Empowering Women in Chiropractic – Epigenetics, Chiropractic and the Future of Precision Health

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Hi everyone. I’m Dr. Melissa here with you today at the impact factor show. This has been fun today. You know, technology is one of the things we’re going to talk about today. It’s one of our greatest leavers to be able to truly scale and grow our reach and our impact, but it can also create curveballs like it did today and getting this show out. So we had to improvise right now, I’m with you on my phone. However, the great thing is, is I’m dedicated to still bringing you wonderful content. All right. So let’s kind of jump in today. Um, you know, I feel there’s some very important conversations that, um, that need to be brought to the forefront right now, especially in our profession. One of the things that’s so beautiful about chiropractic, you know, is of course we are profession founded on principle, natural health from above, down and inside out.

I can remember being in school many years ago. I won’t say how long ago. And at that time there was this huge debate between if you were straight or you were mixer, and there was really this division line and it meant something to just be straight hands only. And while I absolutely love our foundational principles, understanding that we are a profession that uses our hands, we are B, we are able to truly come in and connect with another human being, to assess what is happening in their body to be able to detect and correct where there’s interference, right, where there’s interference with that life force is of course, what we know as subluxation and this idea of removing the interference and allowing that life force that innate intelligence to kind of do what it does. Well, of course that’s what we were based on, but we are now living in a really interesting modern world.

Are we not? And so I’m going to invite you today. I have no idea if you went to school in a time, or maybe this is still part of your reality, if there’s a conversation around straight or mixers, but today I want to invite you into the fact that we all, whether we like it or not have to be mixers by the very fact of using technology like this, we’re coming into a time where things are rapidly changing and the future is faster than you think. I have been fortunate enough for really the past almost decade to be, um, kind of an early adopter into the field of epigenetics and then into precision health and medicine, and really looking at genetics as the human blueprint and understanding epigenetics to me really is an extension of chiropractic because it’s the science and the understanding of how right, our outer world and our, our interactions within it, isn’t forming our very genetic codes.

So I like to think of it as the communication highway between the outer world and the inner world in each and every moment, the body is always on the lookout to determine, is it safe to go out there and thrive? Or is it not? And of course, based on the external conditions, well, that’s laying down information. It’s laying down, literally marks methylation marks that are placed and given to the next generation. Now these are not genetic mutations. They’re literally like marks and pencil to say, Hey, this is what’s happening on this day in time. Now, why am I telling you this? Because, because of my ability to be in this environment of precision health, through epigenetics, I want to pose a couple of things. First and foremost, epigenetics understands that outer world is informing inner world. Well, that’s exactly what above, down and inside out understands there’s information coming from the outside in that’s impacting and affecting our ability to express our innate potential.

And so I pose that chiropractors are perfectly positioned to truly be the leaders in this conversation around epigenetics and moving into more of a precision based model when it comes to health and human thriving. And because the future is faster than we think because of modern technology, because of things like unexpected pandemics, we are now seeing an influx and a rapid uptick in of course tele-health. But what I want to share with you today is not just telehealth and being able to have a way to communicate with clients and patients through our phones and through zoom and computer screens, but something even more exciting is happening, which can impact us as providers. And I want to let you know about this. So right now we are really less than 18 to 24 months away from new technologies being leveraged and utilized in health verticals that will forever change how healthcare is being delivered.

One such methodology is virtual reality, virtual reality, and augmented reality are two tools that are coming in. They are readily, they’re already being used in some therapeutic settings, but they’re getting ready to come in and be deployed if you will, at a global scale, um, beginning in as little as 18 to 24 months. And it’s going to be something that is really can be something I’m telling you, not for us to be, but to understand that technology is coming in and it’s going to be used and can be leveraged for us as providers as a tool. If we understand it, if we can become early adopters, if we can really realize that, yes, we are rooted in ancient principles and teachings for natural health and healing, and yet the world is advancing more and more every day through technology. So how do we, instead of being at odds with it back to the mixers in the streets, how do we find common ground and how do we actually begin to think as early adopters?

How do we, you know, I look, and I can tell you, I believe that chiropractors and the field of chiropractic was really quite a visionary approach while yes, it’s all about innate natural healing. What we as providers have in today’s modern healthcare landscape is an advantage to what most doctors of other degrees have. And what I mean is this, because I’ve worked with every type of provider over the last decade, plus in the integrative health and wellness space, I have a whole network of incredible friends that are MDs and dos and NDS, and, and of course, DCS and NPS and NAS. I mean, there’s all the degrees, right? All the people out there. But if, if, if a provider has come from a traditional allopathic teaching background, they don’t quite understand in the healing, right? It wasn’t part of their vernacular. It wasn’t part of the philosophy of what they were taught.

Um, it was more input output. And so if there’s a symptom, then there’s a pill, right? If you have this, you’re going to give this and, and modern science has had to, or, uh, rather, um, allopathic care has to kind of be that way yet the truth in when I say chiropractors were visionaries, what we have always understood, even if, well, over a hundred years ago, the diagnostics weren’t there to validate it. There was a knowing that wait, it’s more than just one input equals one output. This system is dynamic is complex. And so now where we’re at, I’m going to keep kind of stay with me. I’m weaving these elements together. And I’m going to give you some thoughts to consider about how you can really look at your own opportunities as a doctor of chiropractic, to really leverage technology, to continue to be a trailblazer, to continue to go out and really be the leader, not only in your local community, but on a larger level, if you choose.

And so now here’s a few things you already knew that system was complex. Most allopathic, clinicians and physicians don’t really understand that it’s not until they go out into practice and they do one input equals one output and they recognize, well, the pills aren’t actually correcting the ills. And so then they have to give more pills and more pills. And of course there is no lasting solution, right? And so it’s when they go far enough down that path, or they become disillusioned that they kind of pull back and say, well, wait, what’s really going on here. And I will tell you, and of course you probably know this more and more clinicians of all backgrounds and types are understanding that this human system is complex and dynamic. And there is more than just a single, even a single adjustment doesn’t allow for all of the inputs that single adjustment does remove interference, but where did the interference come from?

Where is it present in their daily lives, in their environment? And what is the full impact, the full impact that, that subluxation and many of us have people that come back again and again and again. So there’s chronicity. Why are there chronic subluxations? Why is there chronicity of who’s showing up in our practice? And this is again, the science of epigenetics is the fact that we are complex bioinformatic organisms, that a single input does not create a single output. And this is actually good. This is actually good because you’re going to be able to leverage this in a way that can take you into the virtual space. It can allow you to use tools like AR and VR. It can allow you to create more of a precision model within your current practice. So stay with me. I’m going to continue to thread this needle for you.

And as we’re going, I don’t know if I can see questions, but if you guys have them, I’d love for you to drop anything in the chat. Um, you know, if there’s something specific you want to know about, then I would love, love, love to be able to have some kind of dialogue with you. If I’m not able to answer it here alive right now, of course I will absolutely come back and communicate. Um, because I’m all about wanting to make sure that you, my fellow peers have this information and these resources. So let’s go back to kind of where we’re at. Um, so obviously more over the past year, right? Tele-health has really increased and people are not coming in as frequently. People are still coming into our practices, but people are now understanding, well, wait, is the, is there something else? Is there another way?

And so, um, when we realize that what major companies are doing right now is putting literally billions of dollars into leveraging technology so that healthcare can become instead of a one size fits most into precision. So let’s keep going down. This lane of what’s coming with the future is faster than you think I’m going to connect it back to the epigenetics, and I’m going to connect it back to your office. So with the understanding that our genetic code, the fact that we can now order a 23andme test kit, and we can get back information on our very genetic blueprint, our blueprint is potential. It’s not our destiny, just because you have the code doesn’t mean the code expresses what informs the code or the signals from the outer world, all these myriad of inputs, not a single input, but all these inputs, right from the air, we’re breathing, the foods, we’re eating the relationships.

