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ISSUE #07: MAY 7, 2008
THE MAGAZINE DEDICATED TO PRACTICE GROWTH AND PROSPERITY SINCE 1954
HOW TO BECOME 34 A SUPERACHIEVER LISTEN TO 42 SUCCEED DOCUMENT YOUR 51 WAY TO NEW PATIENTS
SUGGESTED READING 57 WRITTEN BY YOUR COLLEAGUES
CASE IN POINT: DID 62 THE DC DO HARM?
Recession-proof your practice PAGE 1822 PLUS CONTINUING EDUCATION RESOURCE GUIDE PAGE 66
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CIRCLE 250 FREE INFORMATION CHEC7p4.ps 4/14/08 4:46 PM Page 4 CONTENTS CHIROPRACTIC ECONOMICS • VOLUME 54, ISSUE 7
18 NOW ONLINE at ChiroEco.com The Leading Chiropractic Web Site
Web Exclusive Homecoming 2008: A roundup of events and CE opportunities. Go to www.ChiroEco.com/ homecoming2008. Expert Insights • Reimbursement Rocks: “Golden Nuggets: He Who Has the Gold Wins,” by Kathy Mills Chang • Chiropractic Economics Blog: “All Joking Aside,” by Linda Segall • ChiroMasterMind: “The Art of Networking (Don’t Make These Mistakes!)” by Perry Nickelston Datebook A searchable database of educational events. Resource Centers Articles, information, news, and tools to support your practice. Poll Has the poor economy COVER STORY affected your practice? Go online to www.ChiroEco.com Surviving and thriving in tough times: to answer. How to recession-proof your practice ...... 18 By Tammy Worth Featured Videos Stories about chiropractic from mainstream media. PERSONAL DEVELOPMENT Which states require continuing-education credits? ...... 31 Past Issues A timeless library of past 10 tips to take your practice to new heights ...... 34 issues and articles. By Danny Drubin, DC News 5 leadership tips for a pivotal business year ...... 38 The most important and By Quint Studer current chiropractic news, including industry news and Listen for success ...... 42 health news. By Perry Nickelston, DC
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44 IN EVERY ISSUE EDITOR’S MESSAGE ...... 8 NEWS ...... 10 QUICK TIP ...... 65 DATEBOOK ...... 70 INFORMATION FOR READERS . . . . 74 PRODUCTS ...... 84 MARKETPLACE ...... 87 CLASSIFIEDS ...... 89 CONTINUING EDUCATION DIRECTORY PRACTICE MANAGEMENT AND RESOURCE GUIDE ...... 66 A solution for your healthcare-benefits problem ...... 44 By Matthew S. Clement Chiropractic Coding Questions: ECONOMICS Chiropractic Economics (ISSN 1087- To participate — or not — in Medicare? ...... 46 1985) (USPS 019-178) is published 20 By Marty Kotlar, DC times a year, once every three weeks, by Chiropractic Economics, Inc., 5150 Palm Success File: A prescription for presenteeism ...... 48 Valley Road, Suite 103, Ponte Vedra By Bob Levoy Beach, FL 32082, Phone: 904- 285-6020, Fax: 904-285-9944, Web contact: www.chiroeco.com (A Florida MARKETING Corporation). POSTMASTER: Please send form Compliant documentation: #3579 to Chiropractic Economics, PO Box 3521, Northbrook, IL 60065-9955. A way to acquire new patients ...... 51 Periodicals class postage paid at Ponte By Ted A. Arkfeld, DC Vedra, Florida and at additional mailing offices. GST #131868416. Subscription Rates: U.S. and MEDIA REVIEW possessions, $39.95 one year, Canadian subscribers add $35 per year shipping New books for your chiropractic bookshelf ...... 57 and handling; overseas subscribers add By Wendy Bautista $60 per year shipping and handling. Students, $19.95, Single copy, $4. Statement: While encouraging the free LEGAL expression of opinion by contributors to this publication, Chiropractic Economics Case in Point: Was the chiropractor at fault and members of its staff do not necessarily agree with/or endorse the for harming the patient? ...... 62 statements made in the advertisements By Stuart E. Hoffman, DC or contributed articles. Chiropractic Economics is owned by Chiropractic Ask the Attorney: Economics, Inc. a Florida Corporation, Joseph D. Doyle, President and CEO Do you need an employee handbook? ...... 64 and Linda Segall, Editor-in-Chief. By Steven Conway, DC, DACBOH, Esq. Authorization for the use of photographs and/or illustrations is the responsibility of the author(s). All FINANCE materials submitted for publication shall remain the property of this How to protect your assets from judgments ...... 72 magazine until published. By Darrell Aviss Change of Address: Six to eight weeks prior to moving, please clip the mailing label from Finance and Taxes: LLCs offer unlimited possibilities ...... 78 the most recent issue and send it along with By Mark E. Battersby your new address (including zip code) to the CHIROPRACTIC ECONOMICS CIRCULATION DEPARTMENT, PO Box STUDENTDC.COM 3521, Northbrook, IL 60065-9955. For a faster change, go to www.ChiroEco.com and click on Complying with OSHA regulations ...... 82 “ Customer Service.”
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EDITOR’S MESSAGE
The dreaded ‘R’ word ChiropracticECONOMICS DEDICATED TO PRACTICE GROWTH AND PROSPERITY SINCE 1954 and your practice Volume 54, Number 7 Editor-in-Chief n macroeconomics, a recession is defined as a Linda Segall decline in a country’s gross domestic product [email protected] I Associate Editor (GDP), or negative real economic growth, for two or Wendy Bautista [email protected] more successive quarters of a year. Online Editor As of this writing, economists are still debating if the Amy Mitchell [email protected] United States is officially in a recession. Whether or Assistant Editor not the “ R” word is used, it is quite obvious the country Ryan Daley is facing challenging economic times. In many areas, gas [email protected] prices hover around $4 a gallon; the cost of a dozen eggs Art Director Christine Wojton has risen to about $2 a dozen; and real estate has lost 15 [email protected] percent to 20 percent of its value. Production Specialist If those things weren’ t bad enough, newspapers report Nancy Guth [email protected] Let me know what’s economic slowdowns, business closings, and layoffs. on your mind: Vice President, Web Operations 904-567-1537 Recognizing you may be faced with tough times, we Manuel Lirio Fax: 904-285-9944 decided to explore ways in which you can recession- [email protected] [email protected] proof your practice. The experts with whom we talked Web Developer provided not only commonsense advice, but some thoughtful ideas. What they Juan Correa [email protected] told us can be summarized in two main themes: Circulation Manager • Cut expenses, and Darryl Arquitte • Diversify to increase revenues. [email protected] Following the lines of diversification, one piece of advice from Tom Dorr, the Accountant Harry M. Garrett director of a small-business development center, gave me pause because at first [email protected] blush, it seemed contrary to what many consultants and practitioners advocate: National Account Executives Jeff Pruitt, 904-567-1542 Answer our poll question: Has the slowing of the economy affected [email protected] your weekly patient visits? Go to www.ChiroEco.com to answer and Janice Ruddiman Long, 904-567-1541 see what your colleagues have to say. [email protected] Frank Weiner, 904-567-1540 Mr. Dorr recommended developing marketing strategies to increase the [email protected] number of insurance-paying patients. His logic: In recessionary times, people Advertising Coordinator have less discretionary money. Consequently, people who are covered by Hustin Wildman, 904-567-1543 [email protected] insurance are more likely to come in for treatment rather than people who Classifieds Account Executive have to dip into their pockets. Sidney Duncan III, 904-567-1547 Just as a financial portfolio should be balanced to ward off the effects of a [email protected] roller-coaster economy, so, perhaps, should your practice’ s patient roles. Many President/CEO businesses have discovered the benefits of a balanced and diversified customer Joseph D. Doyle [email protected] base the hard way. It’ s something to think about. Vice President, Business Development The article on recession-proofing your practice contains many other Kevin Noonan pragmatic suggestions and food-for-thought. I am confident you will take away [email protected] at least one idea that can help you survive and thrive in these troubled times. General Manager Kevin Lephart Until next time, [email protected]
Business & Editorial Offices 5150 Palm Valley Rd., Ste. 103 Ponte Vedra Beach, FL 32082 Linda Segall, Editor-in-Chief Phone: 904-285-6020, Fax: 904-285-9944 www.chiroeco.com We invite you to express your opinion on this or other articles. Founded 1954 E-mail your thoughts to [email protected] or fax them to 904-285-9944. William L. Luckey and Helen C. Luckey
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News Flash TOP STORIES Names Study: Imaging not helpful in the News in diagnosing neck pain SCU names new VPs Neck pain is a common ailment whose cause cannot be diagnosed by x-rays, Southern California University MRIs, or CAT scans. That was one of the findings of the Bone and Joint of Health Sciences (SCU) President Decade Neck-Pain Task Force, presented in a Webinar for chiropractic and Ronald Kraft, PhD, announced the medical-mainstream media by Scott Haldeman, DC, MD, PhD, FRCP, appointment of Regina E. Webster president of the task force. as the university’s vice president of institutional advancement and “ If insurance carriers accept the findings of the task force,” said Haldeman John Scaringe, DC, MS, DACBSP, in a question and answer period, “ they will be reluctant to pay for imaging vice president of academic affairs. unless the clinician can show risk factors.” Webster’s experience in The findings of the task force have been published in two major journals, advancement extends over 20 Spine and the European Spine Journal, whose combined circulation is more than years in both private and public 25,000, according to Haldeman. institutions. Scaringe previously In the Webinar, Haldeman reviewed the study’ s major findings: served as interim vice president of • Neck pain is a widespread experience; academic affairs at SCU. • Once neck pain occurs, it is persistent; Source: Southern California University of Health Sciences, www.scuhs.edu • No single cause of neck pain can be isolated even by imaging diagnostics; • Neck pain can be categorized into four grades, ranging from pain that DuBois named causes no interference of activities to serious pathology. Most neck pain falls to F4CP board into categories 1 and 2, said Haldeman. Chiropractic is one of the The Foundation for Chiropractic recommended treatments for this type of pain. Progress (F4CP) has appointed “ There is no best treatment for everyone — no magic bullet,” he said. But, Charlie DuBois, president of patients should be involved in their treatment, he said. “ When patients are Standard Process Inc., to its board allowed to choose options, they benefit more.” of directors. The Webinar was hosted by the Foundation for Chiropractic Progress, DuBois will participate in www.F4CP.com. overseeing the development and implementation of F4CP’s Source: Scott Haldeman, DC, MD, PhD, in a Webinar presented by the Foundation for Campaign for Chiropractic, a Chiropractic Progress (F4CP) campaign aimed at increasing May 23 marks required use public awareness and appreciation of the value of chiropractic care. of NPI on Medicare claims Source: Standard Process Inc., Effective May 23, 2008, all Medicare providers will be required to use only www.standardprocess.com their national provider identifier (NPI) number when filing Medicare claims. The reporting of Medicare legacy numbers after this date will result in claim Northwestern honors denial. From now until May 23, providers are encouraged to test their ability teachers, students to get paid using only their NPI number. Northwestern Health Sciences University honored its student The Centers for Medicare and Medicaid Services (CMS) recommends leaders and outstanding teachers sending one or two claims with only the NPI number and if those claims are during the Student Leadership paid, to continue to increase the volume of NPI-only claims. Awards Banquet March 20. If your CMS-1500 claims are rejected, you may first wish to visit the Students were recognized for National Plan and Provider Enumerator System (NPPES) Web site their participation in clubs and (https://nppes.cms.hhs.gov/NPPES) to make sure the information for your NPI organizations and their leadership is accurate. roles with the University’s Student If claims continue to be rejected, have a copy of your NPPES record in hand Senate. (available on the NPPES Web site) and contact your Medicare contractor. In addition to honoring Student ➤ CONTINUED ➤ NAMES CONTINUED ON PAGE 16
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News Flash
When submitting claims, make sure you pair your individual legacy number Visit us at... BIOFREEZE.COM with your individual NPI number and that claims submitted using your group Medicare number are paired with your group NPI. For more information, visit the CMS Web site at Pain relief www.cms.hhs.gov/NationalProvIdentStand. ® that works Source: Centers for Medicare and Medicaid Services, www.cms.hhs.gov DCs eligible for federal loan repayment program In a report to accompany legislation reauthorizing the National Health Service Corps (NHSC), the Senate Committee on Health, Education, Labor and Pensions made it clear that doctors of chiropractic are eligible to qualify for inclusion in the NHSC Loan Repayment program. “ For more than 35 years, doctors of chiropractic were excluded from the National Health Service Corps because we were not mentioned explicitly as eligible providers,” said ACA President Glenn Manceaux, DC. The report language accompanying bill S.901, supported by both the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC), becomes effective once the bill has been passed by the full Senate. S.901 has not yet been scheduled for further consideration. Source: American Chiropractic Association, www.acatoday.org Medicare changes maintenance-care billing Effective March 3, 2008, Medicare has changed the advanced-beneficiary notice (ABN) rules for both participating and nonparticipating doctors. The new rules no longer require billing on claim forms for chiropractic manipulative therapy maintenance-care services. Additionally, the ABN form has been revised, with a new title, “ Advance Visit us at... BIOFREEZE.COM Beneficiary Notice of Noncoverage.” Although the use of this new ABN form is not mandatory until September 2008, practices can begin using it now. Source: ChiroCode Institute, www.chirocode.com Pain relief that works ® ASSOCIATION NEWS Auction raises money for FCER The Foundation for Chiropractic Education and Research (FCER) is using e-Bay to help raise funds for its educational programs. According to Tom Blackett, FCER’s marketing director, a number of items were posted for auction on the online shopping site. “ FCER has been working on putting together an auction for a couple of years,” said Blackett. “ Over that time, a nice collection of items has been donated to help FCER raise funds for our educational and research programs.” Blackett explained that FCER is fortunate in receiving funds earmarked for specific purposes, such as its fellowship program. Each auction is scheduled to last seven days, the maximum time allowed on eBay. Future auctions are being planned and will be announced on the FCER Web site as well as by e-mail. He said the organization welcomes donations. Anyone interested in donating should contact him at 800-622-6309 or at [email protected]. Source: Foundation for Chiropractic Education and Research, www.fcer.org
The most news you can use is posted on Tuesdays and Thursdays at www.ChiroEco.com.
