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ISSUE #5: MARCH 3 0 , 2 0 1 5 CHIROECO.COM
VOLUME 61, ISSUE 5
CLINICALCONCERNS PERSONALGROWTH 19 Bridging the gap 51 Working the room Kinesiology tape can extend A dynamic presence is yours to have, the care you provide. if you follow these guidelines. BY DANA MACKISON, DC BY TIMOTHY J. GAY, DC
RESEARCHRESULTS MARKETINGMATTERS 25 Mobility or stability? 55 5 steps to marketing magic Using the joint-by-joint approach Power up your efforts with can help you determine the proper relationship-based marketing. therapeutic objective. BY KELLEY PENDLETON, DC BY EDWARD LE CARA, DC, PHD
MONEYMANAGEMENT PRACTICECENTRAL 61 A taxing affair 31 If you don’t build it, Proactive measures can quell THINKSTOCK they will come. your fears of an IRS audit. Commit to airtight documentation BY MARK E. BATTERSBY 42 Call to action or risk the future of your practice. The right combination of BY KATHY MILLS CHANG, MSC-P today’s technologies and traditional methods of 34 Sweat the small stuff marketing will help you How to assemble a top-notch staff find patients and keep through scrupulous hiring. them coming back. BY MONICA WOFFORD, CSP By Karen Appold
INEVERYISSUE 12 Editor’s Note 14 News Flash 66 StudentDC.com 68 Ad Index 69 Datebook BUYERSGUIDE 70 Product Showcase 58 Patient Education 71 Marketplace 72 Classifieds
Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published monthly except semi-monthly (twice a month) in January, February, April, May, June, August, September, and October; 20 issues annually. Address: Chiropractic Economics Inc., 5150 Palm Valley Road Suite 103 Ponte Vedra Beach, FL 32082. Phone: 904-285-6020; Fax: 904-285-9944. Website: www.chiroeco.com. (A Florida Corporation) Postmaster: Please send form #3579 to Chiropractic Economics, PO Box 3521, Northbrook, IL 60065-9955. Periodicals class postage paid at Ponte Vedra, Florida and at additional mailing offices. GST #131868416. Subscription Rates: U.S. and possessions, $39.95 one year, Canadian subscribers add $35 per year shipping and handling; overseas subscribers add $60 per year shipping and handling. Students, $19.95, Single copy, $4. Statement: While encouraging the free expression of opinion by contributors to this publication, Chiropractic Economics and members of its staff do not necessarily agree with/or endorse the statements made in the advertisements or contributed articles. Chiropractic Economics is owned by Chiropractic Economics, Inc. a Florida Corporation, Joseph D. Doyle, President and CEO and Daniel Sosnoski, Editor. Authorization for the use of photographs and/or illustrations is the responsibility of the author(s). All materials submitted for publication shall remain the property of this magazine until published. Change of Address: Six to eight weeks prior to moving, please clip the mailing label from the most recent issue and send it along with your new address (including zip code) to the Chiropractic Economics circulation Department, PO Box 3521, Northbrook, IL 60065-9955. For a faster change, go to www.ChiroEco.com and click on “Customer Service.”
8 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
THEMOSTCOMPREHENSIVEWEBSITEFORTHECHIROPRACTICPROFESSION What’s New Online Plus Resource Centers
More From The Web Expert Insights Chiropractic Table Learn about helping patients who Blogs by Anthony Lombardi, Mark ChiroEco.com/hill present with hallux valgus, better Sanna, Drew Stevens, Josh Wagner, Kelly 3 major benefits of chiropractic care known as bunions, at Robbins, Perry Chinn, Shawne Duperon, ChiroEco.com/hvtreat. and the Chiropractic Economics editorial Nonsurgical spinal decompression for staff. Here’s what’s new: lower back pain Important differences between chiropractic and physical therapy. Results to Referrals Nutritional Supplements Read more at ChiroEco.com/chirovspt. How performance care ChiroEco.com/deeceelabs translates results to referrals The Tuesday Webinar Series Anthony J. Lombardi, DC Top antioxidants to help minimize ChiroEco.com/lombardi free-radical damage Chiropractic Economics webinars are 3 key supplements to help reach your always available to download and view Practice Management weight-loss goals at your convenience. Mythbuster Our latest webinar, “5 Most Dangerous My epiphany Laser Therapy Josh Wagner, DC Things in Financial, Discounting and ChiroEco.com/sigma Collection Policies and How to Avoid ChiroEco.com/wagner Them!” presented by Ray Foxworth, DC, Laser treatment for varicose veins is now online and ready for viewing. Fearless Chiro Suffering from tendonitis? Find relief Chiropractic gets results Protect your practice from penalties. Perry Chinn, DC with low level laser therapy Download any of our webinars at ChiroEco.com/chinn ChiroEco.com/webinar. Resource Guide and Directory Our patient retention resource guide Social Media Shout-Outs and directory is now available online at ChiroEco.com/directory. Neat Tweets Facebook Favorites Follow us on Twitter at Like us on Facebook at ChiroEco.com/twitter. ChiroEco.com/facebook. Job Board Visit ChiroEco.com/jobboard for Cultivate | @CultivateOnSite Our most shared story: employment opportunity listings for: @drbmuth shares his insight with Instrument-assisted chiropractic care @ChiroEcoMag about the benefits may be just what is needed to thaw Associates for your practice & your career as a out frozen shoulders. Billing #chiropractor. bit.ly/1w2VeQd Chiropractic Assistants Doctors of Chiropractic PalmerCollege | @palmercollege Faculty @ChiroEcoMag explains the Front Office/Reception/Scheduling difference between chiropractic and Independent Contractors physical therapy ow.ly/Jom0W Marketing WSCA | @Chiro_WSCA Massage Therapists MT @ChiroEcoMag: Overpronation Multidisciplinary Practice Opportunities vs. supination: What they mean and Office Management why they matter >> buff.ly/1DEC35j Temporary Positions #Chiropractics ...and More
10 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
EDITOR’SNOTE
On your side The evidence is in your favor—again. VolUME 61, NUMBER 5
NEW STUDY, PUBLISHEDINTHE MEDLINE-INDEXED EDItoR-IN-ChIEF Daniel Sosnoski Journal of Manipulative and Physiological [email protected] ATherapeutics, offers more support for the safety of ASSoCIAtE EDItoR Caroline Feeney chiropractic. This was a retrospective cohort analysis of [email protected]
more than 1.1 million Medicare patients aged 66 to 99 years, DIGItAl EDItoR Emily Roland and subjects were divided between those visiting a [email protected]
chiropractor or a primary care physician. ARt DIRECtoR Christine Wojton The researchers wanted to gauge the risk of vertebrobasilar [email protected] stroke (VBS) and any stroke occurring primarily within GRAPhIC DESIGNER Kelley lucas seven to 30 days after an office visit. Of course [email protected] you are familiar with this subject, because every WEBMAStER Nick louckes now and then an article appears that suggests a [email protected] correlation between chiropractic cervical ACCoUNtANt Brenda Murphy adjustments and the occurrence of strokes. [email protected] In this study, it was found that after one week, the risk of stroke was actually lower among patients who saw a chiropractor compared to NAtIoNAl ACCoUNt Jeff Pruitt Let me know what’s ExECUtIVES 904-567-1542 on your mind: those visiting a primary care doctor (1.2 per [email protected] 904-567-1539 1,000 versus 1.4 per 1,000). While there was a Janice Ruddiman long Fax: 904-285-9944 somewhat higher risk found for the chiropractic [email protected] 904-567-1541 cohort at 30 days (5.1 per 1,000 versus 2.8 per [email protected]
1,000), the annual risk of stroke across the U.S. population Susan Nevins annually is approximately 0.3 percent. 904-567-1554 Thus the National Institutes of Health and the National [email protected] Center for Complementary and Integrative Health noted that ADMINIStRAtIVE AND lorie J. McKown the slight differences in outcomes between the cohorts under SAlES CooRINAtoR 904-567-1545 [email protected] examination were statistically insignificant. Furthermore, it
is probable that the chiropractic demographic is more likely BUSINESS & EDItoRIAl oFFICES
to contain members at risk of VBS. 5150 Palm Valley Rd., Ste. 103 A Chiropractic Economics reader recalls the last time a Ponte Vedra Beach, Fl 32082 local news crew appeared on his doorstep, seeking comment Phone: 904-285-6020 about chiropractic and stroke risk. “I told them how much I Fax: 904-285-9944 pay in malpractice insurance,” he said. The reporters turned chiroeco.com
off the cameras and left at once. FoUNDED 1954 You see the excellent outcomes of your care in practice, William l. luckey and helen C. luckey and you know your treatments are safe and efficacious. It’s good to know the science is on your side, too. To your success,
BPA Worldwide Chiropractic Economics’ Daniel Sosnoski, editor-in-chief subscriptions are now audited by BPA Worldwide, the most dominant global media auditing company for B2B publications in the world. BPA certifies that Chiropractic Economics has the highest number of requested readers in the profession. More doctors of Reference chiropractic choose to read Chiropractic Economics Whedon JM, Song Y, Mackenzie TA, et al. Risk of stroke after chiropractic than any other BPA-audited publication serving spinal manipulation in Medicare B beneficiaries aged 66 to 99 years with chiropractic. neck pain. JMPT. 2015;38(2):93-101.