We’re in the bed. We sleep in the products we put on our skin, the quality of our air outside, the how much sunlight exposure we get on and on and on and on the list goes every millisecond there’s inputs coming into our system, that’s informing our genetic potential. Now this is where it gets super interesting. So in the field of advanced science and futures faster than you think what’s happening right now is that, um, you may or may not know, but there are things like gene editing and gene therapy, we’re literally research dollars are going into looking at genetic mutations, being able to take out part of that code to completely eradicate like sickle cell is one of the very promising, um, genetic diseases that within really the next five to 10 years, we’re going to be at a time where gene editing is going to be very normal.

And we’re going to, it’s going to be part of, kind of a clinical solution depending on how children are born into the world. So we’re going to have things like CRISPR at our fingertips to be able to look at working with that genetic code. We have nanotechnology that’s coming in that literally. I mean, it really is. It’s, it’s so fascinating. The things that are coming, um, but nanotechnology are, is going to be able to go in. So right now we have wearable technology, things that we wear on the outside of our body. Maybe you use them, maybe you don’t more than 526 million people use wearable devices, wearable devices, to have a better understanding about what’s happening in their system. And what I personally love about wearable technology is it’s an interface between the outer world and the inner world. So think about how many people have zero awareness, right?

Or minimal awareness between their head and their body. Like they’re in denial that they’re stressed, they’re in denial. That there’s anything wrong, right? Like they’re in denial that they are exhausted that they’re behind, they’re beating their body up and wearing it down, which we know as doctors and clinicians, that if they keep wearing their bodies down, if they don’t take the time to rest and reset, right. Healing cannot. So they come to you saying, Hey, I heard give me an adjustment and fix me. And they expect you to do it in one or two or three visits, but they’re not willing to take ownership over their own health. You are not the person that’s supposed to fix them. They have to become empowered and engaged and an advocate to their own health, which is what wearable technology is now able to do and facilitate because their brain, they may be in denial to themselves.

But the moment they look down at their wearable tech and they see their HRV stress score. And they’re like, Holy crap. I didn’t think I was stressed, but I’m really stressed. They see their oxygen saturation, they see their body battery and they cannot deny the fact that they’re not recovering, that they’re not getting deep sleep, right? They’re not getting these essential ingredients that are important to you as their doctor to be able to leverage and educate on so that they can do more than take two steps forward. And three steps back. You are not here to just be a symptom manager, right? As a doctor, you are a teacher. You’re an educator. You’re a guide on this process, not just a healing because we’ve been living in a world of surviving and just getting by of symptom management. And most of the dollars when we look at the pie of healthcare, the majority of the dollars are spent on the 20% of the population that has sickness and disease.

The 80% that does not yet in sickness and disease that is saying, Hey, what’s out there for me. There’s, there’s very little right now. That’s actively out there for them because all the dollars are spent on sickness and disease. But guess what? There’s a larger piece of the pie that doesn’t want to become sick. They don’t want to become disease. And they’re also not buying into the story of maintenance and prevention prevent. I don’t want it like who wants to think about preventing a heart attack? I’d much rather go out and be unstoppable. I’d much rather go out and be vital and vibrant. I want to be optimized. I want to be at my peak. So the narrative and the story that we have been sharing for so long as clinicians, it’s not resonating anymore. So there’s a big mismatch and this 80% that doesn’t want to get sick and disease, there’s really no path for them.

I want you to think about that. What could that mean for you? What could that mean for you to really go into precision health and optimization? Instead of look sick, people are still going to come in. You still get to work your magic on people that are, are in a state of dysfunction. Because if we now come back again, stay with me, I’m going to weave all of this together and put it in a nice, pretty bow before we wrap up here in 10 minutes. And so now all of a sudden, right, like what I wanted you to know is we have this wearable technology that people are using, but it’s going to go even deeper than that. The nanotechnology is going to be able to come into the system and read the system real time where we are heading is precision. The way that AR and VR is going to be utilized is in, in pairing with the moment there’s the genetic blueprint and they understand the potential and they understand, Oh, you have a propensity to have insulin dysregulation.

Let’s just go with that. This is a really, this is a really normal one. And then of course the foods that we’re eating, the stressors that we’re putting ourselves under are fueling that blueprint of potential. That’s already innately there, but it’s like we put gas on the fire every day. And it’s more than just the food. That’s another talk for another time. But what happens is now like with the AR the augmented reality, if you’ve ever watched, um, a Marvel superhero movie, if you know who Tony stark is, Tony stark had the glasses, right. And inside of the iron man suit, there was those feedback that the feed out, um, what am I trying the readout, right? Like Jarvis is talking to him and you can see all the little things. Well, that’s what augmented reality is. We’re going to be able to have these glasses that we’re able to project and see things within current reality and add to it.

And so now you go into a restaurant and it understands your genetic potential. And it’s also now reading your, your HRV, your stress levels. It’s, it’s, um, getting feedback time on your pulse and your heart rate. And it’s seen that you’re in a stressed situation and you’re wanting to go for the ice cream and chips, or, you know, a hamburger and French fries and what the AR is going to have the capability to do is to remove those items from the menu so that you actually only see the items that are most optimal for your system at that time and gang, no, I’m not sitting here telling you science fiction. I’m telling you what is in development. I know this because I’m in partnership with a large company out of Europe, that they are the forerunners in the health and wellness and lifestyle space with AR and VR.

I’ve, I’ve seen the plans. I know the, the billions of dollars that are flooded into this company. And this is just one of many, just one of many. And they’re in the field dedicated to thriving health verticals, entertainment, sports education. Um, and so now we’re coming into a time, again, the big point I’m wanting you to know, is it lots of money is being spent on technology for precision medicine, but you can already begin to get precise in your practice today. And if we really get honest with ourselves as providers, and now we think through the lens of I’m a chiropractor, I assess for interference to the system. I’m looking for these subluxations, where’s the interference. So now let’s go back to epigenetics is the communication pathway between the outer world and the inner world. What to the, to the degree that the quality. Now, we’re going to think about the quality of information.

The quality of the inputs coming into the system are in direct correlation to the expression of the system. Okay. The expression of the cells of our biochemistry, of our nervous system, of our parasympathetic parasympathetics of our, of our neuro-transmitters of our hormones. It’s all in communication. And yes, we work with the spine that pathway between brain and body. Yet, if you stop for a moment and say, great, here’s a subluxation here’s interference. I’m going to go in and precisely remove it. But then they go back to their environment, filled with all of these inputs that are going to come back in and continue to accumulate. And what is the quality of those signals? Meaning how is their daily life informing their very expression of sickness and disease of balance and homeostasis of health, of thriving, flourishing. There’s a scale from unbalanced all the way to enhanced.

And oftentimes we’re only toggling on the one side, just trying to get them out of unbalanced, out of symptomatic. I’m just back to homeostasis. But what few of us have realized, we’ve talked about the wellness continuum and maintenance, but guess what? There’s so much more than just getting to homeostasis and balance our systems embedded in our very genetic code is literally the code of life that is designed to evolve. And evolution is more than just homeostasis. And why I’m telling you this is, remember that 80%. Who’s not sick and diseased yet. Okay. They want to, they want to be super human. They want to be optimized. They want to perform at their peak. They want to be ageless. They want to live to one 50 and beyond. There’s a lot of people out there I’m in the longevity space. Like, and I’ll tell you the biggest group of biohackers, like our 30 somethings are all about saying, I want to get to one 50.

They’re not focused on it. They don’t want the story of, I want to be identified with the disease and be broken, and I need to be fixed. They’re saying, I want to be unstoppable. I want to be amazing. I want to be limitless. I want to be optimized in every way. So is there an opportunity for you and your practice to begin thinking about how can you create a story, a narrative, a deliverable that you can deliver with and through technology that people don’t have to just come into the practice. They can come into the practice, but then they can have an experience. I call it the visit beyond the visit. What touch points can you begin to think about now creating what types of content and programs that can support what you’re doing in your practice, but they speak to what happens when somebody leaves your practice.

