The Chiropractic Personal Injury Marketplace has Changed
PERSONAL INJURY
Mark Studin
DC, FASBE(C), DAAPM, DAAMLP
Most everyone in the chiropractic profession wants personal injury cases. They pay more, the patients are often more motivated to receive care because of their accident, and, historically, it’s been a relatively easy process. Based on a published study by this author, personal injury reimbursements have increased nationally since 2011, and the industry is stable. However, it appears that many offices are getting busier with personal injury while others are moving in the opposite direction. Why? The main reason is that the industry is changing, and it will change more drastically in the next few years. Those who prepare now will reap the rewards, while those who continue with a “business as usual” attitude will be forever “looking up” at those who prepared for the future, which is right now.
Before building your infrastructure in preparation for a successful personal injury practice, you must have a concise business strategy that reflects your community’s needs and a business plan to gain market share. The current business strategy is predicated on the understanding that you must broaden your referral sources beyond lawyers. You must consider lawyers along with medical primary care providers, medical specialists, urgent care centers, and emergency rooms. These are your referral sources, and you never know what will resonate within your community. Therefore, you must prepare to be successful with all and build an infrastructure that gives you the flexibility.
When you consider building your infrastructure, there is one critical common denominator for all referral categories, and it is best described in the legal world as “Voir Dire.” Those two words are always the arbiter between a successful personal injury practice (or any type of practice) versus one that is not. In the courts, Voir Dire is a hearing to determine if the doctor is an expert, which is wholly dependent upon the doctor’s qualifications and experience. Experience without the credentials to back it up will get you thrown out of court and will also erode any hope of having sustainable growth in any of the previously mentioned referral categories.
When I was “growing up” in chiropractic, I observed that being on the board of the county or state chiropractic political organizations got doctors included on managed care, workers’ compensation panels, IME panels, and other financially lucrative positions. The few in political positions would thrive using my dues, and the rest would be on the outside. Those days are thankfully ending because the marketplace (referral sources) has come to realize that lack of clinical knowledge cannot be compensated with political cronyism and what I call the “oT chiropractic one-step, two-step” where you know 5% but profess to know 200%. In today’s marketplace, “any willing provider” who is committed to clinical excellence that goes beyond your technique can realize sustainable growth with an “ever-increasing market share” by getting your referral sources to run after you.
From a pure business perspective, we must also recognize that we don’t run “mom and pop shops,” but border on small to mid-sized businesses and must embrace terms such as market share, business strategies, etc. These terms are action steps to help guide you in an ever-changing business environment while recognizing that your clinical judgment is never swayed by business decisions. However, a business plan built on your clinical excellence is the only sustainable strategy in today’s marketplace.
One level of clinical excellence that is considered a “minimum standard” by referral sources is being an expert in MRI nomenclature and interpretation. This does not mean you have looked at many images and are familiar with herniations, etc. It means, first, that you are well credentialed in MRI interpretation and goes back to Voir Dire. A common question both in the courts and when working with medical specialists is, “Where were you trained on MRI?” Let’s consider three sample answers to underscore why referral sources will consider referring to you or not:
1. I had training in imaging at my chiropractic college during my doctoral studies.
2. Beyond my doctoral training, I have taken postdoctoral courses in MRI through my state organization approved from the NYS Department of Education, Board for Chiropractic.
3. I have graduate medical training in MRI spine interpretation through the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences that is cocredentialed through Cleveland University Kansas City, Chiropractic Health Sciences.
If you answered with the first scenario, you will probably not be allowed to testify in court because chiropractic doctoral training in MRI does not give you the in-depth knowledge to be considered an expert (the exception is those having done a clinical rotation in neuroradiology during doctoral studies). If you answered with the second scenario, the courts in New Jersey (the nation s bellwether state for medical-legal opinions) have already disqualified doctors of chiropractic as experts with this level of training in the ruling Lamb v Allstate. Although it is a New Jersey case, I have seen the tenants of this argument be successfully used nationally to disqualify doctors of chiropractic as experts in MRI interpretation and place a wedge between doctors and potential referring lawyers.
If you answered with the third scenario, then 100% of the courts in the nation have already allowed doctors of chiropractic to testify over the past five years. However, with these types of credentials, what has happened across all referral sources is for “the referral doors to open.” When you are having a discussion with a medical specialist, and you start to describe the slice thicknesses of image acquisition, correctly overturning the improper read of the radiologist (which is incorrect with a published 43.6% error rate with general radiologists reading spine), the typical response is, “You are a chiropractor?” That is usually followed by, “Where were you trained?” You get to answer, “Through the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences.”