12 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
CHIROECONEWSflash.com
TOPNEWS COLLEGENEWS Chiropractic profession unites in Washington UWS and the Institute for to advocate for patients, expand access Functional Medicine form Members of the chiropractic profession from across the nation gathered in Washington and later met alliance, plan further with congressional leaders to stress the importance of chiropractic’s role in national healthcare and collaboration Medicare reform. The group convened as part of the 2015 National Chiropractic Leadership Since its inception, the master of science in Conference, which took place February 25–28. human nutrition and functional medicine (HNFM) Nearly 700 chiropractic practitioners, students, and supporters converged on the nation’s capital to program at the University of Western States hear speeches from government leaders, receive advocacy training, and urge elected officials to support (UWS) has incorporated innovative content from pro-chiropractic measures that would benefit patients, expand access to chiropractic services for the Institute for Functional Medicine (IFM). veterans and active-duty military personnel, and help chiropractic graduates qualify for federal programs Recently, the two institutions forged a stronger that would enable them to practice in underserved areas in exchange for student loan debt relief. alliance and signed a global agreement that will For more information about the gathering, visit ChiroEco.com/chirounite. lead to further collaboration, including integration Source: American Chiropractic Association, actoday.org of IFM’s novel patient assessment criteria into F4CP announces new executive vice president the UWS program and IFM training for HNFM faculty. Effective March 1, Kris Dowell, executive director of the Michigan Association of Chiropractors (MAC), Daniel Redwood, DC, director of the HNFM assumed the role of executive vice president of the Foundation for Chiropractic Progress (F4CP), program, welcomed the signing of the agreement. replacing Gary Cuneo who announced his retirement in early January. “In our efforts to create the strongest possible Dowell has served as MAC’s executive director for the past 20 years, during which time she has program for our HNFM master’s degree students, helped to merge several major associations in Michigan and implement several important reforms. we are committed to providing our students and Today, MAC is one of the most successful and effective chiropractic organizations nationwide in terms faculty with expanded opportunities for of membership, legislation, and other activities. The F4CP board is excited to work with Dowell and professional growth,” he said. has exciting plans for the continued success of its positive press campaign. to read more about the agreement, visit Source: Foundation for Chiropractic Progress, f4cp.com ChiroEco.com/uwsfm. ACA letter to the Washington Post Source: University of Western States, uws.edu Anthony W. Hamm, DC, president of the American Chiropractic Association, responded to an article National University of in the Washington Post entitled “New rules on narcotic painkillers cause grief for veterans and VA,” Health Sciences signs published February 18, 2015: “The health and well-being of our veterans is of the utmost importance,” Hamm wrote to the articulation agreement editor. “Given the epidemic of overuse and abuse of prescription pain medications in the United The National University of Health Sciences States, veterans need access to nondrug approaches to pain management. In fact, a recent report (NUHS), which has locations in Florida and Illinois, released by an independent National Institutes of Health panel about the need for individualized, has completed an articulation agreement with patient-centered care to treat and monitor the estimated 100 million Americans living with chronic the University of Western States (UWS), located pain, concluded that widespread opioid use does not provide an effective single approach for the in Portland, Oregon. The agreement enables chronic pain patient.” UWS students and graduates of the doctor of to read the full response, visit ChiroEco.com/acawp. chiropractic program to complete a doctor of Source: American Chiropractic Association, acatoday.org naturopathic medicine degree at NUHS in as few
14 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
CHIROECONEWSflash.com
as four additional trimesters, saving both time Cash Practice eliminates weight is lifted, due to the breakdown and and expense for students seeking both degrees. subsequent repair of the muscle. This increase in For more information about the overage fees for the mass then increases the metabolism, helping partnership, visit ChiroEco.com/nuhsagree. Wellness Score System burn more calories throughout the day. During Source: National University of Health Sciences, nuhs.edu Cash Practice Systems announced that their latest the repair time after weight training, the body module, the Wellness Score System, now includes continues to burn fat calories even during the INDUSTRYNEWS unlimited Wellness Reports in the monthly rest period. membership program. Previously, membership Weight lifting may help relieve arthritis pain by Foot Levelers Seabreeze included up to 25 Wellness Reports per month strengthening muscle, which is then able to offer custom orthotic flip-flop with additional reports being between 25 and 75 the joints more protection during day-to-day sets company sales record cents each. activities. Lifting increases strength and connective tissue, such as tendons and ligaments. Foot Levelers, a leading provider of custom The average office uses about 25 reports a This, in turn, can help reduce risk of injury during functional orthotics, points to the success of its month between their new patients and re-exams. heavy activity and regular daily tasks. Seabreeze custom flip-flop, which achieved the This opens up possibilities for offices to use the to learn more about the benefits of weight highest sales record upon launch of any product Wellness Score System for marketing to potential new patients as well as to recall past patients lifting, visit ChiroEco.com/wlhealth. in the company’s history. Sources: PR Web, prweb.com and Health Guided MD, “The Seabreeze custom flip-flop exemplifies without having to worry about the extra cost. healthguidemd.com our focus on innovation and growth both For more information about the announcement, visit ChiroEco.com/wssfees. domestic and international,” Kent Greenawalt, 4 ways to maintain your brain Source: Cash Practice, cashpractice.com chairman and CEO of Foot Levelers, said. “With Many people want to build up “insurance” the addition of two new senior vice presidents ACA delegates declare against dementia and other memory problems. and staff appointments, I expect to lead Foot But there’s no need to invest in pricey brain- Levelers in a sustainable and robust direction. Medicare parity a top training programs. Instead, do-it-yourself Organic growth and acquisitions are a part of priority lifestyle changes have been shown to help ward our aggressive 10-year plan to fuel expansion.” The American Chiropractic Association (ACA) off memory loss and dementia. The following to learn more about the company’s House of Delegates met last week in Washington strategies lead the list: trajectory, visit ChiroEco.com/sbrecord. during the 2015 National Chiropractic Leadership Exercise. “The best evidence so far is for Source: Foot Levelers, footlevelers.com Conference and approved a resolution to make aerobic exercise and physical fitness,” says Carlson Laboratories Medicare parity a top legislative and regulatory Bradford Dickerson, MD, associate professor of priority for the Association. The resolution, neurology at Harvard Medical School. Scores of introduces EPA Gems adopted by the House members, emphasizes the studies and clinical trials have linked regular EPA and DHA are the two major beneficial omega- importance of allowing doctors of chiropractic to aerobic exercise to a reduced risk of dementia. 3 fatty acids found in marine oils. While DHA is practice and be reimbursed for the fullest extent Eat well. The Mediterranean diet—high in most important during pregnancy and early child of their licensure, training, and competencies. fruits, vegetables, and whole grains; moderate in development, EPA is equally critical as we age According to ACA President Anthony Hamm, olive oil, unsaturated fats, lean protein (poultry, and is an important part of a healthy adult diet. DC, “The ACA will develop and implement a fish, beans, and nuts), cheese, yogurt, and wine; For this reason, Carlson Laboratories created comprehensive strategy to ensure that doctors and low in red meat—has been a mainstay of Elite EPA Gems, a highly-concentrated fish oil of chiropractic are recognized as being able to cardiac prevention for almost 20 years. boasting 1,000 milligrams of EPA per soft gel. provide all existing Medicare services, as Stay connected. Being part of a social The high level of EPA in this product aims to allowed under their state scope of practice, to network also appears to reduce the risk of promote healthy immune and cardiovascular beneficiaries.” dementia. systems, as well as healthy hearts, joints, and For details about additional resolutions Keep mentally active. The “use it or lose it” moods with as little as one soft gel daily.* passed during the annual meeting, visit principle appears to apply to brain health. Mental The benefits of omega-3s from fish oil emerged ChiroEco.com/acadelegate. stimulation, like playing a musical instrument, in the 1970s. Researchers recognized the Inuits, Source: The 2015 National Chiropractic Leadership learning another language, volunteering, or Conference and American Chiropractic Association, who inhabited the Arctic regions of Greenland, acatoday.org engaging in hobbies, offers greater benefits than ate a mostly fish-based diet and had ideal blood- repetitive exercises like crossword puzzles. lipid levels and optimal cardiovascular health. to read the full article, visit *This statement has not been evaluated by the HEALTHNEWS ChiroEco.com/staysharp. FDA. This product is not intended to diagnose, Source: Harvard Women’s Health Watch, Add weights to health.harvard.edu treat, cure, or prevent any disease. your exercise routine For further details about the new product, visit ChiroEco.com/epagems. There are many reasons people may choose to Source: Carlson Laboratories, carlsonlabs.com lift weights. Lean muscle tissue is created when
16 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
CLINICALCONCERNS
Bridging the gap Kinesiology tape can extend the care you provide.
BYDANAMACKISON,DC
OME PATIENTS NEED TO BE De Bono, DC, dean of Logan University. extremity complaints including ADJUSTED FREQUENTLY TO ACHIEVE This explains why kinesiology taping patellar-tracking disorder, osteoarthritis, Sdesired results. At times, a little applications are safe, gentle, and iliotibial band syndrome, plantar help between treatments can be effective with minimal adverse effects. fasciitis, shin splints, and Achilles beneficial. To determine if a patient would tendinitis. Sedentary or older popula- Kinesiology tape can assist in benefit from kinesiology tape tions often seek help for back, neck, bridging this gap for patients with application, ask the following: and shoulder pain in addition to ankle certain health conditions. According to Is the patient improving quickly? and foot pain. Jake LaVere, DC, at Functional Sports Will the patient achieve maximum Gregory Doerr, DC, CCSP, head Medicine, “Kinesiology tape can be an improvement without tape? physician at Bergen Chiropractic and adjunctive extension of a practitioner Would kinesiology tape shorten Sports Rehabilitation Center, finds that in between visits. It can minimize pain recovery time? older populations require more while allowing for greater function and If the patient’s injury is causing mild neurosensory and osteoarthritis faster recovery. It can also be a great instability, can kinesiology tape be as applications. reinforcement to the patient as a effective as a brace or athletic tape in “Perform pretesting to determine takeaway from the office.” securing the injured area without which application should be used,” Any patient with proprioceptive or hindering range of motion? Doerr says. For instance, a single leg pain modulation difficulties will Would the patient’s pain, swelling, squat test might determine when the generally respond well to kinesiology spasm, or bruising decrease quicker pain occurs. Then apply tape and test taping, which works by using sensory with kinesiology tape than without it? again to see if the pain has subsided. If input (i.e., tape on the skin) to correct there is no improvement, the patient a dysfunctional pattern. “Taping enables Different populations, may not benefit from that specific tape the use of the body’s own response, different concerns application. rather than applying a strong external As a general rule, younger or active Application patterns are similar force, to affect change,” says Vincent F. populations tend to present with lower from pediatric to geriatric populations;
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 19 CLINICALCONCERNS
Kinesiology tape tension guidelines Technique Outcome Tension guideline Note: As you follow these taping recommendations or personal clinical preferences, make sure to accurately gauge tape tension. Pain reduction Pain perception < 50% Joint support ROM, joint position, joint mobility < 50% to facilitate motion > 50% to limit motion Muscle support Muscle strength or endurance, < 50% power, EMG activation, flexibility, trigger point Neurologic effect Proprioception, balance/postural < 25% stability spasticity/muscle tone, reflexes, motor function, muscle onset Circulatory effect Edema, swelling, blood flow < 25% These recommendations are based on a review of the literature by Phil Page, PhD, PT, ATC, and Performance Health’s Global Director of Clinical Research and Education. According to Page, most higher quality studies with positive outcomes used tensions less than 50%.
what varies is the amount of tension The stretch component applied. “A well-conditioned younger When applying kinesiology tape, athlete can tolerate higher tension consider these five main techniques. applications right from the start, while With each of them, the proper amount a deconditioned older patient would of stretch is critical. require more applications at a lighter tension,” De Bono says. Muscle technique. Kinesiology taping For seniors 65 and older, skin fragility can provide mechanical correction to a and irritation can be a concern, espe- muscle that is strained or requires cially for individuals on corticosteroids. additional support. According to “Reduce tape tension in an effort to LaVere, a 50-percent stretch is needed eliminate any skin irritation that could for maximum benefit. The tape should possibly occur,” says Ted Forcum, DC, help to provide positional stimulus to DACBSP, of Back in Motion the skin, prevent the muscle from Chiropractic and Sports Rehab Center. overworking, and provide stabilization. “Instruct patients to remove tape by Forcum adds that the technique to saturating it with oil or lotion to break inhibit a muscle requires a tension of down the oil-based adhesive. Pull it off approximately 25 percent: “I use in the direction hair is laying, or if moderate to higher tension when needed, use de-hesive spray.” applying the tape over structures where In contrast, with young athletes I want to store parallel elastic energy, Forcum focuses on making sure the or provide proprioceptive information tape application achieves the highest to increase the tonal activity of the functional level by securely adhering it musculature.” because these individuals will perform at a higher range of motion. “It is Pain or analgesic relief technique. This important to make sure that the tape simple application uses either no tension application doesn’t create limitations, or tape-off tension. “This involves especially with multijoint tape covering what hurts,” Forcum says. applications,” he says. “The goal is to inhibit pain sensation
20 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM Kinesiology taping can provide mechanical correction to a muscle that is strained or requires additional support. by creating afferent input via Merkel tape along the dysfunctional fascial Generally, the target tissue should be cell stimulation. For many, this helps to plane. “The main goal is to create a stretched when tape is applied. But if a break the pain-spasm cycle.” change in movement pattern, which fascial pull greatly reduces symptoms In theory, the application of kinesi- will hopefully improve patient function upon manual muscle testing or func- ology tape lifts the skin to allow and reduce pain,” Forcum says. tional activity, then tape should be additional space to decrease inflam- Sometimes the tape need not cross stretched 50 to 100 percent to repro- mation and nerve-ending irritation, over the site of complaint. duce the fascial pull, Doerr says. LaVere says. He suggests using 25 percent tension with stretched skin to allow for recoiling from the tape when returning to a neutral position. “This will cause a wrinkle effect on the skin, which will increase space above the inflamed site,” he says.