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WFC announces (2007), Sydney, Australia (2005), and Orlando, Florida (2003). This is the first WFC Congress in Canada since 10th Biennial Congress 1991 (Toronto). The World Federation of Chiropractic’ s (WFC) 10th For more information, visit www.wfc.org/congress2009 Biennial Congress, co-sponsored by the Canadian or call 416-484-9978. Chiropractic Association, will be held in Montreal, Source: World Federation of Chiropractic, www.wfc.org Quebec, Canada, April 30 – May 02, 2009. “ Celebrating Chiropractic in the 21st Century” will Advancing Chiropractic feature content on the science, philosophy, and art of seeks membership chiropractic, as well as seminars on the management of An organization launched in 2006 and aimed at seniors and youth, sports chiropractic, integration and advancing the cause of chiropractic has rededicated its collaboration, and new clinical research for practicing DCs. efforts to enlist support for its mission. Recent WFC’ s congresses have been in Portugal According to Skip George, DC, one of the founders of Advancing Chiropractic, the group has refined its mission statement and is now actively seeking support from like-minded chiropractors. “ It is time for chiropractic to stand on its own right and for the silent majority of chiropractors to voice their opinion,” George told Chiropractic Economics in an e-mail. “ This Web site [www.advancing chiropractic.com] is being developed for those chiropractors who want to practice within the core values of chiropractic as well as organizing every group throughout the world that still teach and promote the core values.” The organization wants to maintain and advance awareness of the harmful effects of vertebral subluxation within the colleges, chiropractic organizations, and the public. More information is available at the organization’ s Web site. Source: Advancing Chiropractic, www.advancingchiropractic.com
COLLEGE NEWS Logan adds partners to its ‘3+3’ program Logan College of Chiropractic has added three more “ 3+3” articulation partners as part of its program with four-year universities and colleges
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around the country. This year, slightly more than 50 percent of participants New agreements with Southwest Minnesota State indicated they have employee worksite wellness programs University in Marshall, Minn., Southern Indiana in place, and 53 percent of those participants not offering University in Evansville, Ind., and Northwest Missouri worksite wellness plans today indicated they are State University in Maryville, Mo., bring Logan’ s total considering such programs. articulation partnerships to 43 institutions in 22 states. Thirty-six percent, nearly triple last years’ 13 percent, The partnership allows participating students to enroll indicated they offer incentives to participate in their in the program as entering freshman or later. wellness programs. Exercise, smoking cessation, weight Source: Logan University, www.logan.edu management, and nutrition programs are among the most popular. Northwestern’s scholarship Source: Cowden Associates, www.cowdenassociates.com application goes online Northwestern Health Sciences University has placed INDUSTRY NEWS information and applications regarding most of its scholarships online to allow students easier access to ChiroTouch sponsors Resource Center educational assistance options. ChiroTouch, a technology-solutions provider, has The university began accepting online scholarship partnered with Chiropractic Economics magazine in the applications in January for select scholarships and has launch of a new resource center: Practice Management extended the program to most of its scholarships. Software, at www.ChiroEco.com/chirotouch. Source: Northwestern Health Sciences University, The resource center provides news, information, and www.nwhealth.edu tools for success with practice management software, including how-to articles and the latest news on the Palmer opens center topics of billing, electronic medical records, for business development documentation, paperless practices, accounting procedures, scheduling, and practice management. In The Palmer Center for Business Development opened 2008, site visitors will find streaming video, case studies, this spring on Palmer College of Chiropractic’ s campus in blogs, and white papers to support doctors of chiropractic Davenport, Iowa. in their use of practice management software. The center is designed to provide current students and new graduates with best practices in how to successfully run a business. The curriculum is free of charge to N8 Touch signs international franchisees students and alumni, and offers them a supplement to N8 Touch announced the signing of its first international what they learn in the classroom as part of the Doctor of contract — a master franchisee agreement with Drs. Andrew Chiropractic curriculum. Cameron and Mark Pierce of Golden Square, Australia, for Source: Palmer College of Chiropractic, www.palmer.edu the development of 100 N8 Touch franchises throughout the country over the course of the next seven years. HEALTH NEWS Source: N8 Touch, www.n8touch.com Companies shift to wellness NAMES CONTINUED FROM PAGE 10 to manage healthcare costs Senate and club leaders, three students were given Employers in Pennsylvania, West Virginia, and Ohio Student Leadership Hall of Fame awards and three believe the future of managing healthcare costs lies in faculty members were presented with Teacher of the helping their employees manage their health through Year awards. wellness programs, according to Cowden Associates Inc.’ s Recipients of the Student of the Year awards were Seventh Annual Tri-State Area Employee Benefit Survey. Amy Elizabeth, Chris Edwards, and Hua Yang. Teacher of “ Survey responses tell us that worksite wellness the Year awards went to Kashif Ahmad, PhD, MBBS, MS; Huan Ma, PhD, MMed (China), LAc; and Beth programs are the future of employee healthcare cost Burgan, MFA, MA, NCTMB. management. Employers are already looking toward the Source: Northwestern Health Sciences University, next generation of wellness to manage costs,” said www.nwhealth.edu Cowden Associates Executive Vice President Vince Wolf.
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Surviving and thriving in tough times How to recession-proof your practice
By Tammy Worth
e may not know for certain chiropractors funnel a large portion of their marketing funds into the Yellow Pages, Dorr says he knows few if the nation is yet facing people who choose a chiropractor by letting their fingers Wthe “ Big R” (recession), but do the walking. Be listed; just don’ t buy a quarter-page ad. there is little doubt we are in the midst Finally, Dorr recommends considering an outsourced billing service to reduce costs and improve cash flow. A of tough economic times. good billing service has a working relationship with And as individual discretionary incomes shrink, it is insurance companies; the service is accurate; insurance more important than ever for chiropractors to strengthen pays more quickly; and a chiropractor is more likely to their business and shore up their customer base. collect on insurance payments, Dorr says. Because the operations side of the practice is often not “ I can’ t tell you how many doctors leave money on the your area of expertise, this may seem like a daunting task. table if they don’ t bill correctly or accurately and have to But experts agree that with a little marketing knowledge rebill,” he adds. “ This hurts cash flow.” and a touch of business savvy, you can successfully weather the potentially rough and uncertain waters ahead. BE BUSINESS-MINDED “ The same things that make a practice successful also Employing a billing service can also allow you to can make it recession-proof,” says chiropractic financial replace some administrative staff, which can save money. consultant Stanley Greenfield. “ Just keep doing what Though cutting staff may not seem like a pleasant idea, a you did to build your practice and now do more of it. The recession is not the time to get too emotional about your ones who do this will continue to thrive, and when things company, according to Andrew Horowitz, owner of get better they will be the leaders of the pack.” Horowitz & Co. — a financial-planning and investment- advising firm based in Weston, Fla. KNOW THYSELF “ The fact is that by trimming the fat now, you can save One of the first things you should do is analyze your from big headaches later,” he says. “ If you can do with less finances. staff, do it. If you can postpone ordering supplies, do it.” “ A critical aspect to recession-proofing is to first do an Horowitz recommends reducing excess wherever internal audit of your existing business — from a financial possible. Things like water coolers, monthly coffee standpoint you need to know where money is coming contracts, and company luncheons can go. If possible, from and where it is going,” says Tom Dorr, director of the eliminate an unnecessary phone line or service, get an Western Washington University Small Business automatic thermostat for heating and cooling, and review Development Center in Bellingham, Wash. all vendor contracts for pricing and terms. Three major areas often put on autopilot are insurance, During this time it may be instinctual for you to let marketing, and billing. payments occasionally slide in order to keep customers. When it’ s time to renew insurance, shop around, don’ t Don’ t even think about it. just renew, Dorr advises. Understand the kind of coverage “ There is a tendency for businesses to start to allow for you need, know what your policy offers, and see where more and more ‘ credit’ to customers, but that will only you can get the best price and service. hurt the business,” says Horowitz. Next, check your marketing practices to be sure you are When cash is crunched, people quickly learn to juggle
getting a good return on your investment. Though many CONTINUED ➤
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their financial obligations and often MEET OUR EXPERTS pay the squeaky wheels first. Horowitz • Stanley Greenfield, RHU, registered financial consultant; says it is important to be under- www.stanleygreenfield.com; [email protected]; standing of client’ s financial difficulties while still being firm. Now • Andrew Horowitz, financial planner and investment advisor; is the time to shorten the period Horowitz and Company; www.horowitzandcompany.com; before actively pursuing late payments [email protected]; and be squeaky when necessary. • Tom Dorr, director of the Western Washington University Small Business Development Center; www.cbe.wwu.edu/SBDC; LOOK BEYOND [email protected]; and YOURSELF • Timothy Gay, DC, director; Ultimate Practice Systems; If business starts to slow, the staff www.ultimatepractice.com; [email protected]. will likely be worried about their jobs. Instead of keeping them in the dark about the business, get them involved. Make sure every team member understands the benefits of chiropractic and emphasize the financial implications of losing just one or two patients. Clue them in and allow them to help. “ Staff should be ever-present to dissention, disappointment, and patient concerns, and voice this to the chiropractor early on,” Horowitz says. “ Make sure staff is friendly and personally engaging with patients. This way, when a patient calls to cancel, the front line can discuss the advantages lost if they do not come in.” Employees can also help find ways to save money. Ask them to look at their daily tasks to find ways to make reductions and improvements. Allow them to assist with fashioning a more creative schedule when possible. Could there be days where they could cut back or shift their hours? Now might also be a good time to consider either bringing in a partner or renting space to another chiropractor, Horowitz suggests. Start by thinking of someone you have always wanted to partner with, or start spending more time with other chiropractors to see who else might be considering a merger. A young chiropractor might be
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DOLLARS AND SENSE
The most important financial preferably a liquid one, such as a step chiropractors can take to money market account. Greenfield weather a rough economic climate says that after seriously cutting is to have a strong cash position, back, most people can build a says Stanley Greenfield, RHU. reserve in just a few months. He recommends having an Once you fund your savings, “emergency opportunity fund” take a sheet of paper and draw a with a minimum of $10,000 — horizontal line in the middle. This enough to cover two months of line accounts for a 10 percent personal expenses and one month interest rate — the approximate of office expenses. current cost of borrowing money, The way to build this fund is to according to Greenfield. List cut back on excess spending, even above the line any outstanding toward current debt, such as debt greater than 10 percent and mortgages and student loans. below, any debt that is less. “In a lot of situations right Anything below the line is now, people think they need to cheap, anything above is inflated, start paying down debt, and that he says, adding that 70 percent of is not where they need to be; they people who call credit card need to be building a cash companies to get interest rates reserve,” Greenfield says. reduced are successful. So make “It is easy and achievable,” he First, analyze where your some calls. says. “Now is a time to panic for money is going and calculate your Finally, after funding savings the Chicken Littles of the world. minimum living expenses. Cut and reducing interest where But instead of screaming the sky is wherever it is feasible and stop possible, it is time to focus on falling, just make sure you have a paying excess on loans. Then eliminating the above-the-line good umbrella. And right now funnel extra cash in a stash, debt first. that umbrella is spelled c-a-s-h.”
willing to rent space for a period of insurance pay and what portion is a practice’ s clients should be on time while growing his or her private pay. Then develop marketing maintenance care, coming in for practice to help offset expenses. strategies to increase the number of visits anywhere from once a week to Horowitz cautions to seek them with insurance-paying patients, suggests once a month. If a practice has 1,200 “ an eye toward helping, not Dorr. patients and puts 10 percent on swallowing.” “ Say 40 percent is insurance and maintenance schedules, it could “ Cost savings through efficiencies 60 percent is private. You want to get equate to 120 regular office visits and reduction of overlapping that number to 50/50,” he says. each month. expenses may be just what the doctor “ Insurance payers are more likely to ordered,” he says. come during a recession rather than NEW HORIZONS someone having to dip into their Moving out of a comfort zone can A HOLISTIC APPROACH pocket every time.” also be a useful way to boost business. Once you have combed through “ I think one place where doctors “ For some, recession-proofing operations and found creative ways make a big mistake is they make starts by redefining the business,” to cut back, it is also important to short-term recommendations and Dorr says. “ If you open new doors for examine your services to see how don’ t talk about lifestyle or lifetime more services, you don’ t have to go your patients are using them and care,” says Timothy Gay, director of out and get more clients; you will how well you are marketing those Ultimate Practice in San Marco, just bring more needed services to services. Calif. existing clients.” The first thing to do is evaluate Gay recommends that somewhere By inspecting the range of services
what percentage of patients is between 7 percent and 10 percent of CONTINUED ➤
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sales of 2 percent to 3 percent of QUICK TIPS to recession-proof your practice total revenue. Practices that already sell products, but don’ t promote • Analyze finances, • Decrease inventory, them, should shoot for a goal of 5 • Cut excess costs, • Employ a billing service, percent to 8 percent. • Increase insurance-pay • Renegotiate contracts, and And practices that already sell steadily should increase their patients, • Market, market, market. product-revenue goals to 10 percent of total revenues. you provide and what your clients about supplements or pillows? Another area of expansion in are buying, you can close gaps Many chiropractors miss a huge chiropractic is performing blood tests between what they need and what opportunity for product sales, Dorr for food allergies, Dorr says. This is you offer. Do they get massages or notes. He recommends for a practice one good way chiropractors can take yoga classes elsewhere? What with no current product sales aim for interface with patient-care issues, get more mainstream, and “ add value beyond cracking bones.” “ Part of recession-proofing is being aware of the services you offer, who your clients are, and proactively reaching out to clients to get them to come more often,” he advises.
TO MARKET WE GO The last, but certainly not least, way to keep a good client base is through dedicated marketing efforts. There are both traditional and creative ways to make sure your name is on the minds of anyone needing chiropractic services. It is always easiest to start from within. Make sure you are proactively communicating with patients by ensuring they have appointments set up after each visit, and following up with postcards, e-mails, or newsletters. “ We dwell on the patients who don’ t come in, and we don’ t reward the ones who do,” says Gay. While treating patients who are regular clients, he says it is crucial not to forget “ those patients who are sitting on the shelf waiting to be recognized.” He recommends going through former patients’ files and contacting them on at least a bimonthly basis. Other forms of proactive marketing include developing a Web
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site, writing blogs, and using social HELP FOR SMALL-BUSINESS OWNERS media tools, such as Facebook or Reaching out for business assistance can play an important role in the MySpace. health of a chiropractic practice. Dorr said you can also position “Chiropractors go to school to become experts on how to perform yourself as an expert in the field by chiropractic services, not how to run a business,” said Tom Dorr, director of making speeches at service clubs or the Western Washington University Small Business Development Center. your local chamber of commerce, or To help grow and strengthen a practice, Dorr recommends seeking by putting together a newsletter on a assistance from the more than 1,100 small-business development specific subject such as good posture centers throughout the country. These centers provide free, confidential techniques. business counseling, training, research, and advice. For more It is also good practice to spend information on a location near you, visit the U.S. Small Business time with professional referral Administration’s Web site at www.sba.gov. sources, as the recession will most likely affect them as well. Horowitz recommends leading discussions and meetings in which the group brainstorms on creative ways to refer patients when appropriate. “ Make sure that the referral source knows you are in this together and you will work to help ensure that they come out stronger as well,” he adds.
KNOW YOUR VALUE During tough economic times, stress plays an even greater role in everyone’ s lives. To ensure your business and clientele remain healthy and strong, tend to both. “ Review the studies of the relationship of stress to health and longevity,” Horowitz says. “ Ensure that patients are keenly aware of this. “ If the outcome is to aid in mental clarity and a better life, why would they give up a core ingredient to that success? The chiropractor needs to be confident yet understanding, committed but flexible, and see beyond the short-term problems to the longer-term benefits.”
Tammy Worth is a freelance writer based in Kansas City, Mo. She specializes in business and healthcare subjects. She can be contacted at [email protected]. CIRCLE 167 FREE INFORMATION
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Which states require continuing education? s DCs look for convenient Mississippi, Oklahoma, Wisconsin, and Wyoming. States vary greatly in required CE credits. New Jersey, ways to fulfill their continuing for example, does not require any continuing education, Aeducation (CE) requirements, while Illinois requires the most with 150 hours every three the growth of online credit continues years. Some states, such as Missouri, accept online credits to rise to meet demand. only for pre-approved classes, so contact your state Thirty-eight states, along with Washington, D.C., and regulatory board for final approval before attending. Puerto Rico, now accept some form of online credit, while Below you’ ll find a directory of states with information 18 of these states allow DCs to complete all of their on how to contact the state regulatory boards, as well as required CE hours online. the status of online credit acceptance. States that do not accept online credits include For the most up-to-date information on states that California, Florida, Idaho, Indiana, Kentucky, Louisiana, accept online credits, go to www.ChiroEcoCE.com.