That single interaction elevates you in the eyes of the referrer from a technician status (no different from a physical therapist) to a peer who understands how to manage cases. An eight-year practitioner from Texas, after being trained in MRI and other trauma-related courses in the third scenario, walked into an orthopedic surgeon’s office after being granted five minutes of the ortho’s time. An hour later, he walked out with six referrals, and within the next three years, he received more than 250 referrals from this one doctor. The entire hour they were together was focused on MRI slice thicknesses and triaging spine cases. The same doctor in Texas met with another orthopedic surgeon and got more than 150 referrals in the past two years. A 20-year practitioner in Virginia got more than 120 new cases over the past year after he was trained in the third scenario. This doctor also shared with me that he would have gotten more cases, but he is at capacity and needs to expand quickly to keep up with his demand. In both cases, neither doctor markets, advertises, or takes lawyers out to fancy dinners to get referrals. Referrals were built on clinical excellence, a business plan, and a strategy to get the referral sources to run after the doctors. These doctors are only three of hundreds across the country that have the same results.
Our team continually does market research nationally in both the legal and medical market places to ensure we understand the needs of the referral sources in an ever-changing environment. The only constant is that it is always changing. However, it forever remains constant in the necessity for a high level of clinical excellence. If you are still taking your referral sources out for breakfast, lunch, and dinner or to ballgames or other social events to create the relationship, be prepared to lose market share as the contemporary marketplace demands clinical excellence.
Based on our market research results, we have worked with both medical and chiropractic academia and created the following: Trauma Qualification, Hospital Qualification, Evaluation and Management Qualification, Primary Spine Care Qualified, and a Fellowship in Spinal Biomechanics and Trauma. These are levels of academic achievement representing a significant amount of graduate chiropractic (post-doctoral) education. Our research was “spot on” and the results proved that hospitals have reached out to our doctors; lawyers and the courts have recognized these and Voir Dire is a non-issue; and primary care MDs recognize that these doctors have the credentials to manage cases they are ill-equipped to treat. These types of programs set you apart from the rest of the profession and make your competition irrelevant in the market place.
Once you have established a high level of clinical excellence and verified it (mandatory) through an admissible curriculum vitae, the next step entails getting referral sources to know you exist if marketing doesn’t work. Although that is a topic for another in-depth conversation, part of the equation is to use your current patients and their clinical needs to start the discussion with collaborating medical specialists and their primary care MDs. This also gives you the opportunity to ensure cross-referrals instead of you always referring to an orthopedist, neurologist, or neurosurgeon and never receiving a referral in return. You then need to become their source of information when managing mechanical spine issues because allopathy typically has little to no training beyond anatomical issues (fracture, tumor, or infection).
For the legal community, it is even easier. Once you ensure that you will pass a Voir Dire hearing, you then use your team that includes medical specialists and other providers, such as neuropsychologists, etc., inclusive of in-depth knowledge of your patient’s functional loss. As the “primary spine care case manager,” you then have to document demonstratively causality, bodily injuries, and persistent functional losses with indexed, peer-reviewed literature to support your decisions (another New Jersey standard). You then start teaching the lawyers with proven educational materials to give them the power through knowledge to prevent summary judgments built on deceptive defense medicine. Again, this is a topic for a future discussion, but a good place to start.
One advantage I have over much of the profession is that I communicate with doctors and lawyers in all 50 states, allowing me the opportunity to do market research continually regarding the national personal injury standards. Carriers do not have a state-by-state strategy; they employ one rule for the nation and then adapt to each state’s reimbursement policies. Therefore, it is easy for me to determine trends across the country and be able to know what is going to happen next in your state. Simply put, if I see a carrier policy change in New York, New Mexico, Arkansas, and Florida being applied similarly with personal injury, then I know this will follow in the rest of the states. I have observed this policy consistently over the past two decades, and it continues today.
As a result of understanding what is coming next, I have positioned my doctors to be prepared for changes rather than react to them when it is too late. As a result, over the past seven years, our team has been responsible for more than 935,000 referrals in 49 states into the chiropractic profession. This article is sharing with you some of the current and future trends, and, as previously stated, any willing provider can reap the benefits. All it takes is your clinical excellence!
Dr. Mark Studin is the founder of the Academy of Chiropractic and the Doctors PI Program (www. DoctorsPIProgram. com). He also teaches in both chiropractic and medical at various levels on MRI spine interpretation, spinal biomechanical engineering, spinal trauma pathology, triaging the injured and other spinal and trauma-related topics. Dr. Studin consults and creates strategic business strategies for chiropractors, medical doctors, hospitals and lawyers nationally. He can be reached at 631-786-4253 or DrMark@AcademyofChiropractic. com