They speak to all of these epigenetic leavers that are found in their daily lifestyle. That’s what I want you to consider and think about now, a lot of the work I do. So yes, I have a large brand in the longevity and optimization space. I do work with people’s very genetic blueprints. I get very precise and I design incredible optimization programs for them. And a lot of what I do is online. I also leverage technology. I do a lot with neurofeedback biofeedback. I do a ton with helping to optimize that parasympathetic sympathetic response, really still working through the central nervous system, right? The autonomic nervous system. And of course, chiropractic adjustments are amazing for that. But what do we do when they leave? How are you supporting your people to continue to harmonize them, optimize that vagal tone, that parasympathetic response, the more we can get them in parasympathetic and sympathetic, great, the greater, their healing, the greater their opportunity to get to homeostasis the faster you get somebody to homeostasis.

Then the fun really begins. Then you get to move into this optimization lane. So today I’m inviting you to obviously consider, okay, what is coming and, you know, are there ways that I can start looking at technology, thinking about how technology is going to continue to inform my practice and the people I care for? Are there things that I can do now that can create an even more efficient and effective experience for my current patients and clients? And is there a way that I can also have some freedom I can scale? I don’t have to just be one-on-one and my success and failure depends on how many people come through my door. Is there a way that I can start to scale my expertise into the digital space? So beyond my front facing programs and work that I do with all my longevity programs, I do mentor and work with our fellow peers, right?

Just like you, really purpose driven, mission minded, health, preneurs, that understand, I don’t want to be left behind. I want to really be able to understand what is coming and how to stay ahead of it. Remember getting well over a hundred years ago, look, BJ D D they were visionaries. They were trailblazers. They saw something that nobody else saw and they jumped in and they went out and they started to talk about it and to be about it. And they built an entire profession. We are the storytellers. The question is, what story are you going to keep telling? Is it one of limitations, sickness and disease, or are you going to get curious about the technology that is here and coming and how rapidly it is coming and how it’s no longer about let’s find the root cause what we are here? Because look, AI is going to out diagnose any of us in every field of medicine and wellness.

So it’s no longer just our beautiful brains that people are going to come to us for really what people are going to continue to need more than ever is how they retain their humanity in the face of technology. How do we leverage and harness technology to enhance thriving and flourishing? How do we continue to evolve forward into greater States of health and wellbeing? It’s all here and it’s available to each and every one of us. And I just really want to encourage you guys like understand you are leaders in the story that you get to tell can be uplifting and empowering and inspiring. And it doesn’t have to be about you’re broke. You’ve got to come to me to fix you. You’re not here to fix anybody because nobody’s broken. The system is intelligent by design. And your job as it’s always been is to identify the interference, not just in the spinal cord.

Okay. Where is that interference? And this is the epigenetics coming from the outer world that is accumulating and informing the inner world. And then the byproduct. Right? Of course, there are times that there are subluxations from physical trauma, trauma aside, acute impact aside. What’s happening with these chronic visits to your office. It’s all what happens when they leave. And I’m going to tell you, there is no fad diet. That’s a one size fits all. There’s no cure, all supplement that what drives the system. It’s so primal. It is, there is a code of life in our DNA. And it’s very simple mechanisms from out here that inform our expression of thriving in here. And the faster you learn about this and understand how you can share this, the greater side-out leader, you will continue to be that’s who you are, keep doing what you’re doing.

I’d love to be able to share with you any of my resources. If you want to know about more mentorship programs or resources, by all means, you can visit me over at docmelissa.com. That’s primarily my front facing site for my clients, but that’s going to be the best way. I’ve got a ton of resources over there. docmelissa.com. It’s super easy for my clinical programs and the stuff I’ve been doing with my fellow health preneurs like you for years is over at practiceimpactmasters.com. Either way you can find me in both places. I hope this conversation today has been insightful, inspiring, intriguing, and uplifting. And now it’s your turn to really go out there and get curious, understand that you are here to be that true

Early adopter, that trailblazer at leading the way so that you can continue to make a lasting impact in your community, your clients, and all the lives that you serve so that you can go out and have both a business and life you love.

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Empowering Women in Chiropractic – The #1 Biggest Mistake That Keep Associates From Being Busier

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. 

Good everybody. My name is Michael Miscoe with Miscoe Health Law. I’m happy to join you today for today’s ChiroSecure’s Growth Without Risk presentation. A couple of things we want to talk about. We’re going to talk about two totally different topics, but, uh, um, only because the first really isn’t going to take enough time to make it worthwhile you tune in. And that topic is thinking about the end of the, uh, PHE, the public health emergency that was declared in response to, uh, uh, COVID. Now, as you know, there’s been, uh, there’ve been a number of, uh, rural changes, most notably in telehealth, um, where, um, uh, office or other outpatient evaluation management services can be reported, uh, for, um, non face-to-face encounters. Um, the, uh, a variety of, of tele-health, uh, mediums, uh, the old role required, um, synchronous communication. The patient had to be in a special site, um, and, uh, there’s all kinds of licensure issues.

And, and, and because of the PHG, um, and trying to drive, uh, encounters as much as possible into a remote, um, type of environment for public safety concerns, uh, there has been an enormous number of rules, uh, especially in the Medicare side, uh, which has spilled over into the commercial payer, uh, realm where, uh, a lot of exceptions to the normal rules relative to tele-health have come out now what we have to everybody’s getting used to this environment and billing these services this way and using appropriate modifiers and whatnot, uh, but understand once the public health emergency ends, uh, for federal health care programs, certainly all of these exceptions, um, that CMS has granted the permit, um, the services to occur the way they’re occurring now, um, you know, via, uh, relaxed, medium requirements, um, billing, uh, uh, regular ENM services for telehealth or telemedicine, uh, conducted services that all goes away and it’ll go away instantly, and you need to be prepared for that on the commercial payer side, um, there will be rural changes as well.

So to the extent that commercial payers are granting exceptions through the normal rules to allow this to occur in response to the PHC, expect those rules to roll back somewhat as well. Now on the plus side, um, there have been, um, uh, payers are starting to the value of, uh, tele-health. Uh, so I would expect, uh, you know, a continuation of some form of telehealth going forward, uh, that is in a more relaxed, uh, environment than, than what existed before the PHG, but just be very mindful that the moment that, that PHE, uh, uh, declaration is rescinded, a lot of rules are going to change rather instantly. And you need to be prepared for that. Now, switching over to, uh, the other topic, which will carry us through, uh, the remaining, uh, five to 10 minutes of our presentation today. One of the talk about some post-payment enforcement trends that, that I’m seeing, um, you know, as I provide, uh, uh, representation to clients involved in post-payment audits, and this is, uh, both, uh, commercial payer, as well as, uh, Medicare, uh Tri-Care um, and, and other, uh, Medicare part C plans.

Um, you need to be certainly vigilant to watch your billing profile, um, suspect, uh, coding patterns, uh, on the chiropractic side, um, billing for, uh, nine, eight, nine, four twos, always going to get attention, um, nine, eight, nine splitting out, uh, extremity manipulation, uh, frequently, um, which I would say means more than 10% of the time, uh, is probably going to get an alert anytime that you separately report manual therapy from spinal manipulation, uh, with a 59 modifier, uh, same thing with massage. Neuromuscular reeducation is often, uh, miscoded, uh, as massage or manual therapy services. And that that code gets a lot of attention. Um, and, uh, uh, obviously, uh, billing for a number of procedures. Um, a lot of one-on-one, um, especially insofar as massage or manual therapy is being performed by others, build under the provider, um, that raises some incident, two issues that we’ll talk about it in a minute, but those are things, uh, four units of massage, four units, manual therapy.