State Regulatory Board Hours Required Online Credits Accepted ALABAMA www.chiro.state.al.us • 205-755-8000 18 per year 6 hours ALASKA www.dced.state.ak.us/occ/pchi.htm • 907-465-2543 12 per year 8 hours ARIZONA www.azchiroboard.com • 602-864-5088 12 per year 12 hours ARKANSAS www.state.ar.us/asbce • 501-682-9015 12 per year out of state; 24 per year in state 12 hours CALIFORNIA www.chiro.ca.gov • 916-263-5355 12 per year 0 COLORADO www.dora.state.co.us/chiropractic • 303-894-7800 15 per year 10 hours CONNECTICUT www.state.ct.us/dph • 860-509-7603 48 per 2 years 48 hours DISTRICT OF COLUMBIA http://doh.dc.gov/index.asp • 202-727-1000 24 per 2 years 24 hours DELAWARE http://dpr.delaware.gov • 302-744-4500 24 per 2 years 12 hours FLORIDA www.doh.state.fl.us/mqa/chiro/chiro_home.html • 850-245-4355 40 per 2 years 0 GEORGIA www.sos.state.ga.us/plb/chiro • 478-207-1300 20 per year 20 hours HAWAII www.state.hi.us/dcca/pvl • 808-586-3000 20 per 2 years 20 hours IDAHO http://www.ibol.idaho.gov/chi.htm • 208-334-3233 12 per year 0 ILLINOIS www.dpr.state.il.us • 217-524-7534 150 per 3 years 150 hours
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State Regulatory Board Hours Required Online Credits Accepted INDIANA www.in.gov/pla • 317-233-4407 12 per year 0 IOWA www.idph.state.ia.us • 515-281-4416 60 per 2 years 36 hours KANSAS www.ksbha.org • 785-296-7413 50 per year 50 hours KENTUCKY http://kbce.ky.gov • 502-651-2522 12 per year 0 LOUISIANA www.lachiropracticboard.com • 225-765-2322 12 per year 0 MAINE www.maineprofessionalreg.org • 207-624-8600 48 per 2 years 12 hours MARYLAND www.mdchiro.org • 410-764-4726 48 per 2 years 48 hours MASSACHUSETTS www.state.ma.us/reg/boards/ch • 617-727-3093 12 per year 12 hours MICHIGAN www.michigan.gov/mdch • 517-335-0918 30 per 2 years 6 hours MINNESOTA www.mn-chiroboard.state.mn.us • 612-617-2222 20 per year 20 hours MISSISSIPPI www.mississippi.gov/index.jsp • 601-773-4433 12 per year 0 MISSOURI www.pr.mo.gov/chiropractors.asp • 573-751-2104 24 per year Specific courses are approved MONTANA www.discoveringmontana.com • 406-444-5433 12 per year 12 hours NEBRASKA www.hhs.state.ne.us • 402-471-2299 36 per 2 years 6 hours NEVADA www.chirobd.nv.gov • 775-688-1919 36 per year 36 hours NEW HAMPSHIRE Web site not available • 603-271-4560 20 per 2 years 5 hours NEW JERSEY www.state.nj.us/lps/ca/medical/chiropractic.htm • 973-504-6395 Not required Not required NEW MEXICO Web site not available • 505-476-7120 16 per year 16 hours NEW YORK www.op.nysed.gov • 518-474-3817 ext. 450 36 per 3 years 12 hours NORTH CAROLINA www.ncchiroboard.org • 704-793-1342 24 per year 12 hours NORTH DAKOTA www.governor.state.nd.us/boards • 701-352-1690 20 per year 20 hours OHIO www.state.oh.us/chr • 614-644-7032 24 per year 12 hours OKLAHOMA www.oklaosf.state.ok.us • 405-528-5505 16 per year 0 OREGON www.obce.state.or.us • 503-378-5816 20 per year 20 hours PENNSYLVANIA www.dos.state.pa.us/bpoa/site/default.asp • 717-783-7155 24 per 2 years 24 hours RHODE ISLAND www.health.state.ri.us/hsr/professions/index.php• 401-222-2827 60 per 3 years 30 hours SOUTH CAROLINA www.llr.state.sc.us/POL/Chiropractors • 803-896-4587 24 per 2 years 12 hours SOUTH DAKOTA www.state.sd.us/doh/chiropractic • 605-343-7440 40 per 2 years 40 hours TENNESSEE www.state.tn.us/health • 615-532-5096 24 per year 6 hours TEXAS www.tbce.state.tx.us • 512-305-6700 16 per year 6 hours UTAH www.dopl.utah.gov/licensing/chiropractic.html • 801-530-6633 40 per 2 years 10 hours VERMONT www.vtprofessionals.org • 802-828-2390 24 per 2 years 24 hours VIRGINIA www.dhp.state.va.us • 804-662-9927 60 per 2 years 60 hours WASHINGTON www.doh.wa.gov • 360-236-4869 25 per year 12 hours WEST VIRGINIA www.wvboc.com • 304-746-7839 18 per year 6 hours WISCONSIN www.drl.state.wi.us • 608-266-0145 40 per 2 years 0 WYOMING http://plboards.state.wy.us/chiropractic • 307-777-6529 12 per year 0 PUERTO RICO www.usscf.org/credentials/puertorico.pdf • 787-725-8161, ext. 2243 45 per 3 yrs 15 hrs
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PERSONAL DEVELOPMENT
Become a superachiever Follow these 10 tips to take your practice to new heights
By Danny Drubin, DC
ome people seem to have a the patient’ s experience. This kind of patient-centric thinking assures that each patient receives world-class golden personality. Or, at least it care by a world-class team on each visit. Swould seem so if you studied the By understanding the reality that 68 percent of all traits of individuals who have million- patients quit due to perceived indifference, they work diligently to exceed the needs of the patients that they dollar practices. serve. Do these individuals really have a secret in their smile? 2. Have clarity of vision. People who run high- Or, is their success due to something else? energy, high-volume businesses are crystal clear about As it turns out, their “ secret” is a “ whatever it takes” their business, and they know exactly what the business attitude — coupled with an understanding of the differences will look like in the future. among a practice, business, and an organization. They know the past is a place of reference, not Superachieving, million-dollar doctors place a high residence. This type of foresight keeps them on the value on the quality of their life and the time they spend cutting edge of change and consistently moving in the with family and friends. They pursue hobbies and passions direction of their vision. and maintain balance in all they do. They are limitless in their ability to think beyond the So, here is a “ top 10 list” of what superachievers do to existing and construct a plan of action that supports the reach great heights. These individuals: changes necessary to advance their business. 1. Put service first. Million-dollar practitioners 3. Lead with inspiration. They understand the quality understand the best way to achieve greatness is by helping of their team largely reflects the quality of their leadership. as many people as possible. Superachievers recognize their primary responsibility is Their organizations are service-oriented and focus the to hire the very best people for every position within the majority of their time, effort, and energy on the quality of organization. They know the success of the entire
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organization is only as good as the alter their decisions, their behavior lifelong learning. They read, listen weakest team member. will change and so will their carefully, are inventive, detect For that reason, they hire slow, fire outcomes. trends, and are open to new and fast, train with intensity, and retrain 5. Exude a passion for more creative ways of operating their constantly. By realizing that skills perfection. Superachievers business. and attitudes often erode in business, consistently strive for excellence in The thirst for knowledge becomes they make certain their team is held all they do. They know that little part of who they are and mostly they to a high level of both personal and things are the only things when it surround themselves with mentors, professional accountability. comes to building a world-class coaches, and support systems that 4. Are decision-driven. They organization. So, their attention to increase their likelihood of greatness. accept that a significant amount of every detail in every area of their 7. Cultivate a brain for energy is spent on the quality of the business is of paramount importance. business. High achievers make it decisions made to advance the They understand excellence does their business to learn about and business. not require a definition: They know study their business. They know their Decisive by nature, high achievers it when they see it. For that reason, overhead and the percentage of are fearless in the face of taking a their passion for perfection impacts overhead that is salaries. stance. They are practical in their every part of their personal and They know their practice statistics processing, seek the wisdom and professional life. and costs, and pay constant attention counsel of others, and then lead their 6. Are lifelong learners. By to the bottom line. They know their team in the direction of their vision. never accepting they know it all, cost per patient and base their fees They know the decisions they they are constantly seeking newer and services on what is acceptable in made up to this point in their lives and better ways of doing things. the marketplace, as well as what have created what they presently They never accept the status quo. makes sense in pure business terms. have and at the very moment they They have learned the lesson of They are innovative when it
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comes to adding services and are achievers embrace the power of Winning is their habit, and always mindful that to create an partnering. challenges are the things that build ever-expanding organization requires They expand their offices with character and strengthen them for them to outperform the competition. partners who have earned the the next worthy adventure. 8. Are marketing mavens. privilege to become equity owners in Clearly, a great many of you Million-dollar doctors recognize that the practice. already possess some of these “ all business is show business” and In addition, they become income characteristics or have observed the organization with the best show partners with their most loyal and them in others. Know for certain to usually wins. valued team members. what extent you are willing to alter They study the marketing habits They are generous with praise and who you are, how you think, and of Fortune 500 companies and adapt understand that a rising tide lifts all what you do. You can reinvent successful concepts to their business boats. So, when the business does yourself. And, in doing so, push models. Their company’ s marketing better, the people who contribute to yourself to great success. calendar is full, and they always that growth also reap the benefits balance internal and external and dividends of that growth. Danny Drubin, DC, founder marketing methods to drive the 10. Are solution-sighted. They and president of 4th business to its desired goal and see solutions to every challenge and Dimension Management beyond. refuse to buy into the limiting beliefs Corporation, is the author of Plain and simple, they understand of others. They understand that several publications including Letting Go marketing drives business, and it is creating a dynamic business is often of Your Bananas, (Warner Business everyone’ s responsibility to market. filled with problems that others Books, 2006). He can be reached at 520- 9. Build on the power of would think insurmountable and still 575-0207, by e-mail at partnering. To build a successful they persist unfazed in the direction [email protected], or through the and expansive organization, high of their dreams. Web site, www.masterofchange.net.
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5 leadership tactics assure a pivotal business year By Quint Studer
he year 2007 may seem like a behaviors that don’ t depend on particular individuals. distant memory, but look back This is evidence-based leadership which enables companies of all types to create results that last. Tat it anyway. If you feel a vague These practices are not complicated. They’ re simple, sense of discontent, take time now to commonsense tactics you can start doing right away. In fact, if you implement the following five ideas, you’ ll see focus on leadership — your leadership. dramatic changes in your practice by the end of this year. Solid business results that stand the test of time do so 1. Get rid of low performers. Now. Let’ s say employee for one reason and one reason only — consistently Carol consistently comes in late, gets “ headaches” every excellent leadership. Products and services change with other (nonpayday) Friday, and spends more time cheerily the demands of the market. Individual leaders come and chatting up co-workers than she does working. go. The key is to create an organizational culture that Others do notice — and they do become resentful. But ensures great leadership today and tomorrow. worse than merely causing contention in the ranks, In other words, you need a long-term fix — not a magic turning a blind eye to the “ Carols” in your organization bullet, trendy program du jour, or charismatic leader. You squelches profitability. Why? Because middle performers need a culture built on good, solid, time-tested leadership get pulled to the low-performer level, while high principles. performers either disengage or leave. Organizations should institute proven, across-the-board Too many of us give low performers a pass. The remedy
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involves implementing a structured employees, make a personal connec- is reduced by 66 percent. I suggest series of high-middle-low performer tion, recognize success, find out what’ s using a structured list of questions to conversations. It’ s easier not to going well, and determine what discover not only what’ s not going confront low performers, but until improvements can be made. Rounding well, but also what is going well. You you move them up or out, your is the heart and soul of building an can be certain your new employee is practice will never advance beyond emotional bank account with your comparing her first few weeks of short-term gains. The low performer employees because it shows them day work with your company to her last is an anchor holding everyone else in and day out that you care. week at her previous job — which back. Quit looking the other way. 4. Say thanks. In fact, write was filled with well wishes, tearful 2. Accentuate the positive. The thank-you notes to employees who good-byes, and probably a going- next time you’ re having lunch in a do an excellent job. away party. restaurant, listen to nearby conversa- A thank-you note is a powerful Clearly, your company will get the tions. You will probably hear people tool. People love receiving thank-you short end of an unfavorable griping about workloads, difficult notes. They cherish them. comparison. These meetings will clients, annoying co-workers, or the The best thank-you notes are: help you shore up an otherwise ridiculousness of corporate policy. • Specific, not general. A thank- tenuous relationship. Everyone does it, but perhaps you note that focuses on something Once you start implementing they’ d think twice if they realized specific the recipient has done is far these tactics, results quickly follow. how harmful it is to their company. more effective than one that reads, Your employees will see you care
Evidence-based leadership enables businesses of all types to create results that last.
The solution is to hone the fine art “ Hey, nice job!” about them, which boosts morale, of managing up. • Handwritten, if possible. Most which improves performance, which Managing up means you position people would rather receive a three- leads to happier customers, which your people, products, or company in sentence, handwritten note than a leads to higher profits. a positive light. Managing up doesn’ t two-page, typed letter. It’ s more When things aren’ t going so well, just happen; you have to make it authentic and special. a lot of leaders panic and start doing happen in a systematic way. Help • Sent to the employee’s home. things that make employees less employees understand what can When an employee receives a thank- satisfied. Don’ t make that mistake. happen when negativity is allowed to you note at home, it feels more Your job as a leader is to create breed — good people quit and personal than one laid on her desk happy, loyal, productive employees. patients leave — and they’ ll be more along with a stack of reports and They, in turn, will create happy, likely to stop doing it. memos. loyal, profitable customers. 3. Make a real connection with 5. Don’t just recruit great They are two sides of the same employees — every day. Medical employees. Re-recruit them. coin — and that coin is the currency doctors make daily rounds. Start More than 25 percent of that buys you results that last. making rounds in your office to see employees who leave positions do so the outcomes you are looking for. in the first 90 days of employment. Quint Studer, a former hospital Rounding helps you communicate To retain a new team member, the president, is founder and CEO openly with your employees, allowing leader needs to build a relationship. of Studer Group, you to find out what is and isn’ t Scheduling one-on-one meetings — headquartered in Gulf Breeze, going well for them. But remember, the first at 30 days and the second at Fla. He is also the author of Results That it’ s not just empty “ face time” — it’ s 90 days — has enormous impact on Last: Hardwiring Behaviors That Will Take rounding for outcomes, which means retention that directly turns into Your Company to the Top (Wiley, 2007). the process has a serious purpose. savings for your organization. He can be contacted by e-mail at To round for outcomes, take an If these meetings are handled [email protected] or through his hour a day to touch base with successfully, new-employee turnover Web site, www.studergroup.com.
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Listen for success By Perry Nickelston, DC
ale Carnegie, author of How to don’ t care how much you know until they know how much you care.” Win Friends and Influence Take time to listen as a person, not just as a doctor. DPeople, wrote, “ You can make Effective listening requires more than hearing words. It more friends in two weeks by requires you to find meaning and understanding in what the person is saying. Meanings are not in words, but in becoming a good listener than you can people. Put yourself in the other person’ s place and your in two years by trying to get other ability to understand will increase. 2. Look at the speaker. This means make eye contact. people interested in you.” Listening begins with giving the speaker your undivided Carnegie recognized that people who are self-absorbed attention. and talk about themselves all the time rarely develop During a conversation, make sure you have PTC strong relationships with others. Your success as a doctor, (present-time consciousness). In other words, keep your business person, and thoughts focused on the entrepreneur depends on speaker. Don’ t do anything to your ability to establish Jump start distract you from actively relationships. It is essential Here is a quick start for improved communication: listening, such as catching up you understand the Spend one hour this week talking with the most on other work or taking notes. importance of listening and important person in your life and give that person And if you don’ t have the your undivided attention. Spend two-thirds of the develop this skill to time at the moment, then time just listening. maximize the impact of your schedule a time when you Watch what happens! communication style. can give the speaker your full Successful people attention. A person forms a understand the value of becoming a good listener. To be a first impression of you within 10 seconds, so you have one good listener, you have to want to hear. But you also need opportunity to get it right. some skills to help you. 3. Stay quiet. Don’ t be quick to jump in with a Here are five strategies to help you become a better response. Don’ t interrupt. Let the speaker finish before listener. you reply. There is nothing wrong with having a moment 1. Listen to understand. When you don’ t pay of silence before you talk. attention to what others have to say, you communicate Silence will give you a chance to reflect on what’ s you don’ t value them. being said so you can respond appropriately. Don’ t feel But when you listen, you communicate you respect one of you has to be speaking all the time. Silence can be them and show them you care. Zig Ziglar said, “ People an extremely powerful communication tool in business.
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Most people feel very uncomfortable with silence. speaker talks with his hands, do the same. Never mock The one who speaks last holds all the power in a the speaker; merely assume the same language. conversation. This comes in handy during a report of Make listening a priority, no matter how busy you findings. Next time you give a report, simply state the become. Many people take for granted the ability to amount of care required and stop talking. Wait for the listen. Most people consider listening to be easy, and they patient to reply first, no matter how long it takes. You will view themselves as pretty good listeners. see a greater increase in patient compliance. Although it’ s true most people are able to hear, few are 4. Summarize. Listening is more effective when it’ s capable of really listening. Take time to develop this skill active. A technique for active listening is to summarize at and the results will be astoundingly powerful. intervals what the other person says. As a speaker finishes one subject, paraphrase the main points or ideas before Perry Nickelston, DC, is vice president of practice going on to the next one, and verify that you have gotten development for K-laser USA. He can be reached at the right message. 866-595-7749, ext. 102, or through the Web site, Say, for example: “ So, Ms. Smith, let me review to make www.k-laserusa.com. sure I understand you correctly.” This is a powerful technique that lets the patient know you are really listening. After a patient history evaluation, take a moment to summarize exactly what the patient said about his condition. Patients want to know you are listening, but unfortunately many doctors don’ t. This is an extraordinary rapport-building skill to implement. 5. Respond verbally and nonverbally. A good listener stops talking and uses receptive language instead. Follow and encourage your speaker’ s thoughts with such words and phrases as “ I see . . . uh huh . . . oh really.” Doing this forces you to react to the ideas presented, rather than to the person. If you really want to listen, you will act like a good listener. Good listeners speak body language. The best technique is to “ mirror” the speaker by assuming the same body language and conversational tone he or she is presenting. You need to be a bit of an actor. Mirroring the person’ s tonality, sounding like she sounds, makes her feel comfortable. If she talks fast, you talk fast. If she talks slowly, you talk slowly. You can strengthen the bond by using the same words the speaker uses. For example: If he uses the term “ popping sound,” be sure to begin saying “ popping sound.” If the CIRCLE 166 FREE INFORMATION
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PRACTICE MANAGEMENT
A solution for your employees’ healthcare needs? By Matthew S. Clement
t’s a puzzling trend to say the least: minimum high deductible for annual healthcare expenses is $1,100, and the maximum is $5,600. (Family In clear disregard of the “ reversion deductibles are twice the individuals.) to the mean” principle, increases in The costs of prescriptions, physician appointments, I surgical, and hospital stays go toward meeting the health-insurance premiums don’t seem deductible amount. Preventive care (well-care, as it is to be moderating — at least not in any often called) is the notable exception, and is covered meaningful way. immediately. This is known as first-dollar coverage. The majority of carriers currently do not cover Chronic illness and high utilization seem to be two chiropractic care under well-care provisions. primary and closely related culprits for this phenomenon: When a covered employee’ s expenses reach the amount The average American waits until his symptoms literally of the annual deductible, the insurance goes into effect stop him in his tracks. He then spends the next five to 15 and covers 100 percent (or close to 100 percent, expensive years attempting to fix it. depending upon the policy) of all additional claims for the A third likely culprit is a lack of financial incentives to year. (Prescriptions, however, still have a co-pay.) remain healthy. The American healthcare system makes it Expenses incurred under an HDHP may be funded either difficult — almost impossible — to see a chiropractor, by cash (after-tax), a health savings account (HSA, which nutritionist, exercise physiologist, or dentist to stay can be funded by pre-tax dollars by the employee, employer, healthy. Yet, at the first sign of a critical problem, the or combination), or health reimbursement arrangements system pays for the Ritz-Carlton of diagnostics and (HRA, paid for by the employer with before-tax dollars). treatment — all after the fact. An HSA or HRA is an instrument of payment and is A solution to this problem was introduced a few years not required for an HDHP, although an HDHP is required ago — high-deductible health plans (HDHP). (by the IRS) before an HSA or HRA can be established. HSAs may be funded in advance or as needed by the HOW HDHPS WORK employer or employee — up to $2,900 per year for a single In an HDHP, the employer and/or employee bear the employee or up to $5,800 per year for family coverage. responsibility each year of meeting a high deductible Coverage must be equal among employees. before benefits kick in. The amount of deductible depends HRAs are funded only as needed and only by the upon the plan selected. For an individual employee, the employer, and equal coverage rules apply here as well.