Circulatory or lymphatic technique. Kinesiology tape is thought to remove edema by directing the exudates toward the lymph ducts. Cut tape into strips and place them in a fanning pattern along the area of complaint at paper-off tension, which ranges from 0 to 15 percent. This technique lifts the skin, LaVere explains, creating addi- tional space and areas of decreased pressure, allowing excess fluid to drain into the lymph ducts and out of the injured area. “It is thought that the tape will create a potential space and a negative pressure that pulls the fluids out of an area of higher fluid pressure, thereby reducing the inflammation or edema,” Forcum says. “However, just a simple application of the tape to inhibit pain will increase a patient’s inclination to move the part, which would also increase the normal pump action of the lymphatic system to reduce edema and inflammation.”
Fascia technique. Fascial applications aim to improve the quality of a move- ment pattern. This involves applying long strips of kinesiology tape over multiple joints along the involved fascial plane. Other techniques target key areas or points with sections of
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 21 CLINICALCONCERNS
Kinesiology taping expert resources Functional Taping for Musculoskeletal Injuries: functionalsofttissue.com/about-seminars Kinesiology Taping Fundamental Applications: Basics, Upper Extremities, Lower Extremities, Axial Skeleton, and Edema: sportmedics.com/kinesiologytaping.html Motus Myofascial Kinesiology Taping: motustherapeuticmethods.com
Always use caution when stretching tape beyond 50 percent, as that may increase skin irritation.
Correctional (joint or postural) technique. Structural techniques require increased stretch. While 100 percent may be neces- sary, Doerr suggests that the normal range be between 25 and 75 percent, depending on the condition and patient presentation—including body type. “The tape is applied to assist in mechanical stability in movement and to be a postural reminder to avoid injurious positions,” he says.
Education and training When applying tape, be consistent. “Knowing anatomy, biomechanics, and proper body function is advantageous,” LaVere says. “Getting comfortable with different applications is the most important element of using kinesiology tape.” Many tape companies offer specific training programs in line with their philosophy on kinesiology taping. Doerr offers a hands-on taping program that demonstrates several taping techniques including functional taping for muscu- loskeletal injuries. Forcum offers an online kinesiology taping program that goes step-by-step through each of the body parts. De Bono’s myofascial kinesiology taping course offers a foundational background to the physiology behind taping, giving the practitioner an understanding of what is happening when tape is applied. You may benefit by taking other courses that are synergistic with kinesiology taping. Any program that enhances your appreciation of anatomy, fascial planes, biomechanics, neurology, and the pathophysiology of injury would be complementary. If you are intimidated by kinesiology tape due to concerns about stretching it too much or too little, having an indicator on the tape can enable you to stretch it the right amount each time.
DANAMACKISON, DC, is the director of chiropractic education for Performance Health. He can be contacted through performancehealth.com or at [email protected].
22 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
RESEARCHRESuLTS Mobility or stability? using the joint-by-joint approach can help you determine the proper therapeutic objective.
BYEDWARDLECARA,DC,PHD THINKSTOCK
F YOU MANIPULATE AN AREA THAT IS stabilization training, you can then give muscle hypertrophy, what is often INHERENTLY SUPPOSED TO BE STABLE, motor-control exercises for that area. needed is better communication Iit creates neurological confusion. This will allow the superficial muscles between the brain and the stabilizing The brain responds by tightening all to relax, because the brain is no longer system of the joint. Motor control is the tissue around that area to provide recruiting additional muscles to assist facilitated by the transmission of nerve artificial stability. the ones failing to adequately stabilize impulses from the motor cortex, How many patients come in your the joints. resulting in muscle contractions. practice and say, “I feel great after I get Table 2 shows areas that primarily adjusted, but the tightness returns a A systematic approach need stability via motor control. The day or so later”? When patients respond How do you know if an area of the stabilizing system of joints is composed this way, think about what the brain is body is supposed to be mobile or of active (muscle) and passive (joint), trying to accomplish by creating stable? Physical therapist Gray Cook components as well as neurologic “tightness.” The brain is searching for and strength coach Mike Boyle came factors (brain and nerves). The joints joint stabilization and does so by out with a joint-by-joint approach to aren’t inherently stable because they recruiting mover muscles to tighten the body. They determined the areas need to be both stable and readily and provide artificial stability. of the body that mostly need to be mobile, thus requiring the coordinated As manual therapists, the tendency mobile and those that mostly need to contraction of muscles. for most DCs is to move the joint or be stable. The first thing you should notice is muscle to make the area “loose” again, In addition, the list includes a few the joints alternate between mobility but this doesn’t get to the root of the more areas that are chiropractic-specific and stability, e.g., the ankle needs problem. Uncovering the area that (big toe, foot, lower/upper cervical increased mobility, and the knee needs needs stabilization training is the key vertebrae). Start with areas that need to increased stability. This allows for the to relaxing the tightened mover primarily be mobile (see Table 1). efficient transmission of forces muscles. Stability can also be termed motor throughout the body so that not just If you identify the areas that require control because instead of increased one area accumulates stress.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 25 RESEARCHRESuLTS
Table 1. Joints that Table 2. Areas that need to be mobile primarily need motor Big toe control or stability Ankle Foot/arch Hip (multiplanar) Knee Thoracic spine Lumbar spine Glenohumeral joint (multiplanar) Scapula Upper cervical vertebrae Lower cervical vertebrae
Joint therapy A trend in musculoskeletal therapy is a move away from assessing joints and muscles in isolation to a more holistic approach of assessing movement patterns. For example: Instead of isolating the gluteus medius when training the hip, train the pattern of resisting internal rotation of the femur. There are more muscles than just the gluteus medius in the hip and they are all either movers or stabilizers. By using a whole-body movement screen to identify dysfunction, you can then look at individual regions to treat accordingly. Using the joint-by-joint approach helps you understand if the area needs more mobility or more stability. Doctors, therapists, and trainers are all moving toward a more regional approach to treat the area of complaint and then reintegrate that area with the rest of the body by grooving movement patterns. Some term this approach as “treating movements—not muscles.” Injuries relate closely to joint dysfunction, which may or may not be the area of complaint. The back may be symp- tomatic but the problem could be a lack of hip mobility. Loss of function in the joint below—in the case of the lumbar spine, it’s the hips—seems to affect the joint or joints above. In other words, if the hips can’t move, the lumbar spine will move in excess to compensate. The problem is that the hips are designed for mobility, and the lumbar spine for stability. When the intended mobile joint becomes immobile, the stable joint is forced to move as compensation, becoming less stable and subsequently painful. The hips become tight because the core is not strong enough and the hip musculature is being recruited for artificial stability. Like a governor on a motor that controls its speed for safety, the brain can work the same way with the body. It might elect to make the hips (which are supposed to be mobile) tight to slow the system down.
A straightforward process Given the above, it’s easy to see how this plays out in action: Lose ankle mobility—get knee, calf, or foot pain Lose hip mobility—get low-back pain Lose thoracic mobility—get neck, shoulder, or low-back pain
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Doctors, therapists, and trainers are all moving toward a more regional approach to treat the area of complaint.
These processes are the results of end result is a kind of conundrum, a increase the static and active range movement dysfunction, which in turn joint that needs both strength and of motion of an area that should be fuels a vicious cycle. As the spine mobility in multiple planes. stable. moves to compensate for the lack of The lumbar spine is a series of joints strength and mobility of the hip, the in need of stability, as evidenced by An open window hip loses more mobility. This leads to research in the area of core support. Most if not all of the rotary exercises compensatory motion at the spine. The Some trainers mistakenly attempt to designed for the lumbar spine have been misdirected. Shirley Sahrmann, PT, PhD,1 and James Porterfield, PT, and Carl DeRosa, PT, PhD,2 all indicate attempting to increase lumbar spine range of motion is not recommended and potentially dangerous. If increased mobility is a mistake in areas like the lumbar spine, how do patients respond if you manipulate and artificially put more mobility into the segments? In the short term, the patient gets increased motor control, but that may only last between 30 minutes and 24 hours. That’s why you see improved range of motion that slowly diminishes over a day or so. The way to keep this physiological window open is with some sort of neurosensory input to the area. Consider using kinesiology tape in conjunction with low-force exercises to allow the brain to adapt to the new range of motion.
EDWARD LE CARA, DC, PhD, ATC, CSCS, recently sold his practice of 14 years in California and relocated to Dallas. He is the director of athletic training at The KinetikChain and the Director of Trans Global education at RockTape. He can be contacted at [email protected], on Twitter and Instagram at @drlecara, or through rocktape.com.
References 1 Sahrmann S. (2001). Diagnosis and Treatment of Movement Impairment Syndromes. Maryland Heights, MO: Mosby. 2 Porterfield J, DeRosa C. (1995). Mechanical Low Back Pain: Perspectives in Functional Anatomy. Philadelphia: Saunders.
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PRACTICECENTRAL THINKSTOCK If you don’t build it, they will come Commit to airtight documentation or risk the future of your practice.
BYKATHYMILLSCHANG,MSC-P
NTHE CHINESE ZODIAC, 2015 ISTHE interesting, you’ve got an added compli- As Medicare goes, so go most third-party YEAROFTHE SHEEP.IN THE WORLD cation in October, when healthcare payers. Some DCs believe that because Ias defined by the venerable New York providers across the country will be they don’t treat many Medicare patients, Times, 2015 is the Year of the Condo. required to convert to ICD-10 coding. they don’t have to pay attention. Not But in chiropractic, 2015 is most How will your documentation look so. If you bill any other carrier, the definitely the Year of Documentation. then? OIG’s word is essentially the letter of And if you don’t have systems in place Consider some of the following the law. Those insurers will be equally to “build” bulletproof documentation, takeaways, from the OIG’s recently inspecting your documentation. it could also be your Year of the Audit. published Work Plan:1 Is this news? Haven’t you been This is big money: The OIG estimates its hearing about increased scrutiny from Seventy-six percent of OIG’s funding is 2014 recoveries from audits and the Office of Inspector General (OIG), for overseeing Medicare and Medicaid. investigations at $4.9 billion. If you had soaring records requests, and zealous A dry statistic? Think bigger. DCs can’t this kind of potential revenue stream, HIPAA-compliance watchdogs for a opt out of Medicare. So all that well- would you take your foot off the gas, while now? Yes, you have. And yes, funded scrutiny includes looking at or would you put pedal to the metal this is still news. Because as widespread you. It’s critical that you know just and make the most of it? Yes, the OIG as OIG and third-party payer scrutiny what they want to see in your thinks so, too. Ensuring that your has been, it promises, from the OIG’s documentation—how would it pass documentation is impeccable means own lips, to get even more intense. muster if put under the Medicare and that money won’t be coming out of And, just to make things extra OIG microscope? your pocket.
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With ICD-10 in the mix this year, your risk of from Medicare participation, most other carriers will drop you like a hot making unintentional documentation errors potato. At the extreme end of potential increases exponentially. consequences, there’s possible jail time and loss of your license.
The potential consequences of an audit brought 971 criminal actions and 533 DCs are tarnished by the same brush aren’t just financial. During 2014, the civil actions against suspected used on fraudulent practitioners. In OIG excluded 4,017 “individuals and offenders. For those who think getting other words, the OIG is going into entities” from participating in federal kicked out of Medicare would be a 2015 with the presumption that it will health insurance programs, and relief, consider that if you get booted find the same kind of inappropriate payments for medically unnecessary treatment rendered by chiropractors that it found last year. It believes it has identified patterns of abuse, noncom- pliance, and fraud, and will be looking at you and your colleagues with the intention of finding those same patterns.
