surgery on the "first date." and we should at least be aware of how our recommendations arc perceived by those who don't understand what we understand. What is the biggest problem or challenge you see in the chiropractic profession today? RF: The biggest challenge I think we face is failing to adapt. Due to changes in the economy, reimbursements, and a host of other issues that affect us. we continue to operate as islands, which not only affects our income, but our quality of life. Our current model of practice is still predominately solo practice. While this may have worked for main of us o\ cr the years, the landscape has changed and we have yet to embrace the concept of group practice or chiropractic centers. While it is commonplace to sec 10 to 20 OBGYNs or GI docs work together in a single center, you rarely find chiropractors working together in a group setting. As a result, we all have relatively high overhead because there is no cost sharing of common sen ices like billing or sen ices such as radiology. We all engage in individual marketing against each other instead of marketing to the public to increase the awareness of what we do. Couple this with the challenge of actually having some time off. and practice can feel more like a ball and chain than a profession. I have practiced solo for a number of years, and now with two other doctors on board. I can tell you not one of us would ever want to go back to the solo model. There is so much to be gained by working alongside a colleague. There is the ability to sharpen your skills by learning from one another, the benefit of having an "in-house" consult for a fresh perspective or second opinion, all the way up to actually having a life and some time off and not worn ing about having to build the practice back from scratch when you get back. I can't help but wonder if 5 to 10 DCs committed to work together in a community, how successful they could all be by pooling resources. Can you think of one change that a chiropractor can do to significantly impact his/her practice's growth immediately? RF: Commit to regular staff meetings with an agenda where every key indicator of the practice is monitored. This includes stats, such as new patients, office visits, re-acts, sen ices, and collections, as well as kept appointment ratios, drop outs, refer- rals in and out of the practice, and reports to other providers. What can be measured can be improved and we know what we inspect is respected. Having weekly meetings and keeping a watch on these stats is critical, but it's also important to monitor the practice on a daily basis with a morning and evening huddle just to sec what went right, what went wrong, how to improve patient flow and satisfaction. The idea is to be preventative or preemptive. If you wait to look at your stats at the end of the month, there isn't a dam thing you can do about a bad month. If you arc looking at this daily or weekly, the worst thing that happens is you have a bad day or week, and you arc taking small corrective actions along the way to ensure you don't end up with a bad month. I would also suggest getting a coach or mentor or both. Find someone who is doing better than you or a coach guiding practices bigger than yours. Don't rely on learning it all yourself—that is expensive tuition. Be willing to "play dumb" and don't make the mistake of trying to figure it all out yourself. Do you have any recommended marketing strategies that chiropractors can do to attract new patients? And to keep current patients? RF: The practice we have has been built by focusing on one simple principle. If after reviewing a patient's case, we feel we can help, we'll tell them. And if we cant, we'll let them know that too and refer them to someone who can. While that seems simple, it is the most effective thing we can do to build the practice. It builds tnist and credibility. We also make a point to capture the name of the patient's family doctor or other specialists, and in almost every case, we provide an initial report to the doctors, as well as two-week and one-month follow-up reports along with outcome measurements to keep them infonned of their patient's progress. We follow this same pattern with personal injury and worker's comp cases with the intent being to communicate consistently. The repetitive reporting keeps us in "top of mind" awareness of the many doctors we work with. In my mind, there arc only three types of MDs—those who work with us. those who don't work with us yet. and those who will never work with us. My goal is to focus on the first two groups and grow those relationships. The next most important thing to do is to make sure we don't run off the new ones we do sec. You do this by making care affordable and offering reasonable treatment recommendations. To keep patients in the practice. we make it easy for them to rotate in and out of the practice without feeling judged or guilty. Some patients arc as happy and as satisfied as they can be seeing us on a crisis or as-nccded basis. That is their right and their choice. Certainly, it is our responsibility to educate them and offer a better approach based on our training, but some people just have to learn the lesson themselves. And. after a couple of times of them seeing how their approach of just treating w hen in pain works, then they arc a lot more open to hearing about a better way. which may include longer-term, more correct care, as well as prevention or wcllncss. Following this model for years, it is not uncommon for us to see 35 to 40 reacts per month, and this lias been the case for vcars. Can you tell us about what ChiroHealthUSA represents for the profession? RF: ChiroHealthUSA represents some sanity for the profession and the ability for doctors to start practicing with more peace of mind. For too long, we have had to worn and deal with often confusing and conflicting regulations tliat affect our fees, billing, coding, documentation, discounting, and financial