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Your employee benefits adviser employees can use as needed. can walk you through scenarios • Control of care. Philosophically, showing who, what, and how the HDHPs put control of care back on HSA and HRA can operate relative employees. Employees have the to cost controls. (Generally, when an account to use (and can also employer uses an HRA, it is with the contribute to it with pre-tax dollars) understanding that employees will on any type of healthcare need — pay a portion or all of the plan’ s from prescriptions, to office visits, to monthly premiums. HRAs are procedures that all go toward their especially helpful to offset expenses deductible. when employees purchase individual • Portability. Employees can take healthcare policies instead of the the account with them if they leave employer providing group coverage.) your company. The money in the Remember, though, that premiums account belongs to them, and the for HDHPs are 30 percent to 50 account is fully portable. percent lower than for traditional • Earned interest. If they have plans. no medical expenses, the balance in When an HSA is utilized, the the HSA earns interest and may employer will typically pay for some even serve as a supplemental or the entire premium of the high- retirement-savings vehicle. deductible policy, and may also agree Therefore, an HDHP serves as a to fund some or all of the HSA. financial incentive to stay well. Ultimately, the HSA is owned by the employee and goes with the LIMITATIONS employee if he leaves the company. HDHPs do have some limitations. Many physicians are opposed to KEY BENEFITS OF AN HDHP them because these plans place their HDHPs offer employers and fees under greater scrutiny. employees a number of benefits: Pharmaceutical companies do not • Lower costs. Instead of paying like them because small co-pays in advance for coverage the create a reliance on “ lifestyle” drugs. employee may not utilize, you pay for And employees are concerned coverage for so-called catastrophic because they are unaccustomed to events only. The word “ catastrophic” playing such an active role in their is misleading, however, since healthcare decisions. deductibles for families can be as low If HDHPs are explained properly, as $2,200. The cost of catastrophic however, employees get excited that coverage is considerably less than by managing their health they should traditional plans. expect to save money over the Employees file fewer claims when alternative of higher premiums. they have HDHPs than with traditional health insurance, so Matthew S. Clement is a administrative costs are lower for financial planner and employee insurance carriers. Those lower costs benefits adviser in Rockland are reflected in lower premiums. County in New York. He may • More help for employees. be reached at 845-942-8578 or by e-mail Because you save by paying only for at [email protected]. catastrophic coverage, you may choose to take the balance of what Want more information you would have paid and put it into on HDHPs? Go to an HSA for employees, which your www.ChiroEco.com/hdhp. CIRCLE 170 FREE INFORMATION
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PRACTICE MANAGEMENT CODING QUESTIONS Participating provider or nonparticipating provider? By Marty Kotlar, DC, CHCC, CBCS
I received my National Provider Identifier (NPI) nonparticipating amount; and number and want to start seeing Medicare • Medigap information is transferred. Q patients, but I have to decide between being a participating provider or nonparticipating provider within NONPARTICIPATING PROVIDERS the Medicare program. What do you recommend? Medicare nonparticipating providers are those who have not entered into an agreement to accept assignment You will need to decide what’ s best for your on all Medicare claims. They: particular situation after reviewing the differences • Can elect to accept assignment or not accept A between being a participating and assignment on a claim-by-claim basis; and nonparticipating provider — keeping in mind that • Cannot bill the patient more than the limiting participating and nonparticipating providers must follow charge on nonassigned claims. the same rules and regulations as it pertains to proper and Additionally, if you are a nonparticipating provider, you compliant documentation. understand that: For example: Medicare participating and • The beneficiary receives payment on nonassigned nonparticipating providers need to establish the existence claims; of spinal subluxation through the P.A.R.T. exam or x-rays, • Mandatory claims submission applies; understand the AT, GA, GP, GY, and GZ modifiers create • Clinical laboratory services, drugs, and biologicals treatment plans with specific treatment goals, choose must be billed as assigned;. compliant CPT/ICD-9 codes, know when and how to • The approved amount is 5 percent less than incorporate the ABN form, and know how to document participating — even if assignment is accepted on the initial and subsequent visits properly. the claim; and • Medigap information is not typically transferred. TO PARTICIPATE A Medicare participating provider is one who FINANCIAL SCENARIOS voluntarily and in advance enters into an agreement in Typically, three types of financial arrangements can writing to provide all covered services for all Medicare occur with Medicare patients: Part B beneficiaries on an assigned basis. A participating 1. As a participating provider; provider: 2. As a nonparticipating provider not accepting • Agrees to accept Medicare-approved amount as assignment; and payment in full; and 3. As a nonparticipating provider accepting assignment. • May not collect more than the applicable deductible Here is a sample Medicare fee schedule and your fee for and coinsurance for covered services from the CPT code 98940: patient. Payment for noncovered services may also be Your regular fee: $35.00 collected. Par fee allowance (PFA): $32.00 Additionally, Medicare providers understand that: Nonpar fee allowance: $30.00 • Charges are not subject to the limiting charge; Limiting charge fee: $34.00 • Medicare payment is paid directly to the provider; 1. As a participating provider. As a participating • Mandatory claims submission applies; provider, your PFA is $32. Provided the deductible has • Their name appears in the directory of participating been met, the patient is responsible to pay you 20 percent providers (MEDPARD); of the PFA, which is $6.40. • Reimbursement is 5 percent higher than the You bill Medicare $35 (your regular fee). Medicare will
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pay you $25.60, which is 80 percent of the PFA ($32). $25.60 + $6.40 = $32.00. The difference between your regular fee and the PFA is $3.00, which needs to be written off. 2. A nonparticipating provider not accepting assignment. If you are a nonparticipating provider who is not willing to accept assignment, the patient is responsible to pay you the limiting charge fee of $34. You cannot accept your regular fee of $35, even though you are nonparticipating. You bill Medicare the limiting charge of $34. Medicare will reimburse the patient $24, which is 80 percent of the nonpar fee allowance (provided the deductible has been met). 3. A nonparticipating provider accepting assignment. If you are a nonparticipating provider who is willing to accept assignment, the patient is responsible to pay you 20 percent of the nonpar fee allowance ($30), which is $6. You bill Medicare $30. Medicare will reimburse you $24, which is 80 percent of the nonpar fee allowance (provided the deductible has been met). Just a side note, at the present time DCs cannot “ opt-out” of the Medicare program — so if you choose to treat Medicare patients, then you must follow the above rules.
Marty Kotlar, DC, CHCC, CBCS, is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, at [email protected], or through www.TargetCoding.com.
Be the first to learn about changes in Medicare- documentation requirements. Subscribe to ChiroEco Newsflash. Go to www.ChiroEco.com. CIRCLE 290 FREE INFORMATION
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PRACTICE MANAGEMENT SUCCESS FILE Rx for presenteeism By Bob Levoy
t’s a problem more disruptive and on patient services. Cross-training has other benefits, too: costly than absenteeism. It’s called • It allows employees to gain additional skills — I“ presenteeism” — a phenomenon increasing their job satisfaction and earning in which contagiously sick employees potential; • It enables employees to fill in for each other during show up for work. lunch, vacation, or other absences; and Employees who think they are doing their employers a • It improves morale by breaking up routine. favor by showing up for work when they really aren’ t up to “ Cross-training is a quality-improvement tool,” says the task need to think twice. One reason is the lost Chris Kelleher, administrator of a one-physician OB/GYN productivity that occurs when employees come to work practice in Columbia, S.C. “ When one employee sits in but perform below par because of illness. Another more for another, there’ s a fresh mind in that job. We get many serious problem is that while doing their best to stay on ideas and suggestions from cross-trained people, such as the job, contagious employees frequently infect co-workers how to do a job more efficiently.” — not to mention, patients. “ It uncovers hidden talents,” says Helena Dahan, office At times, you see obviously sick employees who cough manager for a four-physician internal medicine practice in and sneeze and pile mounds of used tissues in their Philadelphia. “ Someone who’ s hired as a receptionist wastebaskets responding, “ I’ m fine” when people inquire might find she has a knack for coding, or a biller might about their health. Who are they kidding? turn out to be a crackerjack medical assistant. The more a According to a recent Harris Interactive survey, 56 staffer learns, the more she’ s worth as an employee.” percent of employers report that presenteeism is a problem • It eliminates “ It’ s not my job” thinking among in their organization, up from 39 percent two years earlier. employees; and The reasons that sick employees push themselves to go to • It promotes teamwork. Cross-trained employees gain work are varied. an understanding of other jobs in the practice. As a Dedicated employees don’ t want to let their employer result, they better appreciate the difficulties and or co-workers down, knowing how important they are to demands of their co-workers’ jobs — thus helping to the smooth functioning of the practice. Others are promote teamwork. concerned about missing a day’ s pay or incentive programs Reality check: Cross-training is not for everyone. You that encourage perfect attendance. Some want to avoid can train clinical employees to do clerical jobs, for the guilty feeling many employees have (or are made to example, but the process doesn’ t necessarily work in have) about calling in sick. reverse. Action steps: A 2005 CCH (Commerce Clearing “ We cross-train every position except those that are House) survey asked employers what they are doing to either regulated or license-restricted,” says Kelleher. reduce presenteeism. Consider also that some employees may not have the Sixty-two percent of responding organizations said they temperament or motivation for cross-training. Forcing the send sick employees home; 41 percent educate employees issue may cause resentment. on the importance of staying home when sick; and 36 Hard-learned lesson: Cross-training starts with hiring percent try to foster a culture that discourages sick the right people, those who can multitask, want to learn employees from coming to work. new skills, and can shift gears when needed. If you implement policies such as these, your office undoubtedly will be understaffed and shorthanded at Bob Levoy’s newest book, 222 Secrets of Hiring, times. Cross-training is one solution. If your team is cross- Managing, and Retaining Great Employees in trained, you can quickly fill critical gaps without calling in Healthcare Practices,is published by Jones and Bartlett temporary workers, running up overtime costs, or stinting Publishers. He can be reached at [email protected].
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MARKETING Compliant documentation: A way to acquire new patients By Ted A. Arkfeld, DC
ompliant documentation can and all re-evaluation reports, including the discharge examination report approximately six weeks later. help you acquire patients. To In succeeding months, other medical providers from illustrate, here is a true story: various specialties began making referrals. C What caused the change in medical-doctor behavior? Approximately six years ago, I relocated from Phoenix Compliant documentation — concise, complete, legible to a small northern Michigan town with a population of documentation written in language the medical about 5,000. During my first few weeks of practice, I sent community uses and understands. an introductory letter describing my credentials to every MDs are used to reading E/M initial and re-evaluation family practitioner and specialist in town and the reports from other providers. They are especially surrounding communities. The letter accustomed to seeing orthopedic and was also an invitation to lunch for a neurological reports, along with personal meeting. physical-therapy notes. Days turned into months without Since chiropractors do orthopedic any replies. The other chiropractor and neurological tests on patients, it who had been in practice in this small makes sense to use language MDs feel town for more than 20 years told me, comfortable reading. “ None of the medical providers in this To get referrals from MDs, follow town want to meet with a these steps: chiropractor, and they definitely are 1. Take a good initial exam. This not going to be referring patients.” exam should include four When I practiced in Phoenix, I components: enjoyed excellent relationships with • A history. This should include the medical doctors from all specialties. onset, mechanism of injury (if So, I decided to try a different tactic possible), and chief complaint. Include in my new Michigan community. a review of problem-pertinent The next week, I asked every symptoms, past medical history patient who came to my clinic for his (surgeries, fractures, traumas, and or her primary-care physician’ s name serious illnesses), and family history. and address. Then, when I did a re-evaluation of a • Detailed documentation. The exam should describe the patient, I sent a copy of my report to the patient’ s medical results of various orthopedic and neurological provider. examinations. (Note positive as well as negative results.) I followed this procedure with every new patient who • An assessment of the current phase of healing. This came to the clinic. Two months later, I received a phone assessment would be acute, subacute, chronic, call from the only physiatrist in town. He asked if I would exacerbation of an acute or chronic condition, or an take a referral from him on a difficult case of unknown aggravation of an acute or chronic condition. muscle pathology. I stated it would be a pleasure to take • Plan of treatment. The plan should clearly detail on such a challenging case and I would be in constant frequency and type of treatment, along with short- and contact with him. long-term goals. The case turned out to be multiple thoracic 2. Use correct codes. Invest in an AMA CPT code subluxations with myofascial trigger points. I sent the book. referring doctor a copy of the initial evaluation summary 3. Use language MDs accept and understand. In
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MARKETING
your initial reports, do not write a you to abandon your chiropractic In the long run, it will build long dissertation on chiropractic philosophy. Instead, it breaks down strong relationships that can provide philosophy. barriers to receiving referrals from long-term sources of referrals. Consider not using the word the medical community so you can subluxation in your spinal palpation help many more people. Ted A. Arkfeld, DC, MS, CICE, findings. 4. Keep the patient’s MD up-to- DABFE, CPC, is the president A subluxation to a medical doctor date. With the patient’ s permission, of Advanced Compliance is one step below a dislocation, and send reports of re-evaluations and Technologies PLLC, to document subluxations would results. (www.arkfeldcompliance.com), a create confusion on what exactly you Providing feedback to medical consulting firm specializing in compliance were palpating. doctors is not going to be a quick fix programs, billing, coding, and proper Instead, use such verbiage as to acquire new patients. It is a documentation. He can be reached at fixation or segmental dysfunction. process that requires communicating 989-614-0261 or by e-mail at Using such language does not cause effectively through documentation. [email protected].
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MEDIA REVIEW
FROM THE CHIROPRACTIC LIBRARY New book titles for a professional edge By Wendy Bautista
aintaining a professional the chiropractic profession to submit their latest books for our review. edge should always be in the Please keep in mind that the information on these Mforefront of your continuing books has been provided by the authors and that the chiropractic education. information provided by Chiropractic Economics about these publications does not constitute or imply endorsement, One way to accomplish this is to read what other chiro- recommendation, or favoring by Chiropractic Economics. practors and those close to the profession are writing about. Here are the latest offerings presented in alphabetical Chiropractic Economics invited those from in and around order by book title.
The Activator Method, Second Healthy Eating the Low-Fat Way Edition by Arlan W. Fuhr, DC. by Anthony Parkinson, DC. Paperback, Hardcover, 565 pages. 180 pages. From basic scan protocols to Healthy Eating the Low-Fat Way provides advanced assessment procedures, The a variety of low-fat recipes that are Activator Method is written to enhance generally simple, easy to prepare, and well your skills and be a comprehensive written. This all-encompassing, low-fat resource in an easy-to-understand, cookbook contains recipes that utilize fresh ingredients, how-to approach to this technique. This second edition all with fairly fast cooking times. It also includes an covers all aspects of this controlled, low-force analytical introduction that discusses the difference between good and adjusting system, including the history of the and bad fats, tips on how to lose fat, and ideas on diet and technique, in-depth examinations of the body structures, nutrition. and much more. Available through Lulu, www.lulu.com. Published by Mosby Elsevier, www.elsevierhealth.com.