There’s a lot more information in the 90-page Work Plan, but the key takeaway for chiropractors can be boiled down to this: With ICD-10 in the mix this year, your risk of making unintentional documentation errors increases exponentially. And you know that the OIG and its third-party carrier followers are out there, actively looking to make money off your mistakes. Many doctors don’t know what they don’t know. This year, more than ever, it’s essential that you find out. Because with auditors on the hunt, what you don’t know can cost you your practice.
KATHY MILLS CHANG, MCS-P, has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. She leads a team of 14 at KMC University and is an expert on Medicare and documentation. She can be reached at 855-832-6562 or [email protected].
Reference 1 U.S. Department of Health and Human Services, Office of Inspector General. “Work Plan Fiscal Year 2015.” http://oig.hhs.gov/ reports-and publications/archives/workplan/ 2015/FY15-Work-Plan.pdf. Released October 31, 2014. Accessed February 2015.
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Sweat the small stuff How to assemble a top-notch staff through scrupulous hiring.
BYMONICAWOFFORD,CSP THINKSTOCK
OUR OFFICE MANAGER WAS Down to brass tacks What kinds of personalities have AMAZING DURING THE INTERVIEW. First you must be clear about what the worked well with this team in the YAll of your questions were job in question entails. This seems past? answered quickly and in just the way easy: What does the person in this job Which ones have resulted in a you wanted. That was six months ago, do? A file clerk files. A receptionist breakdown of teamwork or failures and now the questions are different: answers phones. An office manager in effective collaboration? What happened to the great supervises employees and workflow. professionalism? Where did that put- But don’t be fooled—a file clerk It’s often not the standard items in a together person disappear to after does more than just file, and if a bad job description defining employees’ sitting in your office and sharing such hire has been made in this position daily routines that result in the need to a compelling vision of success? previously, that fact is now obvious. fire them. Instead, it is the elements of The hiring had gone so smoothly, How do they file? Meticulously? their personality, and how well they get you aren’t sure what went wrong. But With precision? Always finding ways along with you, your patients, and now you may have to fire what has to simplify the previously complicated coworkers that will eventually erode clearly turned into a bad hire. system? Taking the initiative to create a performance and cause problems. The An old saying urges employers to new system and teaching others in the adage “hire for attitude and teach “hire slow but fire fast,” and yet so office to follow it? These are a just a skills” comes from the many managers many professionals do just the few examples of the depth needed in who learned this lesson the hard way. opposite. Hiring an associate to run the job description. To uncover this level of detail for the office or even manage the front Clarifying positions in depth the job, think back to the time when desk is not a task to be taken lightly or includes answering the standard job your most difficult patient had a reduced to simple items on a list. But description questions and so much meltdown. What person did you need when the desire is to hire the right more: then that you’re hiring for now? person, even if you have to let How well should this job be Consider the largest problem areas in someone go to make room, the performed? the office and what solutions you’d like following guidelines can help. With whom will this person work? to see put in place that no one has
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time to do. Is the job description still relevant? Has the position changed? Does it need to now?
Professionally detailed With a clear definition of the role, create a clear picture of the person who will be the best fit. Ask yourself: What kind of person do you work most effectively with at the office? Is it someone who is a go-getter or does that type of individual challenge you more than you’d like? Does a person who follows the rules to the letter suit your needs? Or for this role, do you want someone who can play in the gray?
It’s your call, but the challenge most employers face is that they spend more time planning their next build-out than on the roles and team members who will keep patients happy during the remodel. Don’t make that mistake, and instead: Give thought to personality traits. Employ an assessment tool. Consider the need for conflict-mediation skills. Determine the desired relationship-building competencies. Dream big and get detailed. Clarify any preferences that may work well with your client base.
These are clearly not your only hiring criteria, but as much as UPS needs drivers who can lift up to 75 pounds, employers are allowed to consider those who will perform well within their business. For example: Don’t hire someone shy when you know that a person with a bit more confidence or assertiveness is what your customers will respond to best. Then make a list of both what the job entails and the type of person you need.
Seal the deal Once these items have been laid out, the job posting and interview process can begin. Whether or not you like someone in an interview is not as important to successful hiring as many believe, but it’s the criteria most often used. In fact, hiring employees based on likeability may later prove problematic. Those who fit the detailed job descrip- tion may be the ones with the least in common with their employer. Look for traits, demeanor, attitude, and skills that create the most check marks on the role-clarity list. With a clearer idea of who you’re seeking, identifying who is the best match (and who isn’t) is more objective and transactional than the average get-to-know-you interview. Looking for someone with immediately evident charisma allows for identification of this person before they sit down, for example. Conversely, that clarity will also help you determine if you can safely keep the interview short.
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When dealing with current asking, “tell me about a time when ...” say nothing could be finer than a great employees who no longer meet or “describe a scenario in which ...” hire. expectations, waiting for a vacancy to The answers will be revealing and, in fill the void is also a recipe for keeping many cases, indicative of the MONICAWOFFORD, CSP is a people long past their point of contri- applicant's integrity. leadership development expert. bution to your practice. Use the same When you find a person to fill a As CEO of Contagious Companies, she shares with method for existing team members to position who performs well, integrates others how to develop their determine whether a change is beautifully with the team, makes the leadership skills. Author of Contagious warranted. job appear easier than it really is, and Leadership and Make Difficult People Disappear, Then, during interviews, ask keeps you and your patients happy, Monica may be reached at 866-382-0121 or questions that prompt storytelling by you win. For most practices, it’s safe to through contagiouscompanies.com.
38 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
Innovative Ideas from the Industry Leaders THINKSTOCK Nutritional support for disc lesions
BYMELISSAHEYBOER
INDING THE ROOT CAUSE OF BACK The answer is two-fold. In addition to an over-the-counter PAIN IS ONE OF THE MOST DIFFICULT Foremost is the necessity for supplement, according to Medline Plus Fdiagnoses a doctor can make. continual chiropractic adjustments. manganese can also be found in “several And disc lesions, specifically, require Like any wellness care plan, adjust- foods including nuts, legumes, seeds, surgical intervention as a last-ditch ments keep the body and mind tea, whole grains, and leafy green effort to treatment and relief for a aligned, and help treat the cause of vegetables. It is considered an essential patient. back pain rather than the symptoms. nutrient, because the body requires it But surgery is costly, dangerous, and But even chiropractic adjustments to function properly.”1 doesn’t necessarily guarantee a perma- require additional support. And when There are also indications that nent fix. Instead, the goal should always chiropractic and other modalities are manganese taken in accordance with be wellness. Conditioning the body to used synergistically, you typically see calcium, zinc, and copper can be heal from the inside out makes patients patients who hold their adjustments effective for weak bones and may feel better and usually indicates long- longer and maintain better overall “help reduce spinal bone loss in older term success, as opposed to a quick, health. women.”1 often temporary fix. Nutritional supplements often play a But George J. Goodheart Jr., DC, was So what should patients do when part in that outcome. quick to point out in a 1954 article in faced with disc lesions? And what Supplements containing manganese The Journal of the National Chiropractic about those who want to nutritionally have been shown to complement the Association that manganese is not a support the repairing of damaged and adjustment and help support weakened cure-all. weakened ligaments? ligaments around the spine. “The patients still require the most
40 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM EDITORIAL SERIES SPONSORED BY DEE CEE LABORATORIES
precision adjustment and management; but they do avoid surgery; they do stay Disc-Gard®+: Correcting disc lesions adjusted better and longer; they do The benefit of a professional high-potency manganese achieve pain relief, and they do refer supplement with other specific nutrients in the repair of patients.”2 damaged or weakened ligaments, along with chiropractic But manganese is just one of the care, to correct disc lesions was discovered more than 50 essential minerals you should look for years ago. when choosing a supplement. Disc-Gard®+ is a professional high-potency manganese Glucosamine and MSM play a vital supplement loaded with scientifically selected vitamins role in the maintenance of joint and and minerals essential for proper ligament tone.* It is also cartilage health, too. a super source of glucosamine and MSM, which are Glucosamine, for example, has been important in the maintenance of healthy, flexible cartilage shown to improve joint health by and connective tissue.* helping to effectively treat various forms of osteoarthritis.3 Research has verified that the connective tissue in tendons In addition, MSM is said to work and ligaments can lose flexibility, allowing the intervertebral discs to bulge, because of its natural ability to help putting pressure on the spinal nerves, and causing muscle spasms and pain. strengthen collagen. Dee Cee Laboratories’ professional high-potency manganese Disc-Gard+ formula Another mineral that’s important to nutritionally supports repair of damaged and weakened ligaments, helping to look for in nutritional supplements is hold the intervertebral discs in the correct position and relieving pressure on the calcium. Most people are familiar with spinal nerves.* calcium and the benefits it can have on Unlike earlier, less comprehensive formulations, Disc-Gard+ has every one of the a patient’s quality of life because of its key ingredients recognized as significant in maintaining proper metabolic activity.* ability to help strengthen bones. According to the National Institute of Just three tablets of Disc-Gard+ provides the greatest amount of ingredients Child Health and Human Development, critical for maintenance and repair of bone tissue, cartilage, tendons, and “Our bodies continually remove small ligaments: 78 mg of vitamin C, 300 IU of vitamin D-3, 9 mg of vitamin B-6, 225 amounts of calcium from our bones and mg of calcium, 120 mg of magnesium, 15 mg of zinc, 225 mg of manganese, 51 replace it with new calcium, a bone mg of potassium, 750 mg of glucosamine, and 750 mg of MSM. ‘remodeling’ process. If the body removes Disc-Gard+ is also specially formulated to dissolve quickly and completely. And more calcium from bones than it because it's only available through healthcare providers, it ensures patients come replaces, they slowly become weaker back time and again. Scientific research proves the upper intestines are most and more prone to breaking.”4 effective in assimilating vitamins and minerals. Slow-dissolving formulations may But a supplement containing bypass this critical region. Disc-Gard+’s special fast-dissolving formulation delivers essential minerals is only effective if more nutrients to the bloodstream for maximum benefits. Disc-Gard+ is registered it’s able to dissolve quickly in the in the U.S. Patent and Trademark office under registration No. 1,556,502. stomach. Fast-dissolving supplements So why take a chance? With patented, safe, effective, and guaranteed potency, deliver more nutrients to the blood- the answer is fast-dissolving Disc-Gard+. stream because some essential nutri- ents are best absorbed in the upper For more information on Disc-Gard+, contact Dee Cee laboratories at 800-251-8182 or visit deeceelabs.com. intestinal tract. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to The faster minerals are dissolved, diagnose, treat, cure, or prevent any disease. the more effective these supplements are and the quicker patients start to MELISSAHEYBOER is a former 2 Goodheart Jr., George J., DC. “A Presentation experience the benefits. associate editor of Chiropractic of a New Approach to Correction of Disc Chances are your patients are already Economics. She can be reached at Lesions.” The Journal of the National Chiropractic Association (1954): n. pag. Print. on track to improved health by getting [email protected] or 904- 567-1540. 3 “Glucosamine.” Mayo Clinic. Mayo Foundation regular chiropractic adjustments. So for Medical Education and Research, 01 Sept. why not strengthen their care—and 2012. Web. 02 Apr. 2013. their ligaments—by adding a nutri- References: 4 “What Is Calcium & How Does It Build 1 “Manganese: MedlinePlus Supplements.” U.S Strong Bones?” National Institute of Child tional supplement to their daily National Library of Medicine. U.S. National Health and Human Development. N.p., n.d. routine? Everyone wins. Library of Medicine, n.d. Web. 02 Apr. 2013. Web. 02 Apr. 2013.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 41 Call to action The right combination of today’s technologies and traditional methods of marketing will help you find patients and keep them coming back. BYKARENAPPOLD
lthough technology your practice to their friends, but this says chiropractors can use new tech- has changed would be time consuming and may nology to target, capture, nurture, and consumer behavior, not be effective,” Charytan says. “In qualify new patients using other tech- chiropractors don’t today’s world, online reviews have nologies as well. These may include Ahave to completely rethink nearly as much influence as personal phone and text blasts, landing pages, patient recruitment and referrals, are more relevant to the videos, and online publications. “The retention methods that have reader, and have much greater reach.” cool thing is with some of the latest worked in the past. With a technology-enabled patient breakthroughs from the last couple of While there’s always excitement and communication system, you can years such as retargeting, many of these buzz surrounding the latest technology automatically email patients after an strategies are now even more effective,” and newest fads in marketing, tried- appointment and ask them to post to Phillips says. “Chiropractors can use and-true methods are still in the mix an online review site such as RateABiz, these strategies to attract new patients because they are known to work. Yelp, Google, or Healthgrades. “You to their events, talks, free evaluations, If there’s a way to go wrong, it can also use technology to amplify the and nutrition appointments.” probably involves being completely reach of these positive messages about Retargeting works like this: After attached to tradition, or abandoning it your practice by making them a someone leaves your website, a cookie entirely. We brought together a group permanent testimonial on your website allows you to promote ads to them of experts to explain how you can get and sharing them on social media about your goods and services on the the balance right. channels,” Charytan adds. Internet. “So if someone comes to your While many of your marketing site looking for chiropractic care and Time shifting strategies should remain in place, most then visits a blog or social media “Most of the traditional strategies that of today’s potential patients look for website, he or she will see your ad for a chiropractors have used are still chiropractors online. “Make sure you free consultation on the sidebar,” relevant today,” says Ariel Charytan, vice have the basics of an Internet presence Phillips says. president of product for Yodle, a client in place, including a professional acquisition and retention specialty firm. website that is optimized for mobile Mainstay recruitment strategies “Technology can help by automating search and exposure on local business Word-of-mouth marketing and asking these interactions to make them more directories,” Charytan says. “Taking current patients to invite their friends effective and efficient so that the ownership of your online presence— and family to patient appreciation days chiropractor or practice manager can including social media and online or events continues to be a must for focus on higher value activities.” reviews—is important for keeping your the brick-and-mortar practice. “One of For example, getting personal reputation as a credible business, which the best marketing strategies is creating referrals is a traditional strategy for can help you recruit new patients.” an electric and attractive culture that is bringing new patients through the door. Warren Phillips, CEO of HCF congruent with the belief system in the “You could ask every patient to mention Seminars, a marketing education firm, office,” Phillips says.