policies. If a doctor is trying to help a patient with the cost of care by offering some form of discount, they must be careful about the way the discount is offered to avoid the risk of having dual-fee system, offering an improper timc-of-scn ice discount, or worse yet. creating an inducement violation. The rules and regulations vary from our boards of examiners all the way up to the Office of Inspector General, and we arc responsible for knowing and following all of them, or face the potential fines and penalties. Couple this with the rules we have to follow in our provider agreements, state and federal antikickback and inducement regulations, and it feels like you need to have an attorney on staff just to get through the day. ChiroHealthUSA makes all that craziness go away by simplifying the doctors financial and discount policy. Doctors in ChiroHealthUSA arc able to offer legal, network-based discounts by using our discount medical plan organization. Using the network model allows the doctor to get paid well when insurance is available, and still keep care affordable for cash and undcrinsurcd patients like Medicare recipients. As a member of ChiroHealthUSA. a doctor lias one fee that applies to all patients for every service provided. Using this approach. a doctor can have a simple onc-pagc summary of his or her financial policy that is not only compliant, but easy to explain to anyone. The policy reads: In an effort to maintain compliance with various state and federal regulations, managed-care and preferred-provider agreements, as well as billing and coding guidelines, we have adopted the following financial policies. Our clinic has established a single-fee schedule that applies to all patients for each service provided. You may be entitled to a network or contractual discount under the following circumstances. If we are a participating provider in your health plan. If you arc covered by a state or federal program with a mandated fee schedule (such as Medicare orMcdicaid). If you arc a member of ChiroHcalthUSA or any other discount medical plan organization we may join. Patients who arc uninsured, or undcrinsurcd (limited benefits for chiropractic care), may join ChiroHcalthUSA in our office and will be entitled to network discounts similar to our insured patients. Membership is $49 a year and covers you and your dependents. Ask our staff for more information. If you are eligible and choose a payment plan that allows for "prompt payment" discounts. Patients who meet state and or federal poverty guidelines or other special circumstances outlined in our "Hardship Policy" may be offered a discount fora period of time as determined by the clinic. Verification will be required. So while our initial focus was on helping doctors avoid fines and penalties as a result of non-compliant financial policies, as it turns out. ChiroHcalthUSA is much like a Swiss Army Knife—one tool, mam functions. For example, we arc seeing more patients transition from insurance to private pay because providers arc able to keep their fees at or close to what patients" copays or coinsurance might have been. We sec doctors being able to make and keep care affordable for patients and their families using a legal and compliant family plan that allows for lower fees for a second, third, or subsequent family member. We see the practices converting more "shopper calls" into new patients because with ChiroHcalthUSA. a doctor can have a set fee for a new patient or routine office visit, and they can actually tell callers their cost and not dance around the subject as we often do now. Wc"vc seen more Medicare patients and those with limited benefits accept full treatment recommendations, including therapy and rehab, because the doctor is able to set a capped fee for their noncovcrcd sen ices. We sec doctors being able to compete with out-of-nctwork plans because they can offer a competitive fee that is in line with what the patient may be paying out of pocket to an in-nctwork provider. We sec more patients choosing care and opting out of filing their insurance when they have extremely high dcductiblcs or copay-ments. We've seen doctors become more compliant because they aren't downcoding or tweaking their coding, and they've minimized the risk of complaints, audits, and fines because they have cleaned up their office financial policy. With over 2.500 providers and over 500.000 people having had access to care, we are truly having a positive impact on the profession. And I might add. the kudos go to the doctors and staff who have decided to start practicing with more peace of mind and arc offering the program to patients. It is as a result of their efforts that ChiroHcalthUSA has been able to donate almost half a million dollars back to the state association, the Foundation for Chiropractic Progress and the Congress of Chiropractic State Associations, the Council on Chiropractic Guidelines and Practice Parameters, and the World Federation of Chiropractic. How do you see the practice of Chiropractic in 10, 20, 30 years? RF: There is and never will be a better time to be in chiropractic. And I would say that last year, this year, next year. 10 years ago. and 10 years from now. Because now is the only time you have to be in chiropractic and you will get out of it exactly what you put into it. If its all about you. you" re not going to get much out of it. If it's all about the patients and the profession then it will reward you greatly. I think the state of the profession in 10 to 30 years will be the collective result of what each of us put back into the profession, and we will only be limited by the limitations we place on ourselves. Or those limitations we allow to be placed on us because we fail to engage. Dr. Foxworlh is a certified \ ledical ("ompliance Specialist and President ofChiroIIealthl'SA. You can contact Dr. Foxworth at 1-888-719-9990, infoiichirohealthtisa.com or visit the ChiroIIeal-thUSA website atwww.chirohealthusa.com