The Layman’s Guide to Smoking Basic Body Detoxification and Cessation by Anthony Parkinson, DC. Cleansing by Anthony Parkinson, DC. Paperback, 151 pages. Paperback, 41 pages. A comprehensive guide and This 41-page book aims to answer the motivational tool, this book is designed for who, what, when, where, why, and how those desiring to become tobacco free and questions of basic body detoxification and remain that way, as well as for those who cleansing. From a chapter on who is best wish to help others quit. The Layman’s Guide to Smoking suited for detoxification to when is the best time to Cessation does not use scare tactics, but rather discusses the cleanse and detoxify, this book guides you through the reasons why people think they smoke, why those reasons process and includes a sample year-long detox program are false, the reasons why people really smoke, and how and a listing of cleansing herbs. those reasons can be relatively easy to overcome. Available through Lulu, www.lulu.com. Available through Lulu, www.lulu.com.
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MEDIA REVIEW
BOOKS WRITTEN BY FRIENDS OF DCs
Communicating Credibility With Your Grow Now: 8 Essential Steps to Flex White Papers by Alicejane Lippner, MD, Your Leadership Muscles by Jim Welch. JD. Paperback, 74 pages. Hardcover, 207 pages. Offering step-by-step guidance on how Written to show you how to flex your to quickly and easily create white papers business-leadership muscles (without that work, Communicating Credibility With Your White intimidating) to promote a culture of Papers will help you write white papers that will perpetual growth, this book covers such topics as the showcase your expertise, enhance your image and eight C’s of the practical growth leader, staff retention, reputation as an industry leader, attract clients, and and the five keys to realistically and objectively assess build your business. It will help you capture your your company’s growth potential. The end of each concept, make your white papers unique, create chapter also offers a “hurdle test” to ensure thorough content that educates and informs, and show you how understanding of the concepts presented, and a 90-day to effectively use white papers to promote your plan to implement all of the elements. business and professional practice. Published by Henchard Press, an imprint of Indigo Available through Infobriefings LLC, Custom Publishing, www.indigopublishing.com. www.communicatingcredibility.com. Herb, Nutrient, and Drug Interactions: Computer Security Basics, Second Edition Clinical Implications and Therapeutic by Rick Lehtinen. Paperback, 310 pages. Strategies by Mitchell Bebel Stargrove, This new edition describes such ND, LAc; Jonathan Treasure, MA, complicated concepts as trusted systems, MNIMH, RH, (AHG); and Dwight L. encryption, and mandatory access control McKee, MD. Paperback, 932 pages. in simple terms. It tells you what you need to know to This resource presents detailed, evidence-based understand the basics of computer security, and it will coverage of the most commonly encountered thera- help you persuade your employees to practice safe peutic agents in modern clinical practice so you can computing. Computer Security Basics 2nd Edition understand herb-drug and nutrient-drug interactions to offers a clear overview of the security concepts you ensure patient safety and enhance clinical outcomes. need to know, including access controls, malicious Herb, Nutrient, and Drug Interactions features software, security policy, wireless network security, comprehensive clinical data to help you develop safe, Web attacks, as well as government regulations and individualized treatment strategies for your patients. standards. References are also included on the bound-in CD. Published by O’Reilly, www.oreilly.com. Published by Mosby Elsevier, www.elsevierhealth.com.
For Doctors Only: A Guide to Working Practicing Profitability: Billing Network Less & Building More by Christopher R. Effect for Revenue Cycle Control in a Jarvis, MBA; David B. Mandell, JD, MBA; Paperless Healthcare Clinic and Jason M. O’Dell, CWP; and Claudio A. Chiropractic Office by Yuval Lirov, PhD. DeVellis, JD, CPA. Paperback, 340 pages. Paperback, 220 pages. For Doctors Only teaches how to Subtitled Collections, Audit Risk, SOAP practice efficiently to get more out of a practice. It Notes, Scheduling, Care Plans, and Coding, this book shows how to protect personal and practice assets helps owners of healthcare offices understand the from lawsuits, taxes, and bad investments while rules of the modern “payer-provider conflict” so they revealing the secrets to building wealth through the can improve billing and reduce audit risk. It also leverage of people, assets, and effort. This book is a touches on modern medical or chiropractic office guide to domestic and offshore asset-protection tools; management software — including workflow, tax-saving vehicles; captive insurance companies; reporting, outsourcing, coding, billing, collections, retirement, practice, estate, and insurance planning; HIPAA compliance, and audit risk management. and investing for physicians. Published by Affinity Billing Inc., Published by Guardian Publishing, 800-554-7233. www.affinitybilling.com.
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MEDIA REVIEW
CONTINUED FROM PAGE 57
Marketing Chiropractic to Medical Practices by Christina Acampora, DC. Paperback, 325 pages. Marketing Chiropractic to Medical Practices leads chiropractors through a comprehensive sales model to demonstrate how to educate the medical profession on utilizing chiropractic services for their patients. This book offers a step-by-step approach to secure medical referrals and develop ongoing professional relationships. It also helps you identify key promotional features of chiropractic services, the strengths and weaknesses of the competition, what physicians want to learn about chiropractic services, and how to modify your promotional approach based on a physician’ s personality. Published by Jones and Bartlett Publishers, www.jbpub.com.
Precision Adjusting For The Master Chiropractor by Eugene Charles, DC, DIBAK. Paperback, 93 pages. Allowing the doctor to return to his or her office and treat spinal subluxations with greater precision is the goal of this book and the seminar based on it. Included in this book is a chiropractic training program with exercises and speed drills to refine psychomotor skills, and a precision spinal adjusting program with specific instructions and pictures on how to perform each adjustment. A DVD is also available. Available through Charles Seminars Inc., www.charlesseminars.com.
Stand Taller~Live Longer: An Anti- Aging Strategy by Steven P. Weiniger, DC. Paperback, 231 pages. This book focuses on the biomechanical benefits of posture exercise as an anti-aging strategy, while incorporating chiropractic as an intelligent habit to keep people moving well. Subtitled 10 Minutes a Day to Keep Your Body Active and Pain-Free, it is written to show how just 10 minutes a day can make a difference not only in how the body moves today, but also how it will move in 20, 30, and even 40 years from now. Available through BodyZone LLC, www.standtallerlivelonger.com. CIRCLE 104 FREE INFORMATION
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Strategic Planning for the Chiropractic Practice by Michael R. Wiles, BS, MEd, DC. Paperback, 154 pages. Strategic Planning for the Chiropractic Practice is written to provide “ 18 step-by- step exercises to create a professional strategic plan for the practice of your dreams,” as noted in the subtitle. This book covers such topics as the definition of strategic planning, issues in long-range planning, creating a vision and mission statement, translating your dream into action, and the five P’ s of professional success. It also includes execution plans, strategic-plan examples, and a strategic-plan template. Available through Jones and Bartlett Publishers, www.jbpub.com.
A Stroke of Midnight by John L. Stump, DC. Hardcover, 210 pages. A Stroke of Midnight aims to bring the facts of a massive stroke to the public and how it can be prevented. In this non- fictional account, the author and his wife chronicle the nearly fatal stroke he suffered and the near-death experience it caused, with a chapter written by his wife describing her role as caregiver’ s experience. Stump interlaces the story with preventive medicine, chiropractic, acupuncture, nutrition, exercise, and several other lifestyle changes that could save someone’ s life. Published by Alternative Concepts, www.alternative- concepts.com.
The Truth About Back Pain by Todd Sinett, DC, and Sheldon Sinett, DC. Hardcover, 203 pages. Written as “ a revolutionary, individualized approach to diagnosing and healing back pain,” this book deals with the structural, nutritional, and emotional side of back pain. It will help you better diagnose and treat problems originating with bones, muscles, or nerves; determine and remedy the effects of poor diet, toxins, and hormones on back health; and understand and eliminate the impact of stress, depression, and other psychological factors of chronic pain. Published by Penguin/Perigee, www.penguin.com. CIRCLE 246 FREE INFORMATION
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LEGAL CASE IN POINT Was the DC at fault for harming the patient? By Stuart E. Hoffman, DC
he claimant, a 42-year-old chiropractor for that condition, with favorable results. Following a thorough examination that included female, was originally seen by instrumentation with surface EMG but no x-rays, Dr. TDr. Jones on June 14, 2007. She Jones diagnosed the patient with multiple subluxations complained of back pain and low-back and ordered chiropractic adjustments twice per week, in addition to ice/heat applications. muscle spasms that started several days The patient came in for six treatments. On the seventh prior. visit, following the routine re-examination, one of the patient’ s children, who were in the adjusting room, No specific precipitating incident, such as a fall, was created a disturbance during the thoracic adjustment that identified in the history the doctor took. distracted Dr. Jones at the exact time of a high-velocity Her prior medical history indicated she had a skiing thrust procedure. accident two years ago, which resulted in acute back pain This distraction caused a misdirection of the thrust, and limited range of motion. She was treated by a away from the intended spinal contact point, and caused a
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mild fracture of the sixth rib just anterior to its angle. stated they could defend Dr. Jones’ informed consent, Dr. Jones’ records did not include an informed consent even though it is not documented in the patient’ s chart, form or documented discussion about the risks of based upon his testimony that it was performed verbally chiropractic adjustment/manipulation procedures. for “ adverse events.” However, this was disputed by the Dr. Jones responded to the misdirected thrust with an patient. immediate x-ray and arranged a referral to confirm his Based upon the issues surrounding this case — the findings of a rib fracture. patient’ s documented injuries and negative expert reviews The patient alleged his negligent manipulation caused — the defense counsel opined this was a case of probable a fracture of one rib, which resulted in considerable liability and estimated the chance of verdict in favor of discomfort and limited mobility, and prohibited her from Dr. Jones at less than 15 percent. conducting normal functions, including child care, for five Defense counsel also estimated that a potential adverse weeks. verdict value could be in excess of $100,000, based on Despite the circumstances of the accidental fracture, settlement data for a number of similar incidents in the the patient held Dr. Jones singularly and fully responsible preceding two years. for the injury and proceeded to seek damages. This matter was ultimately settled for an amount under the estimated jury award, without litigation. WAS DR. JONES RESPONSIBLE? Defense experts, including a chiropractor and Stuart E. Hoffman, DC, FICA, is the president of orthopedic specialist, opined that the thoracic adjustment ChiroSecure. He is an experienced chiropractor and was the sole cause of the injury. Dr. Jones did not dispute licensed insurance broker who advises based on his those findings, based on the facts of which he was knowledge of both the insurance world and the uniquely aware. chiropractic world. He can be contacted at 866-802-4476 or Regarding the informed consent issues, defense experts through the Web site, www.chirosecure.com.
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LEGAL ASK THE ATTORNEY Do you need an employee handbook? By Steven Conway, DC, DACBOH, Esq.
I recently had to fire my first employee. Because Tardiness is a good example. Often, an employee she filed for unemployment compensation, I had handbook states the first offense results in a verbal warning, Q to complete a form that asked if I had an the second offense in a written warning, and the third employee handbook or other documentation that offense in a suspension without pay from work for one day. provided the employee with knowledge of procedures for If you fire an employee following a first offense of termination or discipline. Am I required to have an arriving late to work, potential problems could result. The employee handbook? Is there a way to prevent fired employee’ s tardiness is not acceptable, but your action — employees from getting unemployment? firing — contradicts the discipline series of actions specifically outlined in the handbook. Employee handbooks are very helpful in the Employee handbooks create an expectation by the chiropractic office, but generally there are no employee on how you will treat him or her within the A statutes or regulations specifically requiring them. office. You have to be very careful, however, that the A handbook outlines all of the office’ s policies and handbook does not create the impression of being a procedures — from benefits to termination. This gives contract with the employee. everyone an understanding of how the office functions If you have a current handbook, ask a local attorney and what your expectations for behavior are. familiar with employment law to review it, make sure it is The problem most doctors have with an employee current, and does not create an impression of being a handbook is not the book itself, but the application of the contract with your employees. information it contains. The attorney can also assist in writing the discipline and In other words, problems occur when the the book does termination sections to allow you the flexibility necessary not get updated to include current policies and to manage the personnel within your office properly. procedures, or someone performs an action or procedure To answer your second question about preventing fired contrary to what the handbook states. This is usually not employees from collecting unemployment compensation, intentional, but it still can create unwanted issues for you. just tell the truth and remove any emotions you may have of Some of the most common problems involving why you terminated this person. Be very objective in your employee handbooks originate from the discipline and answers and leave out subjective emotions or comments. termination sections. Many handbooks are essentially a Each state has its own regulations concerning eligibility checklist of offenses and the subsequent remedial actions. to collect unemployment compensation. Generally,
Check employee classifications
When you engage an attorney attorney can tell you if they are (IRS) has specific guidelines that to review your handbook, it subject to overtime pay. determine if an employee can be would also be a good idea to • Contract employees. A recent considered an independent have him or her review how you article advised doctors to turn contractor. classify and pay employees. their insurance clerks into If you have a contract • Salary vs. hourly employees. independent contractors to save employee, ask the attorney to Paying employees a salary does on FICA (payroll taxes), but this is review the classification. not preclude paying them a questionable practice. Classifying employees properly overtime, if they are eligible. The The Internal Revenue Service now can save you headaches later.
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however, employees involuntarily terminated may file and collect unemployment compensation unless it was for gross misconduct. Check with your state’ s unemployment claims office for information pertaining to your situation. If you believe an employee should not be collecting compensation, you can challenge the claim. Employee handbooks are very useful. They outline policies and procedures for the office. Take care, though, in the initial drafting to allow for flexibility in discipline and termination procedures, and to not create an impression of a contract with the employees.
Steven Conway, DC, DACBOH, Esq., is a partner in True North Chiropractic Consultants LLC, which provides guidance and ethical solutions to the barriers found in CIRCLE 296 FREE INFORMATION chiropractic practices. He can be reached by e-mail at [email protected] or through the Web site, truenorthchiropracticconsultants.com.
DISCLAIMER: This column is provided for educational purposes only. The accuracy or timeliness of the information presented is not warranted. The information is not presented as legal advice and no attorney- client relationship is established. Quick Tip Speak from within When giving a talk, draw from your own experiences. You will make a powerful connection with your audience when they identify with common feelings, predicaments, dilemmas, and decisions that everyone experiences as human beings. — Dianna Booher, Booher Consultants Inc. www.booher.com
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CONTINUING EDUCATION GUIDE Continuing Education Directory and Resource Guide Chiropractic Economics is pleased to present the profession’s most comprehensive Continuing 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.