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CHIROECO.COM MARCH 30, 2015 • CHIROPRACTIC ECONOMICS 43 To attract older patients, Drew own smartphone calendar to keep track Stevens, PhD, of Stevens Consulting Meet the experts of their appointments on the go—so Group, recommends using print-based Ariel Charytan, vice president bundling appointment confirmations, methods. In particular, he advises of Lighthouse Product, Yodle, sending calendar invites, and SMS advertising in local newspapers and New York, NY. reminders will help patients stay on offering promotions (e.g., contests, chiro.lh360.com. schedule, especially when they have sweepstakes, coupons, and giveaways) Warren Phillips, MS, CEO of multiple appointments,” Charytan says. via mailers in print. “You have to use HCF Seminars, Pittsburgh, Bob Mangat, CEO and founder of mixed modalities in a market flooded Penn. GetChiroTraffic.com, says it’s smart to with information today,” he says. hcfseminars.com/seminars engage with patients on Facebook or “Regardless of what you do, be sure to other social media sites because many switch things up from time to time.” Drew Stevens, PhD, of Stevens people use them. Regarding content, Other traditional marketing strategies Consulting Group, St. Louis, Mo. he suggests posting non-sales material such as complimentary spinal stevensconsultinggroup.com on general wellness topics that people screenings can still be very effective; Daniel T.Drubin, DC, president can use in their daily lives. “Education- however, they can also require a huge of 4th Dimension Management, based marketing will help you to amount of effort, Phillips says. and co-founder of Social demonstrate credibility and expertise,” Charytan believes that an established 4Chiros, Tucson, Ariz. says Mangat, whose company creates and nurtured referral network is one of masterofchange.net customized materials for chiropractors. the best ways to recruit more patients. Mangat adds that the more online Bob Mangat, CEO and founder “If you have a referral relationship in activity you do off your company’s of GetChiroTraffic.com, place with other healthcare providers, Vancouver, British Columbia, website, the more it will impact your you can use technology to stay in touch Canada. search engine optimization. “Ninety with them and bolster the relationship,” GetChiroTraffic.com percent of search engine traffic comes he says. “Set up a system that automat- from what you do off of your website,” ically sends thank-you notes for each he says. “You should update your referral, and create an e-newsletter customized professional messages. website, but more importantly be with updates about your practice.” Although appointment confirmations active on social media websites, too.” Daniel T. Drubin, DC, president of and reminders ensure that patients Stevens advises using an electronic 4th Dimension Management, and co- show up for scheduled visits, making strategy to communicate and keep in founder of Social4Chiros, says the least calls and sending emails or postcards touch with patients. Some software expensive but most effective way to are time-consuming tasks, Charytan packages can make phone calls or texts generate new patients is through public maintains. to patients you haven’t seen in a while. speaking, regardless of whether you do Therefore, technology that automates Have your message state something so from inside your office or in the this type of communication can be like “there is an appointment opening form of a special consultation. “But extremely effective. But these strategies for you” or “we have a new product or don’t package it as a class, workshop, can have some risks, too. Many patients service such as weight management or or orientation,” he cautions. “Special have multiple appointments in one nutritional analysis.” consultation has more importance in week. Some automatic scheduling the patient’s mind, so attendance and software will confirm and remind the Retention intention compliance go up. Most people do not patient for each appointment, which As with patient recruitment, most want to go back to class or attend a could feel like spam and become off- traditional methods still work well for workshop. Special consultation works putting. retaining patients. “The most powerful best because if you have a ‘class’ and To effectively use technology to marketing and retention tool has and only one person shows up, it is communicate with patients, you need a will continue to be the telephone,” embarrassing. However, one person at solution that can be customized to Phillips says. “Some calls can be auto- a special consultation makes it just send reminders based on that person’s mated or delegated, but there’s nothing that—a special consultation.” schedule and message preferences (e.g., more powerful than a personal call phone, email, or texts). “Many patients from the doctor after the client’s first Technically speaking manage their schedule online—whether adjustment. It really sets you apart.” To keep patients coming back, improve it’s through a shared Google calendar In addition, Phillips is a proponent your patient communication with for all family appointments or their of offering care plans upfront. This is a
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Investing in the education of your patients patients won’t travel more than 10 or 12 miles to see a chiropractor. If that’s will help their health and benefit your practice the case, you have to be a known entity in the long run. in the community and recognized as a brand.” Topics do not have to be chiropractic- commitment from the patient to the shouldn’t cheapen your advertising specific. Instead, focus on subjects doctor, and vice versa. “This not only efforts. For example: Do not promote related to overall health and wellness ensures retention over a much longer your practice with outdoor signage such as nutrition, diabetes, or high time period, but also allows the doctor stating that you now offer massage, are blood-pressure awareness, reviews of to develop a relationship with the accepting new patients, or have a new unhealthy fad diets, or even something patient and, at the end of the day, chiropractor on staff. “You won’t see a as simple as manicuring your lawn in a you’re ultimately selling yourself,” he dentist or osteopathic physician doing healthy way. “Offering something says. “This gives you a lot of time to such promotions,” he says. “Ridiculous contrarian will set you apart from others create value in the relationship and to promotions cheapen the industry.” in the field attempting the same educate the client about the amazing Stevens also recommends offering strategy,” Stevens says. benefits of chiropractic care.” seminars and workshops, getting letters A common retention challenge for For patients whom you haven’t published in regional publications, chiropractors is patients who cancel treated recently, Stevens advises sending being interviewed on local radio and their maintenance appointments. “If a a letter or postcard. Simply state that you television, teaching at a nearby college, patient isn’t currently in pain, he or haven’t seen the patient in a while, and or volunteering with community-based she may be less motivated to keep a that you would welcome an opportunity organizations. “Nontraditional methods standing appointment or come in for a to assist him or her with any issues. are ways for people in the community checkup that could be critical for their As a healthcare professional, you to get to know you,” he says. “Most well-being,” Charytan says. “There’s no
46 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM chiropractic equivalent to the six- in the hospitality area but any longer of work well. If you’re targeting clientele month cleaning in dentistry or the a wait will likely generate irritation. over 50, traditional newspaper annual checkup with a primary care “See them promptly and respect their advertising may be more effective. physician. time.” The same goes for retention—email “Chiropractors need to work a little and text reminders for appointments harder to stay in front of existing Through the ages can be more effective for people under patients. Investing in the education of Recruitment and retention strategies 50, and for those who are older you’ll your patients will help their health and are similar regardless of a patient’s age, definitely have to make personal phone benefit your practice in the long run. but you should be flexible in how you call reminders rather than automated Developing a patient newsletter with deliver the messages, Charytan says. calls. advice on how to maintain a healthy “Some of the stereotypes may be true, Drubin finds that promotional lifestyle including keeping regular but the best way to make sure that your messages should vary among different chiropractic appointments can help messages are reaching all of your age groups. For seniors he sells quality retention.” patients is to have a patient communi- of life. “They care about how long they Drubin emphasizes the importance cation system that can be customized will live and that they can continue to of patients recognizing that chiropractic to individual preferences,” he says. “Ask do the activities they enjoy,” he says. care is an irreplaceable commodity. your patients how they prefer to receive “Younger patients mostly see themselves “Once a patient starts to feel better messages, and with the right software, as being well, which is why it’s hard to symptomatically, the patient will start you can deliver a message that will build a practice in a gym. Emphasize to feel that he or she can no longer reach them every time.” to these patients that they can live a commit to spending so much time at Phillips has found preferences differ better life by protecting their health by the chiropractor’s office,” he says. among age groups. If you target busi- being educated about diet, exercise, Therefore, it’s important to value their nesspeople between the ages of 35 and how to properly lift and bend, and time. A patient will tolerate 15 minutes 50, a Facebook marketing strategy will getting enough sleep.”
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 47 Marketing and retention are among “What separates a thriving chiro- Use digital tools to your advantage while the greatest challenges in any chiro- practor from one who simply survives tapping into the needs of patients’ indi- practic office. “However, using both is the one who is consistent and vidual preferences, which may include traditional and breakthrough tech- relentless in patient recruitment and traditional forms of correspondence. nologies can grow a practice today retention strategies,” Stevens adds. Organic methods of establishing more quickly than ever before,” Phillips your authority in the alternative says. “No matter where you live, or As the experts illustrate, your efforts medicine field take time but can pay even how many people live in your in community outreach are never off in the long run. Start by bolstering area, you can still have a massively finished, while your communication the tactics that are already working successful practice by perfecting options are ever-expanding with your and pinpointing new areas that would recruitment and retention strategies.” patients’ increased use of technology. be worth your investment. Be flexible until you achieve your most effective game plan, and don’t settle for subpar results.
KARENAPPOLD, an editorial consultant in Royersford, Pennsylvania, is dedicated to regular chiropractic care. She has been the president of Write Now Services, which offers writing, editing, and proofreading since 2003. Her experience includes chiropractic marketing. She can be contacted at 610-812-3040, [email protected], or through writenowservices.com.