Those are things that are going to get a payer’s attention and put you on the radar screen. Nobody gets audited randomly. There’s always a reason. And usually that reason is generated based upon data analysis. Um, some other trends that you need to be mindful of, um, is, um, visit frequency issues. You would think that too much is, is problematic. Actually, it’s the opposite, uh, where your visit frequency, your average visits per week, uh, drops below one, meaning you’re doing episodic or once a week, or once every two weeks type of care, that’s indicative of, uh, what would be considered palliative preventive wellness, or maintenance care, which is uncovered, um, and, and providers, uh, that exhibit billing patterns along those lines, those cases, uh, tend to be audited, uh, with some degree of frequency because it’s low hanging fruit. I mean, there’s not much that can be said about your chances of achieving significant durable improvement in the patient’s condition when the patient’s coming on an ad hoc basis.

Um, other things they look for is, uh, your diagnosis reporting, uh, where you consistently use a symptom and subluxation, um, you know, ICD 10 reporting guidelines require you to cease using symptomatic diagnosis is once the, the condition causing the symptom is known, which should occur on the first visit. Uh, so for example, if a patient’s neck pain is due to a sprain strain with a, an encroachment syndrome and maybe ridiculousness, um, those are much more powerful diagnosis is to report. And obviously if you diagnosis follow your exam findings and diagnose the condition based upon what your exam findings tell you, you’re going to get diversity in your diagnosis, and you’re not always reporting the same thing, uh, from patient to patient. Um, so those types of consistencies in, in diagnosis reporting will, will, are very easily identified, uh, with data analytics, visit frequency number of services per visit.

And, and the next thing I’m gonna talk about is consistency in the codes that you bill, um, looked at, uh, or have become involved in a number of fraud cases that are, are based in theory, at least on what the payer is alleging as cookie cutter treatment. Every patient gets the same treatment, no matter what the condition is, no matter what the mechanism is, they always get the same thing. Now, in response, again, superficially, when a provider has his or her hands and adjusting table a STEM machine and attraction table, I’m not surprised that most patients are going to get manipulation, STEM and traction, um, because it’s what the, what the provider has the cookie cutter treatment issue though, um, can be, uh, addressed even in that scenario when the type of STEM, uh, the type of traction, the location of the traction, the location, the STEM is not the same for every patient.

The codes may be the same, but, um, the protocol being used is going to differ varying or dependent on, on the patient’s presentation and condition. And that’s where, um, you know, more deliberate, more detailed treatment orders in your initial evaluation and treatment plan becomes so significant. And, you know, you may be doing a VMs burst on this patient. You may be doing high volt, uh, on that patient. Uh, you may be doing some type of, uh, uh, uh, pulse, uh, uh, DEMA reduc, reducing stim protocol on that patient. Some patients may be getting inner segment segmental traction, some may be getting a form of axial traction. Um, so, uh, varying the type of treatment, um, even though the code is going to be the same and the same false true with your exercises, you know, you should have a treatment order that details the specific exercises sets reps, um, so that you can avoid any allegations that every patient gets the same treatment.

And it’s kind of surprising that some payers are actually bringing this as a fraud theory, because it’s relatively easy to disprove, especially where the provider is, is, is documenting, um, the details as to how the therapy is being performed from one patient to another. Now, if your treatment truly is cookie cutter and every patient’s getting the same thing, understand that there’s risk there. Um, but they won’t know that, uh, they’ll, they’ll see it based upon your coding. Um, but just remember computers are very, very good at identifying, uh, patterns. Uh, so where things are the same, that’s easy to detect, uh, and it can increase your post-payment liability. The last thing, uh, that I would talk about relative to enforcement, there’s, there’s a lot, been a lot of effort on what some payers are calling pass through billing. Um, when in reality, um, it’s, it’s what we call incident to billing.

Now, what pass through billing is, is if you were to delegate the performance of an entire service to somebody else and bill it under you. So imagine you had an independent contract, um, chiropractor, renting space out of your office running his or her own practice under a separate tax ID, and they were providing services for you. Uh, and you were billing their work under your name. That would be an example of pass through billing pass through billing often happens with lab services or iLab gets specimens. And because of, um, insufficient testing capacity, they dumped the specimen off onto another lab, uh, who does all the testing work, sends the report, and the report ends up going back to the physician, but the, the, the lab that received the specimen initially does the billing, and then they pay, um, the, the lab that actually did the work.

That’s an example of what pass through billing is now in your office, when you delegate the performance aspect of a service to a staff member, or maybe another, an associate chiropractor or something like that. Um, that’s what we call incident to billing where the, um, the patient is evaluated, diagnosed. The plan of care is all that work is provided by a credentialed physician. And then say, for example, the, the therapeutic modalities, or maybe even some procedures, um, the performance aspect of that work is delegated to a staff member, uh, in, under the incident to rule that’s called an auxiliary person. And that work is billed, uh, then under the supervising chiropractor. And that chiropractor usually has to be, or physician has to be providing direct on-premise supervision of that work. Now, in these cases, it helps a lot, again, getting back to the detailed, uh, order for the therapy services, where you can demonstrate that the ordering physician, the credential physician actually wrote the order and provided all the who, what, when, where, why of how a therapy is going to be performed, if it’s exercises, the specific exercises to be performed, sets, reps, whatever, and then consistent with your licensure requirements, uh, you delegate, um, the performance of that therapy.

So if it’s a modality, um, you know, uh, an assistant is going to come in and put the pads where you tell them to put the pads, they’re going to switch the knobs to where you told them to switch the knobs. And, um, you’re going to stay in the building to provide supervision, and that commonly occurs. It’s not pass through billing, but it’s, what’s called incident to billing. Now, when you, you’re dealing with time-based services and you have, you know, rehab assistance or massage therapist, or somebody of that nature working under your direction, uh, as permitted by your licensure rules, maybe they’re, they’re certified chiropractic assistants, some places they’re called registered assistants. Um, that’s fine. Okay. But what happens is, is that when you have other people performing time-based services under you and you bill for those services under your name and NPI, it makes you look very busy and, and payers do what is called impossible day analysis.

Um, and so for example, in an extreme sense, say you’re one doc, and you have 20 assistants working for you, and you’re generating, um, 20 times four 80 units and hour of rehab, or let’s say manual therapy for getting the unbundling, a manual therapy or massage. If you run a big massage therapy practice and all of this stuff is being built under you, um, you need to be extremely cautious because, um, that billing profile a payer’s gonna look at it and they’re going to say, there’s no way that this one guy or gal can be doing this much service in this much time. Um, and, and they make refund demands as a result now with massage, especially, we have to deal with the fact that while these people may be licensed massage therapists, they’re not performing within the scope of their license when you’re directing what they do, which means you’re defining the technique, the location of performance.

And it has to be related to the areas of complaint, which usually means you’re not going to bill for units and massage those types of, uh, things. You know, if you’re going to turn a patient over or a massage therapist, either they’re going to build the services themselves, or it’s going to be cash. If you can’t get paid without billing it under you, then if you’re going to build those services out under you, you’ve got a couple issues. You’ve got to document a detailed order. Number one, you have to provide supervision. Number two, uh, number three, have to worry about whether that, uh, service can be separately reported. In addition to manipulation under the payer’s rules for reporting massage and manipulation under CCI, um, massage, always bundles with, um, uh, manipulation. And it can’t be unbelievable for that reason. Then some providers build their massage using manual therapy, and that may or may not be defensible depending on what techniques are ordered and whatnot, anyway, very complicated issue, but on the incident two side of it, it’s, it’s PR it’s possible, but you need to make sure that the documentation indicates that the physician did all of the didactic or physician relative work associated with the service.

The therapist, uh, went in and did what I like to call the Mike, the monkey boy component of the work, where you tell me exactly what you want me to do. And I go in and do what you said, and I don’t turn my brain on. And, um, and, and that way, um, the idea that it was a chiropractic service, as opposed to a massage therapy service, um, the person’s licensure as a massage therapist only means they have sufficient training to follow your orders. So, um, but I will tell you, it is a defense. It’s not a defense that payers react well to, um, they fight pretty hard. Um, so I would tell you keep your massage cash, but that’s an example of an incident to service and how it differs from pass through billing. But those are the issues that payers are beaten providers up on.