Abundant Health Cert Health Sciences Foot Levelers Inc. 916-725-3999 866-990-4444 800-553-4860 www.abundanthealth.com www.certhealthsciences.com www.footlevelers.com
Access Health Consultants Cessna Consulting G-Jo Institue 800-548-3141 828-863-4660 813-907-3010 www.g-jo.com www.accesshealthconsultants.com www.cessnaconsulting.com Chiro-Manis Inc. Georgia Chiropractic Association Activator Methods International 800-441-5571 770-723-1100 800-598-0224 www.chiromanis.com www.gachiro.org www.activator.com Chirocredit.com GMP FITNESS Advanced Rehab Consultants LLC 860-463-9003 888-467-3488 www.FitnWellEdu.com 866-914-2003 www.chirocredit.com www.advancedrehabconsultants.com Chiropractic Economics Gonstead Seminar of Chiropractic 800-842-6852 American Chiropractic Board of Sports 904-285-6020 www.chiroeco.com www.gonsteadseminar.com Physicians 712-362-8860 Chiroschool.com Graston Technique www.acbsp.com 888-615-7534 866-926-2828 www.grastontechnique.com www.chiroschool.com Amrex Electrotherapy Equipment GW Heel Lift Inc. Cleveland Chiropractic College-KC 310-527-6868 800-235-4387 816-501-0100 www.amrex-zetron.com www.gwheellift.com www.cleveland.edu Anabolic Laboratories Hearon Concept Therapy 800-445-6849 208-375-7431 210-698-2254 www.kevinhearon.com www.anaboliclabs.com www.chiropracticprinciples.com Avicenna Laser Heel Inc. Continuing Education Universe HS 800-621-7644 888-284-5273 305-576-1208 www.heelusa.com www.avicennalaser.com Data Trace Publishing Company Honso USA Back To Basics Golf Academy 800-342-0454 888-461-5808 888-578-7437 www.datatrace.com www.honsousa.com www.backtobasicsgolfacademy.com Disc Ease IMPAC Inc. 800-597-0368 BioHealth Diagnostics 503-581-3239 www.disc-ease.info www.impacinc.net 800-570-2000 www.biodia.com DNFT Seminars InteMedica LLC 310-657-2338 800-856-7250 BioPharma Scientific www.nonforce.com www.intemedica.com 877-772-4362 www.nanogreens.com Docs Inc. International Chiropractic Pediatric Assoc. 800-455-7627 800-670-5437 www.docsstore.com Biotics Research www.icpa4kids.com 800-231-5777 Erchonia JR Consulting/Dragon NaturallySpeaking www.bioticsresearch.com 888-242-0571 952-474-3426 www.erchonia.com www.jrconsulting.info BodyZone.com 770-922-0700 Expert Clinical Benchmarks JTECH Medical Industries www.bodyzone.com 800-814-8712 800-985-8324 www.expertclinicalbenchmarks.com www.jtechmedical.com Breakthrough Coaching 800-723-8423 F/D Enterprise LLC Karl Parker Sharing Seminars 800-441-5571 817-477-1044 www.mybreakthrough.com www.coxtechnic.com www.karlparkerseminars.com
Bryanne Enterprises Inc. Florida Chiropractic Association Kinesio Taping 877-279-2663 407-290-5883 519-979-2663 www.bryanne.com www.fcachiro.org www.kinesiotaping.com
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King Bio SafeCareRX Neuromechanical Innovations So Cal University of Health Sciences 800-543-3245 888-294-4750 562-947-8755 www.safecarerx.com www.neuromechanical.com www.scuhs.edu
Koren Enterprises/Koren Publications Inc. Neuromuscular Reeducation Seminars Spinal Reflex Analysis 800-537-3001 888-304-4667 877-259-5520 www.korenpublications.com www.nmrseminars.com www.spinalreflex.com Lakeside Chiropractic Seminars Inc. New York Chiropractic College Spine Research Institute of San Diego 704-892-8584 315-568-3052 800-423-9860 www.LakesideSeminars.com www.nycc.edu www.srisd.com Life Chiropractic College West Next Generation Therapeutics 800-788-4476 866-609-1212 Target Coding www.lifewest.edu www.ngtlasers.com 800-270-7044 www.targetcoding.com Life University Northwestern Health Sciences University 800-543-3202 952-888-4777 The Family Practice www.life.edu www.nwhealth.edu 866-532-3327 www.thefamilypractice.net Logan College of Chiropractic Nutri-West 800-782-3344 800-443-3333 The Masters Circle www.logan.edu www.nutriwest.com 800-451-4514 www.themasterscircle.com Loomis Institute of Enzyme Nutrition Ohio State Chiropractic Association 800-662-2630 800-837-6721 The McKenzie Institute www.loomisinstitute.com www.oscachiro.org 315-471-7612 www.mckenziemdt.org Madeira Success Strategies Palmer College Continuing Education 877-623-3472 Department www.madeirasuccess.com 800-452-5032 The Orthotic Group www.palmer.edu 800-551-3008 Med-Tech USA LLC www.theorthoticgroup.com 407-875-2000 Palmer College of Chiropractic, Florida www.medtech-usa.net Campus The ProAdjuster Group 866-585-9677 877-942-4284 Medical Quant www.palmer.edu www.proadjusterinfo.com 800-373-0955 www.medicalquant.com Parker Seminars/ Therapy & Health Care Products Inc. Parker College of Chiropractic 800-842-8212 Meditech International Inc. 800-438-6932 www.thcpweb.com 888-557-4004 www.parkerseminars.com or www.bioflexlaser.com www.parkercc.edu Transformation Enzyme Corp. 800-777-1474 Metagenics PDI www.transformationenzymes.com 800-692-9400 866-473-4734 www.metagenics.com www.dahan.com Ultimate Practice MicroCurrent Research Pettibon Systems 866-797-8366 602-952-1560 888-774-6258 www.ultimatepractice.com www.microcurrentresearch.com www.pettibonsystem.com University of Bridgeport Microlight Laser Pneumex Inc. 888-822-4476 469-385-4600 800-447-5792 www.bridgeport.edu/chiro www.microlightlaser.com www.pneumex.com Upledger Insititute Morter Health Systems/B.E.S.T. PrescriptionBeds.com/Strobel Technologies 800-233-5880 800-874-1478 800-457-6442 www.upledger.com www.morter.com www.PrescriptionBeds.com V-Juv LLC MyoLogic Diagnostics Inc. Rehabilitation Management Specialists 800-729-8922 800-768-7253 866-734-2202 www.myvjuv.com www.myologic.com www.123rehab.com Vital Nutrients N.E.T. Incorporated Science Based Nutrition 888-328-9992 800-888-4638 866-433-3140 www.netmindbody.com www.sciencebasednutrition.com www.vitalnutrients.net
National University of Health Sciences Sherman College Ward Success Systems 630-889-6723 800-849-8771 925-855-1635 www.nuhs.edu www.sherman.edu www.ultimatecoaching.com
NCMIC Sherman College of Straight Chiropractic Williams Healthcare Systems 800-769-2000 800-849-8771 800-441-3650 www.ncmic.com www.sherman.edu www.williamshealthcare.com
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CONTINUING EDUCATION GUIDE
Programs Offered Education Experience
Adjustive TechniqueBasic SciencesBoundariesDiagnostic Issues Examination ImagingHIV Interpretation Procedures/Diagnosis Prevention/EducationInsuranceMedical/Legal Reporting/ProceduresNutrition Phys. Therapy/Physio.Practice ManagementPrinciples TherapeuticsRadiographic of Prac./Phil.Rehab Technique/Safety of ChiroResearch TrendsRisk ManagementScope ofSports Practice MedicineConventionForum Home StudyLecture Video PresentationWeb Workshop InternationalNational Regional Abundant Health • ••••• Access Health Consultants • • • •• Activator Methods International • • • ••• Advanced Rehab Consultants, LLC ••• • • •• American Chiropractic Board of Sports Physicians •• • Amrex Electrotherapy Equipment Anabolic Laboratories • • •• Avicenna Laser • • ••••••• Back To Basics Golf Academy • • • • •••• BioHealth Diagnostics •• •• • •• BioPharma Scientific • •• • Biotics Research • • • •• BodyZone.com • ••• • • ••• ••••••• Breakthrough Coaching •• •• ••••••••••••••••••• •• Bryanne Enterprises Inc ••• •••••••••••• Cert Health Sciences •• Cessna Consulting •••••• •••••••• Chiro-Manis Inc. •• • •• • • •• • •• Chirocredit.com ••• •••• ••••••• •••• •••• Chiropractic Economics •••••••••••••• •••• •• Chiroschool.com •• • ••• Cleveland Chiropractic College - KC • • •••• • •••• • • • • • •• Concept Therapy • • •• •••••• Continuing Education Universe HS ••••••••••• •• Data Trace Publishing Company ••••• • •• • Disc Ease •• • • • DNFT Seminars • ••• Docs Inc. •• • •••• Erchonia •• ••• •• Expert Clinical Benchmarks • F/D Enterprise LLC •••• ••••• •••••• Florida Chiropractic Association • •••••••••••• ••• •• • •••• Foot Levelers Inc. •• • • • •• G-Jo Institue • •• Georgia Chiropractic Association ••• •••• ••••••• ••••• • •• • GMP FITNESS •• Gonstead Seminar of Chiropractic ••• •••• •••••••• Graston Technique • •• • •••• GW Heel Lift Inc. •• •••••• Hearon ••• ••••••••• Heel Inc. • • •• Honso USA • • •• ••••• IMPAC Inc. • • •• InteMedica, LLC • • ••••• International Chiropractic Pediatric Asc • • • • • • • • • • • • ••• JR Consulting/Dragon NaturallySpeaking •• •• JTECH Medical Industries •• ••••• Karl Parker Sharing Seminars ••••••••••••• •• Kinesio Taping • ••••• King Bio SafeCareRX • •• • •••••••••••••• Koren Enterprises, Koren Publications, Inc. • ••••• Lakeside Chiropractic Seminars, Inc ••••• •• ••• •••••••
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Programs Offered Education Experience
Adjustive TechniqueBasic SciencesBoundariesDiagnostic Issues Examination ImagingHIV Interpretation Procedures/Diagnosis Prevention/EducationInsuranceMedical/Legal Reporting/ProceduresNutrition Phys. Therapy/Physio.Practice ManagementPrinciples TherapeuticsRadiographic of Prac./Phil.Rehab Technique/Safety of ChiroResearch TrendsRisk ManagementScope ofSports Practice MedicineConventionForum Home StudyLecture Video PresentationWeb Workshop InternationalNational Regional Life Chiropractic College West •••••••••••••••• Life University •••••••••••••••• Logan College of Chiropractic ••• •••• ••••••• •••• • •••• Loomis Institute of Enzyme Nutrition •• • •• • Madeira Success Strategies • • • Med-Tech USA, LLC •• •• ••••••••• Medical Quant • • ••••••• Meditech International Inc. • • •• • • Metagenics • ••••• MicroCurrent Research • •••• Microlight Laser • • • ••••• Morter Health Systems /B.E.S.T. •• • MyoLogic Diagnostics Inc. ••• • ••• • • N.E.T., Incorporated • ••••• National University of Health Sciences • • • •••• ••• •• ••••• • ••• NCMIC • •••••••••••• ••••••• • • • Neuromechanical Innovations • ••••••••••••••• ••• Neuromuscular Reeducation Seminars • New York Chiropractic College • •••• •• • • ••• ••• Next Generation Therapeutics • • ••• Northwestern Health Sciences University • • • • • • • • • • • • • • • • • • • • • • • • • Nutri-West • • ••• • •••••••• Ohio State Chiropractic Association •••••••••••• • Palmer College Cont. Edu. Department • • • •••• ••••••• •• •• • • • ••• Palmer College of Chiropractic, Florida Campus • • • •••• ••• ••• •••• • • ••• Parker Seminars/Parker College of Chiropractic •••••••••••••• ••••• • • ••• PDI •• • • ••••• ••• •• •••• •• Pettibon Systems ••• • • •••••• Pneumex Inc. • ••••• PrescriptionBeds.com Strobel Technologies •••••••• • Rehabilitation Management Specialists • • •• • ••••••••• Science Based Nutrition • ••• ••• ••••• Sherman College ••• •• •• •••• Sherman College of Straight Chiropractic • • •• • ••• So Cal University of Health Sciences • • • • •••• •••••• Spinal Reflex Analysis • • ••• •••••••• Spine Research Institute of San Diego • •• • • Target Coding ••••••••••••••• The Family Practice ••• •••••••••••••• The Masters Circle •• ••• •• The McKenzie Institute • • • • ••• The Orthotic Group • • ••• The ProAdjuster Group •••••• • •••••• Therapy & Health Care Products Inc. •• • ••• Transformation Enzyme Corp. • • •• • • Ultimate Practice •••• •••• •• University of Bridgeport ••• •••• ••• •• • • • ••• Upledger Insititute •• • • V-Juv, LLC •• • • ••• Vital Nutrients • •• • Ward Success Systems •• ••• Williams Healthcare Systems • •••••••• ••••••
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DATEBOOK
Advanced BioStructural July 19–20, Denver Freedom Awaits LLC MUAcertification.com Correction Aug. 16–17, Chicago 866-662-BACK 917-957-1708 203-366-2746 Sept. 20–21, Harrisburg, Pa. June 18–21, Fort Wayne, Ind. May 29–June 1, Houston May 31–June 1, Sacramento, Calif. Sept. 20–21, Houston July 16–19, Fort Wayne, Ind. June 5–8, San Francisco June 14–15, Minneapolis Oct. 4–5, Los Angeles Aug. 20–23, Fort Wayne, Ind. July 19–20, Toronto Sept. 24–27, Fort Wayne, Ind. National University of Health Cox Seminars Oct. 29–Nov. 1, Fort Wayne, Ind. Sciences Apollo Physical Therapy 800-441-5571 630-889-6604 Products June 6–8, Indian Wells, Calif. Graston Technique June 20–22, Oak Brook, Ill. 866-789-7456 July 18–20, Atlanta 866-926-2828 June 6, W. Va. Sept. 12–14, Philadelphia June 7–8, Las Vegas N.E.T. Inc. Aug. 16, Los Angeles Oct. 11–12, Fort Wayne, Ind. June 21–22, Boston 800-888-4638 June 28–29, Newark, N.J. July 24–25, Seattle Breakthrough Coaching Cunningham Financial July 12–13, Indianapolis July 26–27, Seattle 800-723-8423 Group LLC Aug. 14–15, San Francisco July 31–Aug. 2, Denver 480-443-0455 The Illinois Chiropractic Society Aug. 16–17, San Francisco Oct. 30–Nov. 1, Ft. Lauderdale, Fla. June 14, Houston 800-424-0121 Oct. 2–3, Philadelphia June 28, Denver June 5, Fairview Heights, Ill. Oct. 4–5, Philadelphia BodyZone.com June 26, Tinley Park, Ill. Oct. 23–24, Denver 866-443-8966 DC Mentors Sept. 26–28, Wheeling, Ill. Oct. 25–26, Denver June 7–8, Springfield, Ill. 800-570-5272 June 21–22, Norfolk, Va. June 6–7, Squaw Valley, Calif. King Bio Neuromechanical Innovations July 26–27, Pittsburgh Sept. 11–12, Squaw Valley, Calif. 800-543-3245 888-294-4750 Aug. 9–10, Milwaukee May 31–June 1, Asheville, N.C. June 7–8, Denver Aug. 23–24, Long Island, N.Y. Disc-Ease Sept. 13–14, Pensacola, Fla. 800-597-0368 Logan College of Chiropractic North American Association Sept. 27–28, Cincinnati May 24, Newark, N.J. 800-842-3234 for Laser Therapy Oct. 11–12, Detroit May 28, Baltimore May 31–June 1, Chesterfield, Mo. 540-337-5452 Oct. 25–26, Seattle May 31–June 1, Chicago June 7–8, Chesterfield, Mo. June 12–14, Palm Beach June 7–8, New Orleans July 12–13, Chesterfield, Mo. Gardens, Fla. Blanchard Golf Injury June 7–8, Louisville, Ky. Aug. 2–3, Chesterfield, Mo. Seminars June 21–22, Las Vegas Sept. 6–7, Chesterfield, Mo. Palmer College of Chiropractic 805-772-8298 June 28–29, Fairfax, La. 866-592-3861 Oct. 24–26, Orlando, Fla. July 5–6, Toronto Loomis Institute Aug. 7–9, Davenport, Iowa July 12–13, Detroit of Enzyme Nutrition Oct. 10–11, San Jose, Calif. CACE of PA 800-662-2630 610-929-9882 Dr. Fred Schofield June 7–8, Chesterfield, Mo. Palmer Continuing Education June 6–7, Monroeville, Pa. 800-554-3260 July 12–13, Chesterfield, Mo. 800-452-5032 Aug. 1–2, Quakertown, Pa. June 7, Carefree, Ariz. Aug. 9–10, Chesterfield, Mo. May 31–June 1, Boston Aug. 2, Phoenix Sept. 5–7, Chicago June 7–8, Detroit CERT Health Sciences LLC Sept. 13, East Elmhurst, N.Y. Sept. 20–21, Chesterfield, Mo. June 7–8, Davenport, Iowa 866-990-4444 Sept. 20, Oakland, Calif. Oct. 10–12, Chicago June 21–22, Boston June 7, Baltimore Oct. 4, Tempe, Ariz. Oct. 18–19, Chesterfield, Mo. July 12–13, San Jose, Calif. July 21, Baltimore July 12–13, Detroit July 26–27, Boston Aug. 16, Baltimore Elite Coaching The Masters Circle Aug. 23–24, San Jose, Calif. Sept. 13, Baltimore 800-696-9036 800-451-4514 Sep. 13–14, Detroit Oct. 25, Baltimore June 7–8, New Orleans June 6–7, Rosemont, Ill. Sep. 20–21, Davenport, Iowa Aug. 23–24, Las Vegas Aug. 15–16, Washington, D.C. Sep. 20–21, Boston Chiro Advance Services Inc. Oct. 30–Nov. 1, Lake Buena Oct. 18–19, Detroit 715-635-5211 Erchonia Vista, Fla. Oct. 25–26, Boston July 18–19, Bloomington, Minn. 888-242-0571 Oct. 24–25, Bloomington, Minn. May 30, Anchorage, Alaska Meditech International Inc. Parker Seminars May 31, Philadelphia 888-557-4004 888-727-5338 The Chiropractic Audio Coach June 7, Salt Lake City, Utah May 24–25, Edmonton, Alberta, June 26–28, Rimini, Italy Teleseminars Canada Sept. 25–27, Dallas 902-449-4840 EON Systems Inc. June 3–4, Toronto June 3, Canada 727-298-5502 June 5–7, Toronto Powersource Coaching Aug. 26, Canada June 7–8, Seattle June 8–9, Toronto 512-306-1844 Sept. 16, Canada Oct. 18–19, Newburgh, N.Y. June 27–29, Toronto Aug. 2, Austin, Texas Oct. 14, Canada July 11–13, Toronto Foot Levelers Inc. July 19–20, New York Sherman College Concept-Therapy Institute 800-553-4860 July 25–27, Toronto of Straight Chiropractic 800-531-5628 May 31–June 1, Greensboro, N.C. Aug. 8–10, Toronto 800-849-8771 May 24–25, Las Vegas May 31–June 1, Williamsburg, Va. Aug. 22–24, Toronto May 22–25, Spartanburg, S.C. June 21–22, St. Louis May 31–June 1, Philadelphia Sept. 13–14, Dallas June 21–22, Atlanta June 28–29, Dallas Sept. 19–21, Toronto July 19–20, Atlanta Sept. 26–28, Toronto Aug. 23–24, Atlanta Oct. 3–5, Toronto For a searchable list of seminar and show dates, visit Oct. 17–19, Spartanburg, S.C. Oct. 18–19, Irvine, Calif. www.ChiroEco.com/datebook. To be listed, submit your event dates at Oct. 24–26, Toronto Tekscan Inc. www.ChiroEco.com/datebook/submitevent.html. 800-248-3669 Oct. 4–5, Washington, D.C.