Quick Tip Backpack safety Offer your patients with schoolchildren the following tips to help prevent the needless pain that backpack misuse can cause.
Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry and the heavier the backpack will be.
Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
Wide, padded straps are very important. Non padded straps are uncomfortable, and can dig into your child's shoulders. — American Chiropractic Association acatoday.org
48 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
PERSONALgROWTH THINKSTOCK Working the room A dynamic presence is yours to have, if you follow these guidelines.
BYTIMOTHYJ.GAY,DC
AVE YOU EVER NOTICED HOW attitude if you’re not feeling on fire. wear includes jeans and pullovers; smart SOME PEOPLE HAVE THE ABILITY If you know that a speaking event is or business casual might entail office- Hto grab attention when they coming up, prepare for it. It starts with appropriate clothes. walk into a room full of strangers? how you think and the type of energy If you’re unsure about the venue, There’s no mystery—it’s because of the you project. consider bringing some formal way they look, act, and carry We are all drawn to people who clothing with you in case you arrive themselves. smile and have a positive attitude. at a function where smart casual is Some individuals are naturally Their charisma is compelling. not enough. gregarious, but others not so much. You many need to practice this in With that in mind, an aura of front of a mirror to see what you look Embrace your swagger. Audiences magnetism is something that you can like to others and how approachable usually respond well if you project a acquire and begin implementing into you may be. Even if feels silly, try it bold confidence and demeanor. Don’t your repertoire of tools to employ in anyway. If you’re like most, you’ll be stand in the corner. Instead, walk in meetings, conventions, parties, and your own worst critic. To become great with your head held high, posture in more. at anything requires diligence. check (chest out, shoulders back), and Your perceived value starts with how Consider a few tips that can make a your eyes forward. you feel about entering a crowded area big difference: Look like you know where you are where you may only know a few going (even if you don’t), and wear a people. Accept that this is something Dress for the occasion. It is better to be partial smile—just enough to make you have to do, and then change your overdressed than underdressed. Casual them wonder what you are thinking.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 51 PERSONALgROWTH
We are all drawn to people who smile and have a positive attitude.
Communicate confidently. When you attracted to others who appear are not proud of the next day. It boils stop and enter into a conversation, interested in them. down to how you want to be remem- have an opening line that is simple. bered at this or any other event. Make This could be, “What brings you to Define yourself. Have a clear vision of a good impression. this event tonight?” Or, “Hello, I am who you are and what you represent. Dr. Jones; this is a great event—and During a conversation, what you do Engage in appropriate humor. There is a you are?” for a living and your goals for the time and a place for humor, so be Make up your own opening lines future will be likely topics to arise. smart about what you say and take and get the conversation started. People want to hear your ideas, but be care not to insult anyone with sarcasm. Always extend your hand and make an a bit generic until you are in a deeper Clean jokes or funny remarks in a introduction. Exercise your swagger. conversation and more comfortable conversation keep it light and upbeat. You communicate with your voice, and with the person you are speaking with. If you are not naturally funny, learn a also with your appearance, posture, Everyone has an opinion and believes few subtle jokes. Interaction with and eye contact. in their worldview, so don’t get too humor will give you confidence. emotionally involved. Act interested. Be attentive to what Go with your gut. We all evoke energy people say. Listen and don’t interrupt Consume mindfully. Be aware of how and vibrations at different frequencies. when someone is making a point. Ask much you are eating and drinking. You If you are not “feeling it” when speaking good questions and stay on topic, and have probably been to functions where with someone, be polite but move on. your efforts will be noticed. People are people have said or done things they The idea is to meet as many people as you can who have common interests that you naturally resonate with at a high level.
Make contacts. Exchange phone numbers or business cards to keep in touch with new prospects or people you had a great time with. This is an opportunity not to be the consummate salesman. If you want to talk to them again, let them know it and be humble.
These are just a few strategies you can use to become more recognized and well received. Be who you are, make a few changes to your approach, and polish your new abilities. Continue to improve your people skills, and you soon may be the life of every party and occasion.
TIMOTHY J. GAY, DC, is a national speaker, an author, and the founder of Ultimate Practice. He has helped thousands of chiro- practors improve their practices through his straightforward, experiential speaking style. He can be contacted at 866- 797-8366, [email protected], or through ultimatepractice.com.
52 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
MARKETINGMATTERS THINKSTOCK 5 steps to marketing magic Power up your efforts with relationship-based marketing.
BYKELLEYPENDLETON,DC
IKE MOST BUSINESS OWNERS, YOU spend too much time working in our business owners and their employees. WANT YOUR PRACTICE TO GROW practices but not enough time working To help people ultimately trust you Land prosper in the years to come. on our practices. Try to schedule time with their health, you need to get out But with all the available options to every week to build relationships with of your office and into their environ- help you market your business, it can businesses in your community. ment. Here are a few suggestions of be overwhelmingly difficult to choose The small-business owners in your things you could begin to implement from among them. area can relate to your challenges of tomorrow to enhance your business- One often overlooked source of owning and operating a practice. In to-business (B2B) marketing: practice growth is your local business addition, they may be more likely to community. You may think you already seek the services and products of other 1. Make a list. Some of the best local market to local businesses because you local businesses (like yours). businesses to develop relationships participate in community organizations As with any marketing strategy, your with will be those whose services are with other business owners. That’s a business-to-business efforts should be complementary to yours: Massage start, but it shouldn’t be the end of your designed to establish a genuine therapists, personal trainers, physical marketing endeavors with other small relationship. We’ve all heard that people therapists, homeopaths, naturopaths, businesses. Intentional relationship- do business with individuals they and the like. building should be an ongoing know, like, and trust. The same is true Include small businesses from other component of your marketing plan. for businesses, too. After all, businesses industries such as hospitality, IT, Best-selling author Michael Gerber are owned by people, so you need to grocery, government, trade professions, (The E-Myth and other books) says we establish the same rapport with and so on.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 55 MARKETINGMATTERS
Tohelp people ultimately trust you with their company, properly vet them. Your recommendations carry your health, you need to get out of your office and reputation. into their environment. Small businesses are the lifeblood of the economy, and they can provide a tremendous boost to your practice’s Set criteria so your list isn’t over- 3. Cross-promote. A popular section in bottom line. Take a long-term whelming. For example, perhaps you some practices is the “community approach to cultivating relationships want to focus on businesses within a corner.” This is a small area, perhaps a with small-business owners and five-mile radius of your practice or cork board, shelf, or tabletop where employees. You may not see results those that have 10 to 50 employees. you keep business cards, brochures, overnight, but with consistent effort Consider starting with a small number coupons, and promotional items from the number of businesses (and people) of businesses (maybe 10 to 20). Once other community businesses. Patients who know, like, and trust you will you’ve opened relationships with the like coming to your office and getting grow. And so will your practice. first group, you can then proceed to information about other local entities. the next portion of your list. When connecting with businesses, ask KELLEYPENDLETON, DC, is a if you can place some of their materials chiropractor, healthcare marketing 2. Start making connections. Using your in your community corner. Encourage consultant, professional speaker, and the author of Community list, designate the businesses you’d like them to create their own community Connections! Relationship Marketing to start with and then connect with corner as well. Cross-promotion for Healthcare Professionals. She uses her those owners and employees. How you doesn’t have to stay in the physical experience and expertise to help other connect with each business may be realm; cross-promote other local healthcare professionals build the practices— different, but here are some suggestions businesses via social media. Consider and lives—of their dreams. She can be to get you started: putting a community corner page on contacted at [email protected] Call a business on the phone and your website to list local businesses or through drkelleypendleton.com. ask to schedule a 15-minute get-to- with contact information and links to know-you meeting with the owner or their websites, too. manager. When you arrive, have some business cards, brochures, or promo- 4. Be creative. Consider giving tional items ready to leave behind. Show discounts, coupons, or promotions to interest and curiosity in their business. the employees of the local businesses Quick Tip Ask for specifics on what they do as you’ve connected with. Perhaps you well as who their target customers are. provide lunch-and-learn health talks or Fiber and stroke After you leave, take a few minutes to co-sponsor a charitable event. Figure Researchers at the University of jot down some notes about what you out the health needs and wants of Leeds in England discovered that by discussed. This way you can refer to these businesses and see if you can increasing fiber intake by seven specific details when you follow up help meet them. grams a day, the chance of with a thank-you note or in future becoming a stroke victim drops by discussions. And be friendly to the 5. Keep in touch. Once you’ve established seven percent. The meta-analysis employees while you’re there as well. a relationship with a local business, don’t compared eight studies from Reach out via LinkedIn or other social let it die. Set reminders to touch base Europe, America, Japan, and networks to make a connection. Then every few months by phone, mail, or in Australia. follow up with an in-person meeting. person. (There are plenty of companies Overall, the higher a person’s intake Poll your friends and associates to see and apps you can use to help automate of dietary fiber and high-fiber foods, if they personally know anyone on your this task.) Don’t forget to acknowledge the less of a chance they would list. Ask if they’d be willing to make an and appreciate any assistance they give have of experiencing an initial introduction. A warm introduction to your practice. For example: If they stroke. This is obviously important, between friends or business acquain- refer a patient, send a (HIPPA because strokes are a leading cause tances can be better than a cold call. compliant) thank-you note back. of both death and disability. Invite the owner or manager to coffee — The Baseline of Health Foundation or lunch for a longer conversation with A caution about B2B marketing: JonBarron.org fewer distractions. Before you cross-promote another
56 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
BUYERSGUIDE Patient Education Chiropractic Economics is pleased to present the profession’s most comprehensive Patient Education directory. The information in the resource guide was obtained from questionnaires completed by the listed companies. Companies highlighted in RED have an advertisement in this issue.