Just wants you to alert, uh, on that. And, uh, to the extent that you’re involved in those types of, uh, billing activities, just make sure your treatment orders are very precise. And so that you can demonstrate that you did all the physician relative work associated with any service that you delegate to another person. One last thing on incident two, uh, while the Medicare rule allows an auxiliary person to be another provider, most payers, um, do not agree with that because they require providers to be credentialed, um, with a new provider, uh, check with your payers to see if they will permit a new provider, undergoing crunch credentialing, uh, to perform, uh, incident to services under the direction, uh, in on-premise supervision of a credentialed provider. Some may, some will not. Um, so check with payers. If, if you know, you need to onboard a new provider, otherwise you’re going to have to plan in advance and get their credentials in place before you put them to work, uh, on patients of that particular payer that requires credentialing. That’s all we have time for today. Next week, uh, Dr. Judson Sprandel II will be up and I’ll look forward to seeing you next time. Thanks for your attention. Have a great day.

Empowering Women in Chiropractic – Action Steps to Take Now To Increase Your Practice Value

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Hello and welcome to today’s show growth without risk. My name is Dr. Janice Hughes, and I’m really excited today to talk about some things that I’m incredibly passionate about, and that’s about how to help you as a healthcare practitioner increase value within your practice. Now, before we jumped in and I start to share some ideas, I do want to say thank you to ChiroSecure. I love the opportunity to connect with chiropractors, particularly obviously the change in the world and know, you know, sort of in-person or physical seminars. It’s just really wonderful to connect. So like I said, I really want to chat today about something that I’m incredibly passionate about and that’s helping chiropractors or other health practitioners increase the value of your practice. Now I know that for us, it’s all about to give, to love, to serve, to help people, to work with patients, you know, to help them, to help people within our community.

For me, that’s a given. I know, and I love that aspect of our profession. What happens though? And I’m going to share from my own mistakes is that I didn’t do things early enough in my career to ultimately crystallize the value of my business. Now, what I mean by that is that you and the work you do and what your team does, you provide this incredible value. It’s an important asset for you. In fact, it’s likely one of your biggest assets. So what I want you to understand is that there are some simple actions and steps that you can take. I can take that any of us can take so that we in essence are increasing the value of our actual business. Now, heaven did this happen to you, but I was on the phone last week with the widow of a chiropractor that passed away unexpectedly.

Obviously, now they’re scrambling. What do they do? How do they value it? What does that look like? How did they get a great chiropractor in there now? I never want you to have to go through that. So I’d love you to start thinking now, even for some of you say, brand new in practice, what are the things you do early that actually adds value to the practice? So let’s start to talk a little bit about that. You’ll notice that, um, you hear a lot of people describe systems, you know, how to put systems into your practice. Well, not only is it important so that you can reproduce your results, but that’s also important so that anyone else could step in and reproduce those results. So that adds incredible value. Now we can call that or standard operating procedures and a lot of people start to panic, you know, well, wait a minute, does that mean I have to write every single thing down that I do?

And the short answer to that is yes. The more you put things in writing, the more powerful your operations manual is the more powerful the ability to reproduce your results. So it’s great for team training. It’s also great because you can see that that’s going to add value. So now how do you do that? Do you have to sit and write, you know, manuals and no, like personally, I love that if any of you are already in a practice where you’ve got your team involved, start getting their help, write some things down from their perspective or audio, it, you know, start to talk through at a team meeting or with one of your great team members about what you do and the order of the things that you do. Now, you’ve got a record of that. Start to do things like videos. If you’re going to do training on a procedure, why not do a video and start to have a file where you save all of those procedures.

Now you notice that you’ve got it in an automated format. So gone are the days where you just think that you have to sit down and, you know, write every single step of the way or have checklists all the time. I like the idea of a, of a checklist or having this manual, but you could do that electronically. So what I want you to understand is that there is no one perfect system. I’m not asking that you do a system that someone else has trained you on. Or, you know, again, that you know is the one that brings the ultimate success. You know, it’s about your systems. What can you put in writing in video or an audio just about every single facet of your practice? And what I want you to understand is that does build your operations manual, your reproducibility, or what, you’ll hear more people in the business world, talk about the SOP, the standard operating procedures.

So I want you to see that you can get started with that. Now. I know one of the things I’m really fortunate, I go into life university and a few of the other schools, and I get to talk to some of the students about business procedures and practices and protocols. And we’ll literally provide them with some templates of those kinds of things. Not because I have one that is the answer that it often is just a starting place, please know, by all means through ChiroSecure, or just reach out directly to me if you want some of those kinds of ideas, but the power comes when you put it into your system, when you make it yours, you know, gone are the, I think a lot of people used to say, well, you can’t have a personality driven practice. Well, yes you can because your personality is a key part of your brand.

But what I want you to understand is that it’s not, you just doing things fly by night, you have a rhythm or a way that you communicate even beginning to do that in a video so that you have that basically as a template, you could start to train an associate. You could start to train other young docs. So pretend you’ve got someone following you or shadowing you. And you notice that then you’re putting it into a format that is reproducible. So I think it’s really important that we, we take some of those business terms like operating manuals and protocols and standard operating procedures. And we just start to think about, you have a unique brand and way that you do things, and that’s what brings great value to your practice. So by putting all of that, into this kind of format, now, I want you to see that you could train others to do that.

So let’s talk a little bit, say for a startup doc, the more you build that, now you can keep adding to that as you bring different team members in, you notice that sometimes when you hire one team member, one staff, they’re almost like a Jack of all trades, but there’s going to be different parts of their job. You know, PR or marketing outreach is different than here’s the protocols for the software program. So I want you to see that even if it’s one person, you know, that’s helping you, or for example, if you’re doing it all on your own, you know, there’s still different hats that you wear. So what happens when you are dealing with an insurance company or following up on some of your billings, what happens when your, you know, thinking in terms of the outreach within the community, just start recording those different pieces and parts of everything that you do.

Now, some of you listening that are not in startup that have these great practices where you have also a lot of teams, numbers stop and think about, do you even no for sure anymore, the things that they’re doing, one of the things that I often began to realize as I had great people on my team, and I’d really empowered them, sometimes I hadn’t touched base regularly with them about any sort of adaptations or slight changes that they’d been making to protocols. Some are good. And then some actually are taking you a little off brand of what you thought your team was doing. So it’s a great way to also review. I like to use the distinction says inspect to respect, if you can, all the procedures and the things that you and your team are doing now that allows everyone to completely respect the protocols, to get back on track.

If they’re slightly off track with things and it happens really easily and sometimes in ways that you would never even think, you know, it might be that you’ve run out of a certain manual or, or brochure that you often like to give to people. And then there was a photocopy mate and suddenly that photocopy wasn’t completely straight, or it doesn’t look the way you want it to look, little things like that can really start to impact negatively impact your brand. So it’s just a great opportunity to review a lot of those kinds of things. Now, if you’re not an early startup, it’s easier to begin to think about what I like to call that 10 year exit strategy. What are all the things you put in place now and begin to work on over the next few years that crystallize the value, but also allow you to think about how over time do you build more freedom and flexibility into the clinic.

So because you have that unique communication style, you have the way that you work with your patients. If you’re a sole practitioner, they’re not used to having you be away, you know, some of you that had to close for craziness with the pandemic and then got yourself open again and are more back on track. But before you know, it, we’re not feeling that we’ve got the freedom and flexibility to take time off. It’s almost like, well, everybody expects us to be there all the time. You know, those kinds of challenges mean that we need to start to think in terms of what, or how do we either bring other people in, or have people on your team that can do some other things for you? You know, one of the things that adds great value to the practice, I always say is that you really educate and groom and work with some of your team members to be able to do a lot of the parts or the pieces that you’ve been doing, but aren’t necessarily that you have to do that.