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CIRCLE 147 FREE INFORMATION CHEC7p72.ps 4/14/08 5:00 PM Page 72
FINANCES
How to protect your assets Some foreign investments are judgment-proof
By Darrell Aviss
ow can you keep your assets disastrous U.S. tax consequences. Offshore trusts have out of the reach of been especially affected by the new, time-consuming reporting requirements for international investing called H judgments? for by the Patriot Act, causing many wealthy investors to When most physicians think about keeping their assets consider returning their money to the U.S. out of a creditor’ s reach, one of the first things that may come to mind is moving assets offshore — but for the last WHY BOTHER? two decades, the U.S. government has attempted to So, why bother? The primary advantage of foreign discourage this activity. trusts derives from “ jurisdictional immunity.” This The Department of the Treasury requires offshore asset- essentially means courts in other countries do not protection strategies to be as transparent as possible, and recognize U.S. legal judgments. Offshore trusts in general under Internal Revenue Service (IRS) rules, every do not protect assets from creditors, but they do shield creation of an offshore foreign trust by a U.S. person must money from the gaze of perfunctory investigations while be reported. providing jurisdictional immunity. Unscrupulous advisors sometimes recommend trusts as The chart (“ Asset protection planning guide” ) lists “ tax-savings plans,” but over the years, the IRS and countries (jurisdictions) offering asset protection: Congress have closed most loopholes. Generally speaking, Certain jurisdictions stand out from the rest — the there is no way legally to avoid paying taxes with an Cook Islands, Nevis, St. Vincent, and the Grenadines — offshore asset-protection trust. In addition to the fact because these countries do not recognize foreign there is virtually no income-tax advantage to a foreign judgments and the settler or beneficiary can retain some trust, the offshore aspect alone may invite examination by control. It’ s not enough to simply put a veil over your the agency. assets to shelter them from prying eyes. Also, trusts are usually expensive to set up and A better solution is to use only those jurisdictions that maintain properly, and failure to do so can lead to offer investment-type products that return your money, not
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Asset Protection Planning Guide
Nation Statutory ‘Beyond Statutory Statutory or state certainty reasonable certainty that certainty that regarding doubt’ stand of settler can be a settler can nonrecognition proof required beneficiary retain some of foreign in establishing degree of judgments fraudulent control intent Bahamas * X X Belize X X X Bermuda Cayman Islands Cyprus X Gibraltar Labuan X X X X Mauritius X X Nevis X X X X St. Vincent and Grenadines X X X X Seychelles X X X Turks and Caicos New Zealand X X Alaska X X Colorado X Delaware X X Missouri Nevada X X Rhode Island X X
*Bahamian law provides for nonrecognition of foreign judgments unless such a judgment is obtained in France or England. Gibraltar: While some believe Gibraltar law provides “instant” protection if the transferor is solvent following the transfers, post-transfer solvency of the transfer, and hence the validity of transfer, may be subject to a challenge.
hide it. Look for those jurisdictions dividends earned. (such as Switzerland or Liechtenstein) Also, insurance contracts are where asset protection is part of viewed completely different by the public policy and has existing laws IRS because there are legitimate that have been tested in the courts. estate-planning reasons for investing Swiss insurance contracts, for in them. example, are creditor- and judgment- proof because of Switzerland’ s strict Darrell Aviss, author of asset protection and privacy laws. Strategies for Protecting Additionally, Switzerland does not Wealth (McGraw-Hill, 2006), is honor U.S. judgments, and Swiss with SwissGuard International insurance companies do not issue GmbH, an independent financial reports to any governmental agency consulting firm. He can be reached at of the initial purchase of the policy, 800-796-7496 or through the Web site, payments into it, or interest and/or www.swiss-annuity.com. CIRCLE 252 FREE INFORMATION
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READER SERVICE Free Information From Our Advertisers RS# Advertisers/Description ...... Pg# 127 Access Health Consultants ...... 87 166 Accuthotix ...... 43 110 Advanced Back Care ...... 52 252 All Care Consultants ...... 73 102 Axiom Worldwide ...... 87 270 Biotics Research ...... 85 133 Biotics Research ...... 21 167 BodyZone.com ...... 26 139 Breakthrough Coaching ...... 13 112 Cert Health Sciences ...... 11 225 Chiro Practice Marketing ...... 53 163 ChiroConceptions ...... 88 129 ChiroManis/Cox Seminar ...... 87 246 Claken Software ...... 61 116 CMCS Management ...... 14 294 Douglas Laboratories ...... 59 145 Douglas Laboratories ...... 25 135 Douglas Laboratories-Wobenzym ...... 7 271 Dynamic Practices ...... 85 137 Dynamic Practices ...... 27 298 EClaims, Inc ...... 89 106 Elite Coaching ...... 24 141 Erchonia ...... 5 231 EZ Notes ...... 62 290 Fernandez Consulting ...... 47 254 Florida Chiropractic Association ...... 77 131 Foot Levelers ...... 9 100 Foot Levelers ...... 94 143 FootMaxx ...... 17 221 GW Heel Lifts ...... 83 214 Hill Labs ...... 92-93 281 IMPAC ...... 37 280 IMPAC ...... 36 125 InPhase Technologies Group ...... 56 120 Jean Murray ...... 88 263 King Bio ...... 84 170 King Bio ...... 45 274 Levy & Rappel ...... 85 273 MarketDecompression.com ...... 85 267 Medi-Stim Inc...... 84 156 Merchant Services ...... 88 171 Midot-Meditech ...... 87 * MPN Software ...... 49 268 Multi Radiance Medical ...... 84 283 NCMIC ...... 39 187 Neuro Resource Group ...... 63 296 NZ Manufacturing ...... 65 189 OnlineChiro.com ...... 30 269 OPTP ...... 84 149 OUM Chiropractor Program ...... 33 147 Parker College/Parker Seminars ...... 71 174 PBI/Myovision ...... 35 205 Performance Health/The Hygenic Corp...... 15 265 Pivotal Health Solutions ...... 84 276 Premier Research Labs ...... 85 266 Ridge Medical Products ...... 84 108 Select Comfort Corporation ...... 28-29 172 Spinal Aid Centers ...... 23 264 Standard Process ...... 84 250 Standard Process ...... 2-3 122 TBI, Inc...... 89 272 The Masters Circle ...... 85 104 Titronics ...... 60 292 TriMedica International ...... 74 * Ulan Nutritional Systems Inc...... 20 114 Vax-D ...... 54-55 206 Wellspring Healthcare ...... 41 275 WondaWedge ...... 85 CIRCLE 292 FREE INFORMATION
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CIRCLE 254 FREE INFORMATION CHEC7p78.ps 4/13/08 12:49 PM Page 78
FINANCES FINANCE AND TAXES LLCs offer unlimited possibilities By Mark E. Battersby
here is a relatively new business Even a limited partnership (LP) has one party who assumes liability — the general partner — and that structure on the block. While partner usually must have substantial net worth. Tthe S-corporation remains the Furthermore, limited partners who participate in most-used type of small-business entity, managing a chiropractic practice risk losing their limited liability. the limited-liability company (LLC) is gaining popularity for both new and LLC ADVANTAGES LLCs differ from corporations in a number of ways: existing chiropractic practices. • Less formality. Corporations are required to keep LLCs are business entities that bear a semblance to formal minutes, have meetings, and record resolutions. The partnerships. Owners of an LLC are called “ members,” LLC business structure requires no corporate minutes or and since most states do not restrict ownership, members resolutions and is easier to operate. In fact, in some states, may include individuals, corporations, other LLCs — LLCs can be created with just one natural person involved. even foreign entities. Membership is not limited, and • Profits to members. All business losses, profits, and most states also permit “ single member” LLCs — those expenses flow through the chiropractic practice to the having only one owner. individual members. Only a few types of businesses cannot be LLCs, such as • No double taxation. Best of all, the double taxation banks, insurance companies, and nonprofit organizations. of paying both corporate tax and individual tax is avoided. Generally, this will be a tax advantage, but circumstances LLC DEFINED can favor a corporate tax structure. An LLC is a business structure that combines the pass- • Liability protection. Even more importantly, owners through taxation of a partnership or sole proprietorship with of an LLC have the liability protection of a corporation. the limited liability of a corporation. As in the case with An LLC exists as a separate entity much like a owners in partnerships or sole proprietorships, LLC members corporation. Members cannot be held personally liable for report business profits or losses on their personal income tax debts unless they have signed a personal guarantee. returns; the LLC itself is not a separate taxable entity. Like owners of a corporation, however, all LLC owners DISADVANTAGES or members are protected from personal liability for Admittedly, this limited liability is not foolproof. business debts and claims — a feature known as “ limited • Corporate veil not impenetrable. Both LLC liability.” This means if the practice owes money or faces a members and corporate shareholders can lose this lawsuit for some other reason, only the assets of the protection by acting illegally, unethically, or irresponsibly. practice are at risk. What’ s more, many courts are increasingly reaching Unlike S-corporations, LLCs have no limit on the behind the corporate veil into the pockets of members number or nationality of members, can own subsidiaries, and shareholders who have not kept the practice entity and can have more than one class of interest — a good fully separate from their personal finances. method of unequally dividing income and losses. • Limited life. While corporations can live forever, an LLCs can select varying forms to distribute its profits. LLC is dissolved when a member dies or undergoes Unlike a common partnership in which the split is 50-50, bankruptcy. Some states stipulate that an LLC must LLCs have much more flexibility. LLC profits are taxed dissolve after 30 or 40 years. only once, at the tax rate of the owners. • Limited public growth. Owners of businesses with Sound like a partnership? Well, not quite. LLCs protect plans to take their company public, or issuing employee the personal assets of all members from debts and lawsuits. shares in the future, may be best served by choosing a
CONTINUED ➤
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FINANCES
corporate business structure. and decide how your LLC will be Tax Act (SETA). Limited partners • Difficult to raise capital. It run, rather than having the state and S-corporation shareholders may be more difficult to raise capital dictate its terms. generally are not subject to self- for an LLC, as investors may be more Under LLC rules in most states, employment taxes — a 2.9 percent comfortable investing funds in the there is no need to keep exhaustive Medicare levy on all salaries and 12.4 better-understood corporate form minutes, hold meetings, or make percent FICA (Social Security) tax with a view toward eventually taking resolutions to, in effect, stay legal. on income up to $97,500 (in 2007). the operation public. However, this is often a trap for the The IRS’ position, subject to • More paperwork. Running a unwary and is the first place the IRS change, is that LLC members who sole-proprietorship or partnership or an aggressive attorney will attack participate in management are usually involves less paperwork and is when attempting to “ pierce the subject to employment taxes. If LLC less complex. Under federal tax laws, corporate veil,” and go after the members are legitimate, passive an LLC may be classified as a sole- shareholders personally. If the records members, according to the IRS, they proprietorship, partnership, or are not maintained perfectly, the should not be subject to those corporation for tax purposes. corporate protection may be lost. employment taxes. Classification can be made on the tax Limited-liability companies work return thanks to the so-called “ check- SWITCHING for startups, practices branching out, the-box” question on the tax return. In most situations, a chiropractic and those that want an alternative to If not selected, a default often applies. practice operating as a partnership a limited partnership (LP) for such
If your practice is currently a partnership, you can easily convert to an LLC and gain its advantages.
• No uniform state laws. The can quickly and inexpensively financial entities as trading pools and laws of various states governing LLCs convert to an LLC. Partnerships can hedge funds. They also work well for vary. This makes doing business in usually convert without tax estate planning, because owners can more than one state difficult. consequences, with the new LLC gradually give most of the shares to continuing to file a partnership tax heirs while retaining management FORMING AN LLC return with the IRS. control. (Local professional licensing Usually, an LLC is formed by simply Because of the similarity of the rules may affect using an LLC for filing articles of organization with the structures, the IRS does not usually estate planning.) state’ s LLC filing office, usually the treat the conversion as a taxable The LLC is rapidly becoming the secretary of state’ s office, and paying a event. entity of choice for principals in filing fee. Many states, in fact, provide A corporation can also convert to many chiropractic practices. It a fill-in-the-blank form that takes only LLC status, although it may not be a continues to gain momentum as a few minutes to prepare. wise move for the shareholders of more people learn of its existence — The operating agreement, for the many incorporated businesses. IRS and its profitability. most part, contains any procedures regulations require the incorporated and rules that the parties desire and, business to liquidate first, thus creating Mark E. Battersby is a tax and once put into place, can just sit there, considerable tax liability. Even a financial advisor, freelance maintenance free. The operating corporation with depressed values that writer, lecturer, and author agreement explicitly states the rights converts would have to be prepared to with offices in suburban and responsibilities of the LLC prove its estimate to the IRS. That Philadelphia. He can be contacted at 610- members. could mean a costly appraisal. 789-2480. Without a written LLC operating agreement, the LLC laws of your TAXING QUESTIONS DISCLAIMER: The author is not engaged in state will govern the inner working Using an LLC to operate a practice rendering tax, legal, or accounting advice. of the LLC. Generally, it is preferable raises a number of tax questions. For Please consult your professional advisor to clarify your business arrangements starters, there is the Self-Employment about issues related to your practice.
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STUDENTDC.COM Click it! www. studentDC com Home Colleges Career Development Financial Preparation Job Search Practice Startup Checklists Resources The online resource for future doctors of chiropractic. Set up your office to comply with OSHA
SHA is the acronym for the 2. Hazardous chemicals. For all substances your employees use that might be hazardous, you must: Occupational Safety and Health • Obtain an information sheet called a Material Safety OAdministration which enacted Data Sheet (MSDS) from the manufacturer and keep it a law in 1970 to protect the safety and where employees can get to it if there is an accident. The MSDS will include information on how to deal with spills health of America’s workers — and all or other accidents. businesses having one or more • Properly label all chemicals, especially those that have been transferred to different containers. employees must comply. See the “ hazcom” (hazardous communication) As soon as you hire your first employee, you will need to requirements at www.ChiroEco.com/hazards. comply with this law, so it’ s a good idea to set up your 3. Bloodborne pathogens. Although most chiropractic compliance systems now. offices do not draw blood (which requires strict adherence Check to see if your state has an approved OSHA to regulations regarding bloodborne pathogens), every program (www.ChiroEco.com/oshastates); if not, the federal office should have an exposure control plan. OSHA compliance requirements apply to you. The plan should detail your efforts to observe the Here are the general requirements for OSHA general requirements for bloodborne pathogens, compliance: implement housekeeping procedures, universal 1. OSHA poster. Each workplace (that’ s an OSHA precautions (treating everyone as if he/she were term) must display a poster informing employees of their potentially infected), disposing of biohazard materials, and rights under OSHA. You can download the poster from providing personal protective equipment for employees. OSHA’s Web site at More information from OSHA on this subject is www.osha.gov/Publications/poster.html. available at www.ChiroEco.com/bloodborne. Note that it must be placed in a “ conspicuous place” 4. Fire and egress (exit) precautions. As part of this where all staff members can see it, but it doesn’ t have to requirement, you may want to purchase fire extinguishers be in a place where patients can see it. The break room or and determine how you will deal with fires in your office staff room might be a good place. (including exit plans).