2 Imagine BodyZone.com ChiroPractice Marketing Dynamic Disc Designs K-Med Services Inc. 480-657-8506 770-922-0700 Solutions 250-751-0897 800-243-2603 2imaginethis.com bodyzone.com 866-285-2011 dynamicdiscdesigns.com kmedsupplies.com chiropracticemarketingsolutions.com 2nd Cousin Inc. Breakthrough Coaching eyeQuest Networks Inc. Kennebec Proof Preferred 413-232-3219 800-723-8423 ChiroPractice Mentoring 770-933-1800 412-278-2040 healthnewspodcast.com mybreakthrough.com 608-489-7542 eyequestnetworks.com proofpreferred.com chiromentor.com 3B Scientific British Institute Feeling Pretty Remarkable Killer Ads 888-326-6335 of Homeopathy ChiropracticOutfitters.com 416-750-1500 a3bs.com 706-233-9000 609-927-5660 952-270-0258 feelingprettyremarkable.com thekillerads.com chiropracticoutfitters.com 3DRX Inc. bihusa.com Foot Levelers Inc. 360-909-3709 Chiroschool.com Kinetic Concepts LLC Bryanne Enterprises Inc. 3drx.com 707-927-4611 800-553-4860 845-802-4433 877-279-2663 chiroschool.com footlevelers.com themovementonline.net/ A2Z Health Massage bryanne.com Therapy Schools ChiroVision Forte Holdings Inc. King Bio 888-303-3131 BStrong4Life 800-438-9355 800-456-2622 800-543-3245 a2zhealthstore.com 866-515-4907 chirovision.com emr4chiro.com safecarerx.com bstrong4life.com Access Equipment Corp. CJ3 Consulting Functional Medicine Masters Koren Enterprises 256-245-8390 Business Industrial 512-474-1895 888-777-3020 800-537-3001 chirocity.com Chiropractic Services cjmertz.com functionalmedicinemasters.com korenpublications.com 404-518-4338 Activator Methods Int’l bics2020.com Clinic Artwork Future Health Inc. Legacy for Life 800-598-0224 715-575-4119 888-434-7347 877-557-8477 activator.com CATS - Cranial Adjusting clinicartwork.com FutureHealthSoftware.com legacyforlife.net Turner Style Addison Health Systems Inc. 705-792-1315 CommVantage Gallery Medica Lippincott Williams & Wilkins 800-496-2001 catsworkshop.com 866-399-4009 818-761-1355 800-638-3030 writepad.com 3dpractice.com gallerymedica.com lww.com ChiroColumn aDIO Productions ConCentro Laboratories LLC GMP Fitness Living Well Labs 800-461-2346 888-707-5656 520-876-0308 adioproductions.com chirocolumn.com neuropathyusa.com 888-467-3488 800-540-1674 gmpfitness.com livingwelllabs.com Advanced Rehab ChiroConceptions Concept Therapy Institute Consultants LLC 301-777-3710 210-698-2254 Graston Technique LSI Int’l 866-914-2003 chiroconceptions.com zonedoctors.com 888-926-2727 800-832-0053 advancedrehabconsultants.com grastontechnique.com lsiinternational.com ChiroDesign Group Cox Technic Resource American Anatomical Corp. 512-301-0821 Center Inc. H.W. Industries Inc. Massage Warehouse 800-344-5904 chirodesigngroup.com 800-441-5571 800-824-5084 800-910-9955 americananatomical.com coxtrc.com hwind.com/chiro massagewarehouse.com ChiroMatrix American Nutriceuticals 800-444-4200 Creating Wellness Health Visions Inc. Medi-Stim Inc. 888-848-2548 chiromatrix.com 888-589-9355 888-480-1350 800-363-7846 888vitality.com creatingwellness.com healthvisions.com medi-stim.com ChiroPlanet.com Anatomical Models 888-364-5774 Davlen Associates Ltd. Healthy You Medical Arts Press International chiroplanet.com 631-924-8686 800-826-9946 800-328-2179 877-208-9372 davlendesign.com healthyyouweb.com medicalartspress.com bagofbones.us Chiropractic Business Academy 888-989-0855 Demandforce Himalaya Herbal Healthcare Medical Electronics Inc. Apex EDI chirobizacademy.com 800-246-9853 800-869-4640 866-633-4876 800-840-9152 demandforce.com himalayausa.com meditronics.net apexedi.com Chiropractic Images Discover Wellness Inc. 514-277-3546 Hoggan Scientific LLC Meditherm Inc. Back Talk Systems Inc. stephenshortt.org 760-208-1895 drstevehoffman.com 800-678-7888 866-281-5479 800-937-3113 hogganhealth.net meditherm.com backtalksystems.com Chiropractic Leadership DoctorPromo BML Basic Alliance 516-867-8237 Image One MGV Marketing 800-643-4751 800-285-2001 doctorpromo.com 800-536-3030 561-392-5206 bmlbasic.com subluxation.com imageoneads.com mgvmarketing.com Dr. Pete Gratale’s Power Body Logic Chiropractic Marketing 360 Centering Inform for Life Miridia Technology Inc. 214-378-6100 888-929-3633 970-260-2003 800-234-8325 888-647-4342 ebodylogic.com chiropracticmarketing360.com powercentering.com informforlife.com miridiatech.com BodyPartChart Chiropractic SEO Wellness DrBarbaraEaton.com JTECH Medical Mojo Interactive 888-712-4278 847-807-4382 907-444-9043 801-478-0680 866-626-3867 bodypartchart.com chiroseowellness.com drbarbaraeaton.com jtechmedical.com locateadoc.com
58 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM Morgan Professional Products Patient Media Inc. Rosen Coaching Strobel Technologies Tim Stensrud Design 800-403-5295 719-488-6663 808-878-8384 812-280-6000 780-449-7272 morganprofessionalproducts.com patientmedia.com rosencoaching.com strobel.com healthcaredesigner.com MPower Media Perfect Patients S.A.M. LLC Sunset Park Massage Supplies Totally Booked Practice 888-232-9862 800-381-2956 800-752-3263 813-835-7900 888-243-2661 mpowermedia.com perfectpatients.com morenewpatients.com massagesupplies.com totallybookedpractice.com Myogauge Corp. Performance Health/Biofreeze Science Based Nutrition Synergy Therapeutic Systems Trigenics Institute of 888-696-3539 800-639-3539 Functional Neurology myogauge.com 800-246-3733 937-433-3140 biofreeze.com sciencebasednutrition.com targetexercises.com 416-481-1936 trigenicsinstitute.com MyoVision Performance Health/TheraBand Sigafoose Seminars Systemic Formulas Corp. 800-969-6961 800-445-4647 Trusted Voice myovision.com 800-321-2135 800-331-6930 theraband.com sigafoose.com systemicformulasmedia.com 877-558-6423 trustedvoice.com National Health Education Target Information Pivotal Health Solutions Sigma Instrument Methods Society Inc. Management Co. Upledger Institute Int’l 800-241-7705 800-743-7738 888-860-9492 pivotalhealthsolutions.com sigmamethods.com 800-258-0258 800-233-5880 voiceforhealth.com targetinfo.ws upledger.com Natural Touch Marketing PostureCo Sigma Instruments Tekscan Ventura Designs 800-754-9790 866-577-7297 724-776-9500 800-248-3669 888-713-2093 naturaltouchmarketing.com postureco.com sigma-instruments.com tekscan.com posturepro.com New Harbinger Publications Inc. PreventiCare Publishing Spinal Reflex Institute Int’l The Family Practice Inc. Visual Odyssey Inc. 800-748-6273 912-897-3040 877-259-5520 newharbinger.com 866-532-3327 800-541-4449 preventicare.com spinalreflex.com thefamilypractice.net neuropatholator.com Noromed Inc. Rizzo & Jones Associates Standard Process Inc. The Integration Group Watt Media Inc. 800-426-0316 877-947-7200 800-558-8740 noromed.com 443-438-9610 800-250-8233 rizzoandjones.com standardprocess.com integrateyourpractice.com watt-media.com Novel Electronics Inc. Roscoe Medical Stoneybrook Publishing Inc. 651-221-0505 The Masters Circle Wellness Way novel.de 800-871-7858 800-736-3632 800-451-4514 888-450-3333 roscoemedical.com stoneybrookpublishing.com themasterscircle.com wellnessway.com Nutraceutics Corp. 877-664-6684 nutraceutics.com Officite 630-928-0950 officite.com OnlineChiro.com 888-932-5550 onlinechiro.com OPTP 800-367-7393 optp.com Pain & Stress Center 800-669-2256 painstresscenter.com Palmer College Continuing Education & Events 800-452-5032 palmer.edu/ce Parker Share Center 972-438-6932 parkersharecenter.com
The information in the Buyers Guide was obtained from questionnaires completed by the listed companies. Chiropractic Economics strives for accuracy in all reports but is not responsible for errors or omissions. For the complete buyers guide of services these companies provide, and to view all of our other complete buyers guides, visit ChiroEco.com/buyersguide.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 59
MONEYMANAgEMENT
A taxing affair Proactive measures can quell your fears of an IRS audit.
BYMARKE.BATTERSBY THINKSTOCK
NE OF THE MOST NERVE- risk of small-business owners and self- sources and coming up with a different WRACKING THREATS FACED BY employed professionals being audited. total—or spotting income that wasn’t Othousands of chiropractors reported. each year is the possibility of being Shrinking the target Consider other moves that may help audited. The Internal Revenue Service There’s no sure way to avoid an income reduce the risk of being audited: is apparently sending mixed signals tax audit because details about the IRS’s about tax audits. On the one hand, the targeting process are cloaked in secrecy. Hire a professional to prepare your returns. IRS’s own figures reveal that, in general, But most returns are first reviewed by This can reduce the chance of errors or only 1 or 2 percent of taxpayers have a computer, which scans for triggers overlooking important information their returns audited each year. previously associated with noncom- that affects your finances. But programs such as last year’s pliance. In addition to auditing flagged nonaudit letters demanding explanations returns, the IRS also selects some at Be honest. While it may be tempting to for discrepancies between amounts random. lie about income or expenses, those who reported as paid by patient credit cards An easy and often-overlooked are honest fare better when it comes to and reported income may be cause for method to legally reduce the possibility avoiding an audit and surviving one. concern. This, along with the IRS’s of an audit is to simply double-check recent announcement about homing in your numbers. Many audits stem from Watch the deductibles. If not handled on cash-based businesses and profes- the IRS checking the figures on the correctly or honestly, deductions can be sional practices, appears to increase the return against those reported by other a huge red flag that leads to an audit.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 61 MONEYMANAgEMENT
File electronically. When tax returns are tative trudge down to the IRS office required to make quarterly estimated filed electronically, the risk of IRS armed only with the specific documents tax payments during the year. If filing errors from information being keyed and information requested? There is as a sole proprietor, a partner, an S in is reduced substantially. no one correct answer, so evaluate the corporation, or a self-employed indi- risks and benefits within the context of vidual, estimated tax payments will Battleground selection your situation. have to be made if a tax bill of $1,000 The worst thing you can do upon or more is anticipated. receiving an audit notice is ignore it. Red flags Fortunately, among the more important Avoiding costly penalties, fees, and Not taking business deductions or taking rights given any chiropractor (or audits is crucial to your success. The excessive deductions. The most practice) whose returns are targeted is most common tax mistakes made by commonly overlooked deductions whether to be represented by a tax those operating a practice include: include depreciation, the decrease in professional or to answer the IRS’s asset values over time due to wear and questions directly. Failing to file and pay taxes on time. tear, out-of-pocket expenses, purchases Another important consideration is Determining the correct tax form and of new equipment, and automobile where to hold the meeting. Should it its filing date depends on your practice’s expenses. Taking excessive deductions take place in the accountant’s office structure. If, for instance, you operate as or mixing personal and business where the working documents are an S corporation, Form 1120S is used deductions can lead to a federal tax easily accessible? Should it be at the (due on March 15). With a sole propri- fraud charge. chiropractor’s place of business to etorship, Schedule C must accompany demonstrate that there is nothing to Form 1040 (due on April 15). Keeping poor records. With good hide and the practice is legitimate? records, all practice-related expenses can Or, should the practice’s principal, Forgetting estimated tax payments. be deducted, inventory tracked and manager, or the operation’s represen- Some businesses and practices are managed, employee payrolls maintained
62 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM An easy and often-overlooked method to legally Until an agreement is reached with the IRS, from the initial screening of the reduce the possibility of an audit is to simply tax returns for accuracy until the final double-check your numbers. appeal has been exhausted, the appeals process remains open and payment of the contested tax bill need not be paid. and reported, and the potential for the new assessment due within 30 days. Mistakes in favor of the taxpayer are costly errors eliminated. Anyone failing to agree with the discovered in about 25 percent of cases. examiner’s findings can appeal during The IRS is usually quite sympathetic Misclassifying employees as independent the 30-day period. An appeal, handled to honest mistakes and more than contractors. A practice may try to treat by an IRS appeals officer, can often willing to discuss underpayments of workers as independent contractors to take a year or longer, during which the taxes within the gray areas of our tax save money, as payroll taxes are not tax bill remains in limbo. rules. They’ll frequently negotiate the due for contractors. But this can end A disagreement over an auditor’s amount of taxes due. But they don’t up costing your practice should the findings is usually referred to the like deliberate fraud. IRS disagree with your assessment of appellate level of the IRS, where the their status. representative is often more knowl- Go straight to the top edgeable and likely to be more lenient. The main purpose of the U.S. Tax Checking the checker Of course, even here, the chiropractor Court is to review deficiencies asserted Whether it is a field audit, office audit, does not have to agree. While the by the IRS for additional income, estate, or a correspondence audit, at the end additional taxes demanded by the IRS gift, or self-employment taxes. The tax of the examination, a 30-day letter will auditor can go unpaid, the interest and court is the only judicial body from be issued. If the IRS is correct, the any penalties continue to accrue. But which relief may be obtained without examination report can be signed with further appeal is still possible. having to first pay the disputed taxes.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 63 MONEYMANAgEMENT
The court offers the option of using a relatively informal procedure for cases in which both the disputed tax deficiency and the amount of claimed overpayment is less than $50,000. Usually, chiropractors represent themselves or their practice, though they may be represented by anyone authorized to practice before the IRS. Unfortunately, decisions by the small tax case division of the U.S. Tax Court neither set a precedent nor can they be appealed. Naturally, any chiropractor who loses in regular tax court may appeal the case to the U.S. Court of Appeals. But the free ride ends when the tax court rules. If it decides in the IRS’s favor, future appeal requires an appeal bond guaran- teeing payment of any tax deficiency finally determined.