So let’s think about an example. Many of you use things like, you know, the insight scans, you know, some of you, if you do more functional neurology work, you’ve got people who maybe do some of the eye training techniques and the technology. You know, if you’re doing a little bit more functional med, you, you may end up having, you know, supplementation or, you know, questionnaires that you give to patients at a certain point. Well, do you need to do that? Or can you begin to train some great people on your team to do those pieces, not to make the diagnosis, not to take, you know, again, that clinical side away, but is it say some of the regular treatment pieces or checks and balances? You know, if you build an SOP, a standard operating procedure where someone on your team checks in every 30 or 60 days with someone, for example, that maybe you have on a certain supplement, number one, it’s better for patient care, but it also adds more value in the long run to your business because you have an operating procedure that not everything has to go through you.

So you notice that it’s a lot more subtle than we think that we can be enhancing and increasing the value of our practice even while we’re in it all day, every day. So a little bit of this, I want to, again, my background is a coach. I like you thinking, well, what can you be working on now? So the first thing is kind of pull out and take a look at what you have. Do you have a procedure manual? Some of you will call it a, you know, an operations manual. And when is the last time you actually even looked at that? I laugh because a few docs as I just do some complimentary consults for people, you know, I’ll ask them about that. And they’re like, well, I think I had one, or I think it’s stored somewhere. And they actually even have to search for where it is.

So a first step is just, if you’ve got something already, pull it out. If you don’t have anything yet, ask some of us for a template, ask a chiropractor that you know, and you like the way they do business and you like who they are. And maybe ask if they’ll share their operations manual now, because you’re going to copy it, that you’re going to look at it and use some of the categories and the ideas. Then it’s really engaging your team. Like I said, if you’re new into practice and you maybe don’t have a team it’s yourself sitting down and maybe putting a little bit of these things in writing, but ideally from many of you that have got great team members, it’s really get some of this in writing. A perfect example is what tends to happen as I even help people talk about their practice or their value, I’ll ask them for, you know, an equipment list or, you know, their furniture lists.

Most people don’t even have a list or a record of the kinds of equipment that they have in the practice. The same thing that could be an actual document that you guys are already working on now. So that if that is, is 10 years down the road, as an example, you can turn around and just updated or keep that active and updated all along the way. Another thing that I like you to think about now is just this idea about thinking in terms of your practice as an actual business. Could it be that if you’re a little disconnected, we’ve just gone through tax season. If you’re a little disconnected from the aspects of your practice that are a little bit more about the business, is it that you could take an action step to have a stronger look at that? Part of the reason is that you increase the value of your healthcare practice by knowing the numbers and taking a look at the things that you’re spending time on.

So let’s go back and use that example of some functional medicine. I know some practitioners that have some supplementation in the practice and they do some kind of an assessment, and they have patients that get on these different supplements, a great professional line. Then often they don’t have ways that they check back in with people. So that could be something that you add to some of your procedures, because like I said, it’s good for the patient. It’s also good for you that the other thing, taking a look at your P and L’s your profit and loss statements is how much does it cost you? Not only in the product that you’re ordering that in your time to have that within your practice, because sometimes you start to take a look at these things and you realize, wait a minute, there’s something that’s taking a lot of my time and, or my staff and team’s time.

And isn’t actually increasing the profitability of the business. Now, those are just a couple of ideas, ways that you can right now, take a look at where you at, where would you love to be? And then how do we increase the value of these different parts and pieces of your business, of your practice? So, like I said, it’s, it’s just thinking in terms of, from my perspective, it’s a, given that you, as a chiropractor or any healthcare practice that you’re providing great service, that you do great work, I’d like to increase the value of that. Because remember when someone is now gonna say purchase that practice or where you’re looking at down the road, selling the practice, you hopefully have generated multiple years of great profitability and revenue from the practice. I just want you to be able to prove that and show that so that you could then turn around and sell your practice as an actual asset.

So lots of different little ideas here today, but please reach out, ask questions. You’ll notice that ChiroSecure brings myself and other great people in to do the show growth without risk so that we can help you. We want to help you now. And the idea that I’m talking about is help you for the future as well. Speaking of future, please know that next week, the host for the growth without risk show is Mike Miscoe. So please by all means, make sure you’re checking in each week, each Tuesday with a great material and information that’s being shared. I want to thank ChiroSecure again for creating this opportunity for me to talk about some of the things I’m passionate about. I love helping chiropractors recognize and increase the value of their practice. The impact that you have is incredible. I want that to also be a great business asset for you. So thanks and have a wonderful week.

Empowering Women in Chiropractic – How To Use Your Ethnic Edge To Market Your Practice – Chen Yen

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Only I looked different if my skin were different and I would have an easier time growing up. And, and because perhaps your, uh, what you experienced at home was different. Um, how you’re raised was different. And I, you, on some level, you, you, you wish that at, at, at a certain point of time in your life, that, that, uh, if you were just like more like the people around you in terms of, of the majority, but everybody else looked like them, then things would be different for you. So I’m Chen Yen. I am the host today for Chiroecure welcome, and I’m the six and seven figure practice make-over mentor@introvertedvisionary.com. And today I want to talk about how to actually use your ethnic advantage ethnicity as an advantage in your practice, because, you know, as someone who might be a color or a first-generation immigrant or second generation immigrant, you know what it’s like, even though you feel like we are all the same in the sense that that each one of us is, are just people and, and, um, but it’s inevitable just until there’s complete openness to all, and also understanding of diversity that, uh, sometimes we may be a little bit treated a little bit differently.

And so, I mean, for example, when I was growing up, I remember, well, actually this was when I was older. Um, I was in college, uh, uh, Ohio state university. And I, uh, I was actually in an honors dorm at the time and went into the elevator and walked into it. And the guy, the janitor said to me, there’s no room for u in the elevator Chink!. And I thought, wow, what did I just hear? Right. So, you know, even, even myself growing up in place where, where for the most part, most people were, were, um, friendly to me. I still felt like there would be those moments that just reminded me of how not everybody might, might see me equally or treat me equally. And so I, one of the things about that is how can we, we actually use our ethnicity and our diversity to, um, to be an advantage in our practice is to actually look at how, um, what is your advantage right now?

You know, one advantage is that you perhaps, whatever it might be, it might, it might be your culture because if you’re your cultural understanding that your parents raised you with because of, um, the culture that, of your own ethnicity, you’ve, you’ve learned to, to grow and love, that is an asset for you in your practice. It is an asset that, um, can help other people who are also who see you in the reflection, um, can, can relate to. And, and then, so are you actually making an, a concerted effort to perhaps inspire people of your own ethnicity, um, to be interested in, in working with you to be interested in chiropractic or, or functional nutrition, whatever you’re you’re involved with. And, and also in some I, in some cultures, chiropractic is not as, um, like it’s not just an everyday part of a culture either.

Um, for example, in the Asian culture, at least from what I’ve noticed, I, you know, chiropractic isn’t as popular as, um, as acupuncture comparative way. And so there’s such area of opportunity for, for educating and helping people understand the benefits of chiropractic and through people who, um, perhaps are of your ethnic background as well. So how that would look like in terms of, of an advantage for you in the practices, looking at well, are there ways to actually advertise more in front of them to speak in front of them? Um, so because you and your voice is what will help change things you and your voice is what will also help people understand whether it’s about chiropractic or whether it’s about, uh, you and, and your culture and, and, uh, what’s, what’s unique and special about you and your practice. So, and even if you’re watching this and you are not, you wouldn’t consider yourself a particular ethnic background or, or, um, that, or have a, um, or aren’t an, an immigrant or no first or second generation immigrant look for what is your unique advantage of it might even be that you are very close as a, um, couple to your spouse.