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OSHA has more information on this subject, which you can find at www.ChiroEco.com/firesafety. Online resources 5. Recordkeeping requirements. You may be required • OSHA’s Small Business Page. This page provides to keep records of workplace-related injuries, accidents, access to the most popular materials for small illnesses, and exposures, and if you have a major incident businesses, including free, on-site consultation, in which employees are hospitalized, injured, or killed, you interactive software, technical information, and easy-to-follow guides for specific OSHA standards. It must report this to OSHA immediately. also includes links to OSHA local offices and the This link contains a recordkeeping handbook — Small Business Administration. www.ChiroEco.com/records. http://osha.gov/dcsp/smallbusiness/index.html 6. Employee training. Finally, and most important, • OSHA’s Small Business Handbook. These employees must be trained in all of the above procedures guidelines represent OSHA’s policy on what every in order to protect themselves. Each employee should worksite should have in place to protect workers receive training at hire, and at least once a year (more from occupational hazards. The handbook can be often if there are changes in the office). found on the OSHA Small Business Page. OSHA has a service that allows employers to have an inspection to determine if there are any potential hazards. OSHA safety procedures, and implement protections for (More information about this program is available at your employees. OSHA is for the safety and health of your www.ChiroEco.com/smallbusiness.) employees, but patients also benefit from these You are required by law to put together an OSHA regulations, and you benefit by having a safer work manual for your office, train your employees regularly on environment for everyone.
This article was meant to give you a very brief overview of OSHA regulations. See the general resources from OSHA below, or visit the OSHA Web site (www.osha.gov) for more details on how you can comply.
CIRCLE 221 FREE INFORMATION
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PRODUCTS AND SERVICES
Fever relief Pain-relief cream SafeCareRX Fever Reliever by King Bio helps Profen HP by Ridge Medical Products is provide fast relief from fever, sweats, chills, formulated to be an anti-inflammatory shakes, and aches. The product also aids in pain-relief topical ibuprofen cream. The relief from vomiting, rheumatic pains, muscular product contains ibuprofen and arnica soreness, nausea, and faintness. Each of the intended to deliver pain relief for muscles product’s ingredients has been prepared and joints. The product is odorless, absorbs according to Homeopathic Pharmacopoeia of into the skin instantly, and can be used to the United States standards and is registered treat acute pain, arthritis, soreness, carpal as an approved drug by the FDA. tunnel syndrome, and hand stiffness. Call 800-543-3245 or visit www.safecarerx.com. Call 866-321-1732 or visit www.profenhpcream.com. Circle 263 on free product info card Circle 266 on free product info card
Liver support Programmable A-F Betafood from Standard Process Inc. electrotherapy contains fat-metabolizing agents including The EV-904, a programmable TENS vitamins A and B6, essential fatty acids, and Unit by Medi-Stim Inc., offers five betaine. It is formulated to work treatment modes (burst, normal, MW, synergistically to support healthy liver, SD1, and SD2), adjustable pulse rate cardiovascular, metabolic, and cellular and width, treatment timer, functions. A-F Betafood is also designed to compliance monitor, and the ability to promote the transportation and use of fats, store custom programs that can be set and locked. The helping to prevent the accumulation of fat in the liver. product’s store and recall program is designed to make it Call 800-848-5061 or visit www.standardprocess.com. easy for patients to choose from five pain-relief settings. Circle 264 on free product info card Call 800-363-7846 or visit www.medi-stim.com. Circle 267 on free product info card
Therapeutic pillow The RelaxRight Pillow by Pain-reducing laser Pivotal Health Solutions is a The LaserPrism AIM by Multi variable-density pillow with a Radiance Medical is an FDA-cleared hollow core. The product combination emitter that combines two types of incorporates multiple radiances, memory foam in a multipositional 25,000 milliwatts of peak power, red design intended to accommodate a wide range of body LED’s, infrared, static magnetic field, and electrical types in one pillow. The pillow’s hollow core is designed to stimulation to promote an optimal healing environment. It is cradle the head and provide therapeutic traction to the neck. designed to provide temporary relief of minor muscle and Call 877-834-2377 or visit www.relaxrightproducts.com. joint pain, arthritis, and stiffness. Circle 265 on free product info card Call 800-655-1155 or visit www.brookdalemedical.com. Circle 268 on free product info card
Mirror box The Mirror Box by Orthopedic Physical Therapy Products (OPTP) is designed for problems such as complex regional pain syndrome, phantom limb pain, stroke, and focal dystonia. It is accessible from the front two sides and can be used for feet as well as hands. The product contains one semi-assembled, portable box of white corflute construction, a Perspex mirror, background notes, and instructions. Call 800-367-7393 or visit www.optp.com. Circle 269 on free product info card
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Antioxidant protection Orthopedic shock absorption NitroGreens by Biotics Research The Perfect-Step by Levy & Rappel is designed to provide Corporation is intended to provide an the combination of multiple shock-absorbing layers with the organic proprietary blend of grass juices, support of a semi-flexible, vegetable-sprout concentrates, and polyethylene-derivative vegetable juices to supply phytonutrients thermoplastic shell. The and offer antioxidant protection. It is product features a low-profile formulated to support healthy immune design intended to provide a good fit in all types of footwear, function, the production of nitric oxide, making it useful for everyday activities and common foot the detoxification of heavy metals, and healthy blood pH via ailments. alkalinizing properties. Call 800-564-5389 or visit www.levyandrappel.com. Call 800-231-5777 or visit www.bioticsresearch.com. Circle 274 on free product info card Circle 270 on free product info card
Multiuse pillow Practice-building strategies The WondaWedge is an inflatable The 12 Simple Tactics to Double Your Practice in Under 6 triangular pillow with an attached Months system by Dynamic Practices includes location-tested mat designed to provide proper back strategies to help your support. The product is intended for practice move towards recuperation or reading in bed; or as a sleep aid for patients insurance independence, with GERD, sleep apnea, or respiratory problems. Inflatable to even if you are not ready to the patient’s level of comfort, the product is manufactured to go all cash. Created by a chiropractor, this sytem includes be used outdoors as well as indoors. psychology-based scripting and strategically-designed intake Call 800-549-5773 or visit www.wondawedge.com. questions intended to help you build your practice. Circle 275 on free product info card Call 800-471-9421 or visit www.dynamicpractices.com. Circle 271 on free product info card Antioxidant regenerator DHLA Nano-Plex by Premier Research 6 DVD set Labs is designed to provide a stable, live- Live@The Masters Circle is a six source, reduced form of DHLA and aims DVD set featuring Patrick Gentempo, to regenerate the body’s stores of key DC, Sue Morter, DC, and John antioxidants. A one-quarter teaspoon Demartini, DC, in live-audience serving provides 80mg of DHLA and 5mg presentations. The speakers discuss of resveratrol. The product is designed to topics that include: The role of be easily digested and assimilated by the values in creating your success, the magic of intentional body and formulated to quench all free living, and the inspired philosophy of a chiropractic master, radicals known in living tissue. while addressing key issues in your practice. Call 800-325-7734 or visit www.prlabs.com. Call 800-451-4514 or visit www.themasterscircle.com. Circle 276 on free product info card Circle 272 on free product info card
Marketing your practice Market Decompression Resources CD by MarketDecompression.com is a spinal-decompression marketing program created by full-time DCs. It covers subjects including proper coding, billing and collection procedures, billing fraud and how to avoid it, and patient-financing options. It also includes patient-agreement letters, newspaper ads, radio scripts, professional banners, highway billboards, 14 MD letters and referral sheets, and preauthorization language for insurance companies. Call 512-445-3366 or visit www.marketdecompression.com. Circle 273 on free product info card
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Advertising Marketplace FREE INFORMATION FREE INFORMATION 129 127 CIRCLE CIRCLE FREE INFORMATION FREE INFORMATION 171 102 CIRCLE CIRCLE
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Advertising Marketplace FREE INFORMATION FREE INFORMATION 156 120 CIRCLE CIRCLE YOUR AD COULD BE HERE!
1 NEW /4 page ad format available Call for YOUR space today! 904-285-6020 FREE INFORMATION Jeff Pruitt, Ext. 542 163 Janice Long, Ext. 541 Frank Weiner, Ext. 540 CIRCLE
88 CHIROPRACTIC E CONOMICS WWW. CHIROECO. COM V OL 54: ISSUE 7 • MAY 7, 2008 CHEC7p89.ps 4/13/08 12:57 PM Page 89 FREE INFORMATION FREE INFORMATION 298 122 CIRCLE CIRCLE CLASSIFIEDMARKETPLACE<< ANTI-AGING NATURAL, PROFITABLE, ETHICAL and uncomplicated stem cell product for your practice. FREE Physician’ s Reference Bibliography describes everything. Emergent Health, 843-236-9310, [email protected] ASSOCIATE WANTED SEEKING FULL AND PART-TIME ASSOCIATES. POSITIONS AVAILABLE IN WI, FL, NJ, NY, MA, VA. RELOCATION ASSISTANCE, SIGN ON BONUS, SALARY AND BENEFITS. PLEASE CALL 888-369-2224, E-MAIL MDs for DCs SHEILA@ALLCARE CONSULTANTS.COM, MDs AVAILABLE in every specialty OR REGISTER ONLINE @ who want to work with you. Complete MD/DC practice startup, MD training, THE CHIROSITE.COM and ongoing support. Call today to speak to Marc H. Sencer, MD, President and Founder. 7 WHY 1-800-916-1462 advertise here? Because it works! or visit www.MDsforDCs.com And every ad that runs here, also runs on our Web site: www.ChiroEco.com V OL 54: ISSUE 7 • MAY 7, 2008 WWW. CHIROECO. COM C HIROPRACTIC E CONOMICS 89 CHEC7p90.ps 4/13/08 12:59 PM Page 90 Classified Marketplace To place an ad call 904-567-1543 or visit www.chiroeco.com ASSOCIATE WANTED EQUIPMENT FOR SALE HOMEOPATHY ASSOCIATE NEEDED IMMEDIATELY COLD LASER $1200 Our new cold laser for busy chiropractic office. Great earning has five true pulsed laser diodes in one 2" potential with great benefits. Opportunity wand (3-635nm 5mw & 2-808nm 150mw) for partnership after 6 months, Paid and includes a portable power supply. FREE 60 training, vacation time and malpractice Satisfaction or your money back and one year insurance are just a few of the added warranty. $1,200 www.ColdLaserTherapy.US incentives. Future buy out option available. or 877-LASER-50. Financing from $2 a day. Ideal candidate will be self-motivated and possess confidence and certainty in COMPLETE NEW X-RAY SYSTEMS themselves and chiropractic. All interested AS LOW AS $11,087. Includes freight, candidates please send resume to installation and full-factory warranty. Over [email protected] or fax 248-471-5008. 500 installed. For details, visit our Web site at www.americompus.com or call 800-458-1782. URGENT NEED FOR AN ASSOCIATE! Practice Grossing $500,000 South Coast LORDEX DECOMPRESSION SYSTEM – Massachusetts. POTENTIAL LIBERAL NEW $59,900.00. Refurbished $39,000.00 – BUYOUT PROVISIONS, INCLUDING Fully Warranted – Includes Marketing INCOME OPPORTUNITIES REAL ESTATE IN CONTRACT . Material. 281-395-9512 E-Mail EXPAND YOUR PRACTICE AND CONTACT DR. MIKE MEROLLA 508 [email protected] INCREASE YOUR PROFITS 725 1888. Or [email protected] With Unique 100% Therapeutic Grade FINANCIAL SERVICES Essential Oils, Skin Care & Health ONLINE PRACTICE SAVE THOUSANDS ON PERSONAL Products. DISTRIBUTORSHIP MANAGEMENT and employee health insurance premiums AVAILABLE Call 718-798-8047 and out of pocket health expenditures. WWW.Youngliving.Org/MCurry No Contracts. No travel. Find out how patients pay you upfront in [email protected] No seminars. Learn from the cash using an HSA. Visit www.health- best in the profession. savings-account-101.com MARKETING Direct to you. BUY YOUR BUILDING. No tax returns, STOP SMOKING LASER TRAINING Guaranteed results! No income verification, Cash-Out. Loans I can teach you to use an $1800 cold laser www.drjaymorgan.com under $750,000 on commercial properties. to help your patients stop smoking & loose Fixed or adjustable rates. 15-20 year weight. Doctors are earning $300 for a half amortization. Loans to corporations, hour treatment. Internet based training is economical ($500) and convenient. CAREER OPPORTUNITIES partnerships, and trusts. 832-385-4323 http://stopsmokinglasertraining.us/ Or call ATTN. STEELER FANS!! Pgh. PA. Do 917-687-4706. Financing from $2 a day. you want to own a successful office collecting over 500k/yr? We are looking for WANT MORE...... Believe and You Will highly motivated docs that are serious about Receive See Patients 2 days a week, Spend succeeding, but lack the tools to open their your time how YOU want to!! Opportunity own practice. Our hands-on approach will to create the most profitable home biz. Not show you the way! Email me at MLM, training included. [email protected] or fax me at www.cashwithintegrity.com 727-741-0838 412-399-4093. This opportunity is perfect for the unseasoned doctor that wants to HELP US HELP EACH OTHER... No begin their career on the right path. selling, MLM, convincing, or pressure. Less Classified Marketplace Information stress, more focus. www.relaxwithcash.com 31y/o D.C. ABLE TO RETIRE? [email protected] FIND OUT HOW… . To place an ad, fax ad copy with This Simple Businesswill generate you a payment to 904-285-9944 or call 904- WHAT'S THE WORST THING 2nd HUGE Stream of Income and Teach 567-1543 for more information. ABOUT LEAD BOXES? you to Run YourPractice AND Life with Line Ad Rates: $3.00 per word or Getting them into stores! More Abundance and More Success. number group Let this DVD train your staff “ HOW TO” Call 800-676-7412 (eg : phone number) Minimum $60. 15 new patients a month www.CreateWealth4Freedom.com Boxed Display Ads: $200 per column inch, no more than 50 words per inch in a www.mastermackmarketing.com box ad Don’t miss a single issue! Payment: Full payment must accompany all ads. Visa, MC, Check or Money Order Our free, bimonthly newsletter provides are accepted methods of payment. No students with information on starting refunds will be issued for classified their own business, managing their advertisements. finances, preparing for their career, Camera ready ads may be reformatted to attracting patients, and more. To sign up fit requirements. All copy subject to FREE, log on to publisher’s approval. In no event will the liability of Chiropractic Economics exceed www.studentDC.com the cost of the advertisement. www.chiroeco.com 90 CHIROPRACTIC E CONOMICS WWW. CHIROECO. COM V OL 54: ISSUE 7 • MAY 7, 2008 CLASSIFIEDMARKETPLACE<< NUTRITION PRACTICES FOR SALE PRODUCTS AR, AL, AZ, CT, GA(9), IN,KY,MA, MO, MI, NC, NJ, NM, OK, OH, PA, SC, TN, TX, WV. $200.00 for your Practice Evaluation. I have new doctors who want to buy your practice. Call Dr. Tom Morgan, 770-748-6084. [email protected] www.VolumePractice.com PRACTICE MANAGEMENT PRACTICES FOR SALE SELL YOUR PRACTICE IN 180 DAYS OR LESS – GUARANTEED!!* “ Hassle Free listing” ™ , cancel anytime, 100% cash at closing. Call for details. Professional Practice Advisors, Inc. 800-863-9373. www.practiceadvisors.com SUPPLIES OHIO CHIROPRACTIC PRACTICES SCIATICA? LOWER BACK/HIP FOR SALE in Columbus. This is a BWC PAIN? Relax 20 minutes daily on the based practice and very well established. Sacro Wedgytm sacral stabilizer. For the Sandusky, Ohio, 30 year practice! 614-918- PRACTICE OWNERSHIP therapist, it’ s like a third hand! Sacrum is 3000. [email protected] HAVE YOUR OWN SUCCESSFUL isolated, cradled and elevated. Free OFFICE NOW! FOR DETAILS CALL professional info, 1-800-737-9295. Cost VERMONT. PRACTICE FOR SALE IN 1-800-300-2205 or visit us at $29.95 with volume discounts. BURLINGTON— rated by Outside www.chapmanmanagementcorp.com www.sacrowedgy.com magazine as one of the top 30 places to live. Excellent office space with very reasonable NO MALPRACTICE INSURANCE? rent, full x-ray facility and TWO busy spinal I will show you how to get it! decompression units. Physical therapy [email protected] 219-742-6144 department has two PTs willing to stay on. Priced for a quick sale at only 225K (one third of annual income). Owner financing PRODUCTS available to qualified buyer. Contact [email protected] or call 802-660-3110. WHY advertise here? Because it works! And every ad that runs here, also runs on our Web site: www.ChiroEco.com V OL 54: ISSUE 7 • MAY 7, 2008 WWW. CHIROECO. COM C HIROPRACTIC E CONOMICS 91 CHEC7p92.ps 4/13/08 1:00 PM Page 92 CHEC7p93.ps 4/13/08 1:01 PM Page 93 CIRCLE 214 FREE INFORMATION CHEC7p94.ps 4/13/08 1:02 PM Page 94 CIRCLE 100 FREE INFORMATION