The latest threat IRS officials say the letters questioning underreported business income recently sent to many small businesses, professional practices, and others are not the same as an audit, but rather requests for more information. Some lawmakers and business owners who received the letters say the initiative is alarming. On another front, a number of lawmakers have questioned whether the failure to voluntarily disclose information required under the Affordable Care Act (ACA) within the first year of its implementation would result in a practice or business being flagged for an audit. According to the IRS, however, because reporting ACA-related information will be voluntary for the first year, those choosing not to report it will not be penalized. The IRS recently rolled out a streamlined program designed to enable small taxpayers, businesses, and practices under- going audits to more quickly settle their differences with the IRS. The Fast Track Settlement program is designed to speed up the audit and appeals process for small businesses, professional practices, and self-employed individuals who are being examined by the Small Business/Self Employed Division of the IRS. Honesty and clarity can go a long way toward preventing and dealing with an IRS audit. As illustrated, the audit of your practice’s income tax return need not be the end of the world. If that examination does result in an assessment of additional taxes, appeal after appeal is possible until, at some stage, either compromise is reached or you are satisfied with the outcome.
MARK E. BATTERSBY is a tax and financial adviser, freelance writer, lecturer, and author located in suburban Philadelphia. He can be reached at 610-789-2480.
DISCLAIMER: The author is not engaged in rendering tax, legal, or accounting advice. Please consult your professional adviser about issues related to your practice.
64 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
STuDENTDC Click it! studentDCcom Home Colleges CareerDevelopment FinancialPreparation JobSearch PracticeStartup Checklists Resources The online resource for future doctors of chiropractic.
All about branding
BYPETERG.FERNANDEZ,DC
OW CAN PEOPLE IN YOUR Study yourself sending out a confusing message listing COMMUNITY DIFFERENTIATE Take a picture of your office and sign, multiple specialties, e.g., “I treat personal Hbetween your practice and the then drive around your town and look injury, sports injuries, and offer other chiropractors in your community? at your competitors. If you all look the nutrition, pediatrics, rehabilitation, If they can’t, why would potential same, just like the rows of spices, your acupuncture, and psychological patients choose you? branding isn’t working. Your office counseling.” Instead, your branding After you open for business, if must stand out. should be razor sharp. traffic isn’t coming to you, then your Next, compare your advertising marketing messages aren’t creating (print, newspaper, TV, and radio). Action plan interest or establishing your competitive Does your advertising look and sound 1. Write out your competitive advan- advantage. The key to marketing, then, the same as everyone else’s? If so, you tage, e.g., latest equipment, testing, is to establish a brand for your practice. need to brand yourself better. education, experience, and the health Branding is more than a name and a The same applies to your website. problems you treat best. logo. It’s the message you give the And, believe it or not, your fee 2. Develop a marketing plan that public about the uniqueness of your schedule is also part of your branding. promotes your competitive advantage. practice. It requires that you package Are your fees high or low? They’ll 3. Develop a short statement that all aspects of your marketing with the make a difference in how your care is captures what you do, e.g., “Care for same look and feel that creates your perceived. Some people seek the best patients who suffer from chronic back distinctive value. It must provide the care and are willing to pay more for it. pain.” differentiation that makes potential Decide on the type of care you want 4. Pinpoint your marketing efforts to patients say, “I want to go to this doctor.” to render and the kinds of patients you reach your target market. Branding includes your office want to serve. Then develop a program 5. Aim all your marketing at your building, the name of your practice, that will attract that population to your chosen demographic. the clothes you wear inside and outside practice. your office, your signage, stationery, Follow the above, and you’ll be business cards, advertising, public Caution: If you choose to be the lowest- pleased with the results! relations, speeches, literature, pamphlets, priced practitioner in town, develop a and anything with your name on it. program that promotes your advantage. PETERG.FERNANDEZ, DC, the When all your marketing conveys your But the lowest-priced practitioner works “start-up coach,” has been a competitive advantage, you have four times harder for little net profit. Is practice consultant for almost 30 years. He has consulted in the created your brand. this what you want to do? Or, do you opening of more than 3,000 new want to be a first-class doctor getting practices and can be contacted through The Case in point “first-class” fees? Practice Starters Program at 800-882-4476, Walk down the spices aisle of your [email protected], or through local supermarket and look for salt. Focus your brand practicestarters.com. You’ll see box after box. Most people Your message should focus on the type buy the one that has branded itself as of healthcare you deliver, such as nutri- better and more consistent. Your tion, sports injuries, or disc decom- branding should do the same. pression. Don’t make the mistake of
66 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM
ADINDEX
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68 CHIROPRACTICECONOMICS• MARCH 30, 2015 CHIROECO.COM DATEBOOK
DAtE EVENt WhERE SPoNSoR PhoNE Apr. 11-12 Impulse Adjusting technique Chicago Neuromechanical Innovations 888-294-4750 Apr. 11-12 Graston technique M1 Basic training Indianapolis Graston Technique 888-926-2727 Apr. 11-12 Graston technique M1 Basic training Albany, NY Graston Technique 888-926-2727 Apr. 11-12 Graston technique M1 Basic training Anaheim, CA Graston Technique 888-926-2727 Apr. 11-12 Supporting Your Body from toes to Nose Renton, WA Foot Levelers 800-553-4860 Apr. 11-12 Stress, Structure, and Neurology Newark, NJ Foot Levelers 800-553-4860 Apr. 11-12 CE Event: Posture Rehab Exercise, Assessment, and therapy Dallas BodyZone 770-922-0700 Apr. 11-12 Ergonomics Assessment Certification Workshop New Brunswick, NJ Back School of Atlanta 800-783-7536 Apr. 11-12 Activator Methods: Basic, Intermediate, and Advanced Lisle, IL Activator Methods International 800-598-0224 Apr. 11-12 Kt1 & Kt2: Kinesio taping Fundamentals & Advanced Decatur, GA Kinesio Taping Association 888-320-8273 Apr. 16-19 CE Event: Posture Rehab Exercise, Assessment, and therapy Jacksonville, FL BodyZone 770-922-0700 Apr. 16-19 Flexion Distraction Protocols Fort Wayne, IN Cox Seminars 800-441-5571 Apr. 18 hands-on Skills of Flexion Distraction Vancouver, Canada Cox Seminars 800-441-5571 Apr. 18 hands-on Skills of Flexion Distraction Temecula, CA Cox Seminars 800-441-5571 Apr. 18-19 Biomechanics, Imaging, and the high School Athlete Chicago Foot Levelers 800-553-4860 Apr. 18-19 Biomechanics, Imaging, and the high School Athlete Florence, KY Foot Levelers 800-553-4860 Apr. 18-19 Graston technique M1 Basic training Orlando, FL Graston Technique 888-926-2727 Apr. 18-19 Graston technique M1 Basic training Dallas Graston Technique 888-926-2727 Apr. 18-19 Graston technique M1 Basic training Buffalo, NY Graston Technique 888-926-2727 Apr. 18-19 Impulse Adjusting technique Sacramento, CA Neuromechanical Innovations 888-294-4750 Apr. 18-19 ICPA 200-hour Certification Program Overland Park, KS Cleveland Chiropractic College 800-969-2701 Apr. 18-19 Scalp Acupuncture Chesterfield, MO Logan College of Chiropractic 800-842-3234 Apr. 18-19 Chiropractic Rehab Certificate Program #3 Chesterfield, MO Logan College of Chiropractic 800-842-3234 Apr. 18-19 Activator Methods: Basic, Intermediate, and Advanced Aurora, CO Activator Methods International 800-598-0224 Apr. 18-19 Activator Methods: Basic, Intermediate, and Advanced Atlanta Activator Methods International 800-598-0224 Apr. 18-19 Advanced Extremity Adjusting: Deliberate Practice Protocols Columbia, SC Foot Levelers 800-553-4860 Apr. 25 Kt3: Kinesio taping Clinical Concepts Kennesaw, GA Kinesio Taping Association 888-320-8273 Apr. 25-26 Advanced Extremity Adjusting: Deliberate Practice Protocols Albany, NY Foot Levelers 800-553-4860 Apr. 25-26 the Kinetic Chain & low Back Stabilization Boston Foot Levelers 800-553-4860 Apr. 25-26 Stress, Structure, and Neurology Pittsburgh Foot Levelers 800-553-4860 Apr. 25-26 Graston technique M1 Basic training Pittsburgh Graston Technique 888-926-2727 Apr. 25-26 Graston technique M1 Basic training Ann Arbor, MI Graston Technique 888-926-2727 Apr. 25-26 Graston technique M1 Basic training Boston Graston Technique 888-926-2727 Apr. 25-26 Graston technique M2 Advanced training Boston Graston Technique 888-926-2727 Apr. 25-26 Impulse Adjusting technique London Neuromechanical Innovations 888-294-4750 Apr. 25-26 CE Event: Posture Rehab Exercise, Assessment, and therapy Portland, OR BodyZone 770-922-0700 Apr. 25-26 Insurance Compliance and Your Practice Profile Chesterfield, MO Logan University 800-842-3234 Apr. 25-26 CEAS I: Ergonomics Assessment Certification Workshop Warwick, RI Back School of Atlanta 800-783-7536 Apr. 25-26 BStrong4life hands on Rehabilitation Seminar Naperville, IL Neuromechanical Innovations 888-294-4750 Apr. 26 Kt4: Kinesio taping Specialty Sports orthopedic Concepts Kennesaw, GA Kinesio Taping Association 888-320-8273 Apr. 30-May 1 Spring Symposium Chesterfield, MO Logan University 800-842-3234 Apr. 30-May 1 Ergonomics Assessment Certification Workshop Austin, TX Back School of Atlanta 800-783-7536 May 1-2 Ergonomics Assessment Certification Workshop Austin, TX Back School of Atlanta 800-783-7536 May 2 hands-on Skills of Flexion Distraction Atlanta Cox Seminars 800-441-5571 May 2-3 Kt1 & Kt2: Kinesio taping Fundamentals & Advanced Redwood, CA Kinesio Taping Association 888-320-8273
For a searchable list of more seminars and show dates or to submit your event, visit ChiroEco.com/datebook. Sponsor companies are listed in RED.
CHIROECO.COM MARCH 30, 2015 • CHIROPRACTICECONOMICS 69 PRODUCTSHOWCASE
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*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
For a comprehensive, searchable products directory, go to ChiroEco.com and click on “Products and Services.” Tosubmit your products, go to ChiroEco.com/products and fill in the required information.
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