Q:

Dr. M

I notice you write alot on certain practice mgt. issues.  Ižm curious what type 
of practice you have. Is it cash or insurance and what type of volume do you 
see.  Do pt's pay as they go or do you carry accts.  Do you have adjusting 
rooms or an open adjusting room for all.  Do you do any specific work, x-ray 
every pt. to find a static subluxation, do you do post scans to see if you 
corrected the subluxation or do you go by symptom response, are you full 
spine or upper cervical, what is your technique of choice. Do you do post x-
rays to see subluxation correction.  Do you charge per visit or do you offer 
pre-pay programs.  Actually these are the most important practice mgt. 
question we need to ans. for our newly graduated DC.  What is your fee.  
Most definitely always ask for referrals.  How long is your report of findings;  
Please respond.  thanks.

A:

Thanks for your e-mail. To answer your question point by point would take 
much time. I taught until recently a class at Life University concerning starting 
a practice and the text I used and wrote is called Smart Start. Your questions 
were the topics I covered and took an entire quarter to cover. Unfortunately, 
students graduate chiropractic school with hands on patient experience but 
little hands on business experience. Your questions dwell more on what to do 
with the patient once they are in but little about getting and keeping them there. 
This is why I created the class I taught for four years at Life and why I wrote 
the book. Each chapter has two sections .. the first half concerns practice 
management .. the questions you asked .. the second part is public relations .. 
getting them in. I recommend you purchase the book.

Now .. to answer your questions .. Ižve been in practice for 22 years and 
have a general practice. I use the Activator for all new patients and then mix 
and match using diversified.. drop table .. Cox .. etc. I have Spinalator type 
tables and also occasionally use muscle stim. I have many relationships with 
local HMO and PPOžs and have gotten lazy as they usually fill my office up 
with new patients. Until recently, I was involved in many corporate 
ergonomic programs and would generate patients from the community. Since 
these insurance plans all differ from a few approved visits to many .. I attempt 
to convert my patients into what I call „corrective and maintenance care.ū No 
matter what their insurance approves .. especially the limited policies .. I try to 
have them decide to continue care on their own and I offer them a few options 
over a period of time to pay. You can find my financial worksheet and many 
other ideas on my webpage: http://www.mindspring.com/~chirosmart and 
search under Practice Tips. 

I do not personally like open adjusting .. although a number of my friend have 
their office set up that way .. so I donžt do it. I have a circular flow of my 
office. The reception area is a 14 foot added and built new extension of the 
bldg. I recently bought and moved into 2 years ago .. it is quite large and 
comfortable. The adjusting room .. one only .. has a Zenith Hilo with drops, 
there is a straight bench and an old McManis table for the lumbar distraction 
(Cox) work. The „therapyū room is next to it and behind the CAžs desk .. has 
five spinalator type tables and there is a small room with a straight bench 
across from the adjusting room with a muscle stim and where I place patients 
that I occasionally block (SOT). So .. I have a diversified office and use many 
technics. 

All patient who become patient are x-rayed. I do spot films .. area of concern 
and if I feel the opposite end (lumbar or cervicals) will be a problem I may just 
do a lateral of the area .. the other is AP and lateral. I had a 14x36 bucky in 
my other office .. was there for 19 years .. and loved to take full spine views. 
I do not post x-ray often. If I was into CBP or other technics that required line 
analysis and specific changes I would do it. I find that chiropractic is very 
diversified between those that get into the mechanics and those that get into the 
generalities. Math was and still is my worst subject so analytical chiropractic 
is not my cup of tea .. although I applaud those that do. After 22 years of 
practice and getting the results that I feel comfortable with .. I feel no need to 
change .. just broaden my knowledge base. So .. in answer to whether I am 
subluxation based or just general in nature .. pain reduction .. I am both. 
Although I do not use the x-ray as my only criteria  I do go over very heavily 
the subluxation complex and the role our spine plays with general health and 
wellness. Patients decide .. and that is the key after my humble educating 
them .. whether they want to go beyond relief into what I call corrective care. 
This can be over a  period of six to twelve months. Fees are discussed and 
financial options are available and known to them.

As far as fees .. our office fee is $35 a visit. Since I have a large percentage of 
HMO and PPOžs the co-payments and insurance payments are our concern .. 
this is limited in scope but they do market patients here and then we attempt to 
convert them into the cash program. We use a program called PCD (preferred 
Chiropractic Doctor) which is in many states that is a supplement to their 
insurance and reduces my fee .. decided by me .. to $25 from $35. This is 
optional in an office setting and is what I chose to do.

My report of finds differ to some degree depending on the patient and what I 
need to do to get them to understand. I use a Parker handbook which is quite 
good and a created book of structure and spinal pictures that I go over with 
them

I hope this answers your questions. If finances is limited I recommend you 
purchase my Smart Start Book which has most of what is in the others except 
the PI book. 

By the way .. if you find value to my weekly e-mails and you know of other 
DC's with an e-mail address .. please have them contact me about my weekly 
e-mails or send me your chiropractic e-mail address list and I'll get these folks 
on board. This is how my list grows

While I have your attention .. a mild commercial for my books:

If you wish to purchase my Smart Start Book ($59.95) or my PI Workbook 
($20) or Workshop Workbook ($20) or the PR and Marketing Book ($20) or 
a document disk for the Smart Start Book with the forms and letters and a 
complete narrative with ratings for Windows and Mac (please request which) 
($15) .. you can do it on-line at http://www.chirostore.com/cgi-
bin/netcat.pl?page=cat8.htm .. or call my office at 770-491-3639 and order it 
directly.

Also .. I am scheduling one day weekend seminar dates for my Marketing and 
Public Relations program. Information can be found on my webpage: 
http://www.mindspring.com/~chirosmart under Seminars. If interested in 
sponsoring a seminar call my office or e-mail your interest. 

Have a Great Day

Dr. M