And, um, that, you know, you really looking at how that is an asset in your practice, and, and you can inspire people who are also wanting to, you know, have a good, good relationship as a couple. And, and so perhaps as part of your practice, you end up highlighting those things, those elements of what, what, um, you know, people can aspire to as far as being, being a great couple. So, um, and then you could talk about, about chiropractic as the couple, or, you know, different stories related to that too. So regard, regardless of what, what your ethnicity is, you can look for what, where where’s the advantage. And so I’m curious, I would love to see you type it in the chat. I, what is one thing that, based on what we’ve talked about so far that perhaps you could relate to, or that you can look at?

Hmm, well, this is an area of opportunity for me in, in, in my practice, because here I am, you know, maybe I’ve been, been looking at how can I have more people find out about me and, uh, but I haven’t really thought about, Oh, what, what is my unique advantage that nobody else, because of the perspective, because of the unique perspective you have grown up with, um, with all the, the experiences and, and whether you might consider good or bad rate, they all add up to being such rich experiences that make who you are today and make you the compassionate chiropractor that you are today. And I think one of the things about this too, you know, as I think about the different things I’ve experienced, um, growing up is personally, I feel like I can, I have more compassion for all kinds of people and also for also with, with traveling to a lot of different places, right?

And so what can you, how can you bring more compassion into your practice and, uh, that you already have, but it’s just, you know, making, making it a point to, to, um, highlight that and, and your understanding of, of different cultures and, and your rich experience. The other thing is one very powerful, um, way to grow your practice is by educating people through speaking. And why is that? Because when people don’t really know about, you know, if you are just, you know, sending a, an, I mean, if you’re just posting ads, if you are writing, you know, flyers or, or an article, or, you know, blog articles, if you’re posting on social media, uh, there’s only so much that someone can get to know you through that. And there are, especially because of your, your ethnicity and your diversity of how you grew up there.

I bet they’re such interesting stories that could be really inspiring for people. And it’s that, that, um, uniqueness of, of your experience that could really get someone interested in working with you versus someone else. There are so many chiropractors to choose from. Why would they choose you over someone else? And when you could share those kinds of stories, when you can share, uh, also by educating, then people will be more likely to come see you, because part of the reason why they’re not coming is because they either don’t know how chiropractic or functional medicine can help them. I, or they don’t really realize that that you’re there and that they resonate with you enough to come in. So I believe that it, uh, one of the, the ways to, to really, um, be, you know, really having a more of a platform to, to share, um, is by you being able to speak about it, and we need more diversity and chiropractic with different voices, um, beyond just, uh, what the majority of, of chiropractors and, and the ethnic backgrounds that, you know, to, to actually be speaking and having a voice and, and sharing from you there, your own unique perspective in this profession.

So with that, I look forward to you, um, sharing your unique journey and experiences to inspire people. And, um, and for more six and seven figure practice make-over tips go to introvertedvisionary.com, where there are specific practical tips that you could use right away to be getting more new patients in this week and join us next week for Walter, um, who will be Walter Sanchez, who will be the host of our show next week. So until next time.

Empowering Women in Chiropractic – Selling Your Practice…Now, Next Year, In Ten Years?????

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Well, hello everybody. Thank you so much for taking some time to spend with me today. I’m Dr. Randi Ross. I’m a premier practice consultants, and let’s give a little bit of a shout out to ChiroSecure for always hosting these events. It’s so important that everybody stays connected to things that are really valuable to building or business. So today, what I’m going to talk about is giving you a few things to think about as far as, um, you know, selling your practice. And, and a lot of people are saying, Oh, you know, I’m first in practice, or I’m only here five years or 10 years, not something that’s really important or valuable to me, but what I’m going to share with you really kind of changes that mindset. It gives you a little bit of a shift because whether you think you’re going to sell your practice now in a year or 10 years or 20 years, there’s things that you can be doing that you can really hopefully protect getting the most value out of the sale of your practice when the time is right.

So one of the things we find a lot of things that people do wrong, and I’m going to hopefully get you to correct some of those things. Um, and this is always coming from the, the, you know, the mindset of you’re a business owner, you’re a business entity, and there are certain things that you should always be doing to keep your busy, excuse me, business positioned properly. We call it always being market ready. Um, and unfortunately, sometimes what does happen is people are not thinking about selling. It’s not something that is really, you know, on your radar for the near future, but unfortunately, sometimes things happen and sometimes people get injured or hurt. You can get sick. And obviously the worst is unfortunately, sometimes people suddenly pass away. So always knowing what the value is of your business at any given time and being prepared.

And that’s where Michelle A. Little bit off today with you is really so important to take some notes here and hopefully you’ll get yourself in that better position by the time we’re finished here today. So one of the things that we notice often is people often don’t have their, what I call their business finances, really up to date and current at all times. And it goes beyond a tax return. Obviously all of you as business owners, you know, file a tax return and hopefully most or many of you have P and L’s are what we call profit and loss statements. Um, those are important to keep up to date, not only yearly, but even as each quarter evolves, you should really make sure that you’re going to your accountant and you’re keeping all those things up to date. And don’t skimp on that. Having a good accountant is invaluable and they can really help you keep a lot of these financial documents kind of current and available when, and if they’re ever needed.

Um, certain other pieces of, you know, I consider it under the umbrella of financial is, you know, your equipment and what is your equipment worth. And a lot of times people have trouble understanding that, uh, you know, what is the actual value of my equipment? You know, I have a, a table that’s two years old in one room and I have, you know, a high, low with drops. That’s 10 years old and another war room. What is the actual value in really understanding the, the real time value of your assets is something that you should really keep again up to date, take the time to update that every year and keep it current.

And don’t overvalue

Things, um, because that’s never going to serve you. Uh, typically this is another thing that your accountant can help you with because they’re doing all those taking depreciations and stuff, um, as time goes by. So that’s, that’s important to keep up to date as well. The other thing that, um, people often struggle with, that’s an important part of really keeping everything current for your practice, whether you’re, again, you’re selling this year five years, 10 years, whatever it might

Be is understanding

Your overhead. I have to tell you, I talked to many, many doctors every week, and one of the biggest challenges is really understanding, um, what it costs them to run their business, a big challenge for a lot of people. Uh, and I, I think probably one of the biggest, uh, pieces of that puzzle is often as small business owners, you are legally allowed to write off certain things that might actually fall under the umbrella of personal information or personal finances. But as a small business owner, you can write those offers a deduction. What happens is they make you look like you have less profit, which then you don’t pay as much taxes, but when you have to go to sell your practice, that has the flip effect one you’ve now lowered the profit that your business makes until you increase your overhead. So having a, what I call a real time expense of what it costs to run your business, you know, again, something just for you is so important, a to understand, and B to really have that as an accurate up-to-date real time list.

And it often changes it can be a moving target. So that’s something you should really explore from time to time. And that kind of, you know, encompasses when we talk about, Oh, you know, again, when I say having your practice market ready at any given time, uh, is in these are important pieces of financial information. And then of course, there’s all the stats that I don’t have to teach you guys, you know, the, the new patients and the office visits, and, you know, the, the breakdown, I don’t know if your different services and all those things are important to keep updated, and you should understand those as the business owner, this should not be pieces of information that, you know, only in office, his manager, as someone else understands, you should be reviewing it and be able to kind of reproduce that information if, and when it’s ever needed.

It’s a good idea to keep all of this somewhere. As I said, unfortunately, we get calls frequently more frequently than I would like about from a family member or, um, you know, a CA that someone suddenly passed away and they have no idea where anything is, you know, and just like you’re prepared when you have a will or anything attached to an estate that people know what to do. If something happens, your business should have the same type of respect that people know what to do. If something happens to you and we’re not Keno floundering and have to become investigators to figure out exactly what your business was doing and where that information is that a potential buyer would need to do their due diligence on to see if this is something that they want to do. And it really has a huge impact on the families when this is all organized.

And in order your staff, when you’re selling your practice, one of the variables is a staff that’s well-trained and tenured in place. Yes, there are some times where people want to bring their own staff and team members, but more often than not, I’ll say probably 90% of the time. They actually want your staff to stay on board, to be excited about a new buyer. And the potential that goes with that can, you know, new energy that comes in, um, and the buyer wants them to stay on board. They know the way the practice has been running. They’re, you know, they’re skilled and proficient in that they know the patients. Um, and we actually, when we do a transition in a, in an acquisition, we have a specific training just for how to, um, introduce the staff to an income doctor and what they should, and shouldn’t be saying, so Stanford are really valuable.

So keep your staff well trained, um, and understanding the, the different parts of your business, um, and, and making sure that there is a way for them to, I’m trying to think of the right way to say this almost kind of, um, uh, seamlessly, you know, continue to do their services with someone else that might be the owner or take over the practice. Um, so keeping staff up to date, keeping them trained, keeping them motivated. These are all things that really are so valuable. Um, when we’re continually positioning or business, obviously it helps you when you are there as well. One of the other things that is really important that seems to be lost on a lot of people is what I call the aesthetics of your office. Um, and these really need to be updated today. I would say anywhere between every five to seven years, um, it doesn’t have to be a huge expense, but aesthetics change just like if you own a home and if you were going to sell your home and it hadn’t been updated in 10 years, chances are, you’re going to put a coat of paint on there.

You might even upgrade, you know, the countertops in your kitchen and your bathrooms. You might do a whole refurbish. Well, your practice has the same type of element in there. And too often, we see practices that have not been updated in not only five to seven years, but some of them decades, uh, and you have, you know, uh, green walls and Brown chairs and, you know, a dark gray carpet. And does it function for you? Does it impact your business? Probably not. Maybe there are some people that are a little turned off by that, but I can tell you when it comes time to sell your practice, it’s statics today, more than ever, or really important. And, um, buyers are often looking for what I call the new model of healthcare offices. And they’re a little bit, um, spa-like or more of your waiting area, be more of a living room feeling.

Um, they’re, they’re, they’re, we’re getting away from that very sterile type of systematic chairs in a row, a coffee table with some, you know, magazines thrown on it. Uh, we really have gotten away from that, and there’s some great designers in our industry that really do amazing things. And if you don’t have a budget for that, any of your local decorating stores will often be there to help you out as what are the colors that are being used now, you know, what types of furniture are, you know, more systemically, pleasing, and comfortable to people. And, and I can tell you, this is probably one of the biggest, um, kind of pushbacks we get when someone goes to actually visit a practice that we’re selling is they often come back and say, that practice needs a facelift really bad practices in bed. You know, it’s, it’s doing, it’s making money.

And sometimes that someone’s positioned, well, why should I, you know, five, 10, $15,000 in updating or face lifting my office, I’m making money? Well, because in today’s environment, it’s something that has become an important piece to the puzzle of when you’re going to sell your practice. So, and, and also minimize the personal touch in your office. Sometimes we see, we see practices that are so personal and so individual, um, and again, I’ll kind of relate that back to real estate. You know, often when a realtor comes in, they’ll have you minimize how much, you know, personal things are on the walls, or, you know, displayed out, uh, you know, in the area, obviously if there’s, you know, something that you’re attached to in the community and you received awards or things like that, that’s fine. But sometimes people go too far. And if there is something that they have a passion for, they kind of flood their office with that.

And that’s really a turnoff to a buyer, um, and can sometimes even be a bit of a turnoff to new patients as they walk in. It’s kind of like, Whoa, you know, it’s almost like, you know, an overwhelming amount of neurological information coming in. So we say, if it’s a fresh coat of paint, um, and, and carpeting, if that’s the bare minimum you do or flooring, most places aren’t even using carpeting anymore. They’re using various kinds of flooring, whether they’re, um, kind of a vinyl or tile or, you know, different types of materials, depending upon where you are, might be the different types of materials that you use. So when I was in practice, we carpeted our offices. You know, today that’s not the style, that’s not the aesthetic. And it’s definitely something not very important for you to be on top of, you know, I don’t care if you’re in practice two years or 40 years, you should always be putting your best foot forward of how your practice looks, and it does have an impact on patients.

And they do talk about that. And when you are ready to sell, whether by choice or not, I want someone to walk into your office and be like, wow, this is a nice practice before they’ve looked at anything else, just looking at again, the overall aesthetic of w you know, when they walk in, what does it look like? Uh, so that’s a really important thing to stay on top of, we have a lot of, a lot of people that we have a challenging conversation with about that, but if you’re doing it on a regular basis, then it’s not a challenge to you. It’s just a part of anything else that you do. You upgrade computers, you, you know, you might, um, change, you know, to a better software program. This is, should be part of that same mindset. You know, it’s time for me to update my practice.

And what are the last things that, you know, I want to talk about, and it kind of pulls of this together is, you know, always being prepared. You heard me talk about that, um, a few moments ago, and I, and I think often, you know, most of us think nothing’s ever going to happen to us, or, you know, I’m definitely not going to sell for another decade and I don’t have to worry about these things, but, you know, that’s not a good way to run a business. And any successful business has different plans in place. One of the plans they have in place, even if they’re young in that business is some type of exit strategy. And that’s a little bit about what I’m talking about today is you should always have a plan because, you know, again, sometimes life happens and our exit strategy is forced upon us.

One of the best ways to really have a feel for, for, okay, what is my practice worth today? And then staying on top of that. And, and it works in a couple ways. One, it gives you that, uh, what we call evaluation report to really understand, you know, what my practices were because, you know, some of us are often a little surprised upon presenting evaluation that maybe the practice isn’t worth as much as they would thought. Sometimes it worked with, as they thought, sometimes it works the other way, but what that also does, it’s another tool to give you a guide as to where do I need to go? You know what I mean, here? I want to be here. You know, what are some of the things that I need to do to get there? And often people think, well, I do stats that gives me all the information I need.

And I’m here to tell you, it’s, it’s a, it’s a different model of evaluating your business. So one of the things that we’re going to offer here, um, I know our website is up there. The easier one is just volumepractice.com. And if you want to go to, when you land on the home page, there’s a little blue button that says, intake asks you a couple of questions, and then, um, and there’s a code that you can put in on the bottom. And if you just put may 20, 21 in the code, we’re going to actually give you 25% off for being here on the ChiroSecure call today. And it’s, again, it’s a great tool, um, for you to understand the current market value of your practice, as well as a good look at what do I need to do, or what would I like to do?

What profit centers can I add to increase this value in the next five years when I’m going to most likely be looking at retiring. So it, it really is a valuable tool. We have our clients update them every year so that you really always know what’s going on. Well, that’s it for me for today. I hope that I got you thinking a little bit differently about, um, the ultimate sale. Well, and your practice. You know, whether it’s now five years from now, 10 years from now, at some point you’re going to take, you know, this, this thing that you birthed over many years and gave your blood, sweat, and tears to, and want to recoup that value, whether it’s to invest in another business or practice, or ultimately retire for your family. And there’s a lot of great tools, some of which we’ve shared here today, that can be useful to you as far as staying on track and hoping that you get the most that you can for your practice when that time comes to sell well. I’m Dr. Randi Ross. You could always reach out to me if you have any questions about what we talked about here today, um, go to our website, put in that code May, 2021. And, uh, we’ll give you a 25% off evaluation report. And again, give you that good picture of what’s going on in your practice today.

Join us each week as we bring you the best in business growth, practice management, social media, marketing, networking, leadership, and moms more. If it’s about women in practice and business, you’ll hear it here. We hope you enjoy this week’s Facebook live event. Please like us on Facebook comment and share. We look forward to seeing all of you next week for another episode of empowering women in chiropractic. Now, go ahead and hit the share button and tell your friends and colleagues about the show. Thank you for watching. Have a beautiful day. This has been a ChiroSecure production. [inaudible].