Missouri State Chiropractic Association

Did you ever write a letter that started with that salutation? Maybe you actually do not know who is on the receiving end of a correspondence of that variety; or, maybe you do. Personally, I have written those with a mystery recipient as well as the party being known. Today, it is both.

To my fellow MSCA members, I want to salute you for seeing the need to join the only chiropractic organization that is fighting for our rights and the rights of our patients. Historically speaking, those who are active with the MSCA will also be more active when it comes to giving to PAC, participating in legislative day, attending the convention, buying raffle tickets, etc. Well, keep fighting the fight, for our cause is a righteous one. Keep battling while, at the same time, reminding your fellow, non-member colleagues down the street, or across the state, to join the MSCA.

While I know many of you by name, I honestly would recognize many of you by face before I could recall your name. That does not matter. What matters is that we, the DCs of Missouri, have a common cause. We need to recognize this, not one another.

When I take time to attend district meetings and seminars (in St. Louis and across the state) please listen to my message. My message is clear. So please listen and then take action. The action is simple also:

Join MSCA
Join the MSCA Legal Action Fund
Ask your district leaders how to help

If my wife, son or daughter were to ask, “What do you do for your profession?” I would have an answer. If your loved ones asked you the same question, would you have an answer? So, To Whom It May Concern ... may mean more than just you. Think about it.

Executive Directors Report

Member Benefits Help Us All

With your MSCA membership comesgreatto take advantage of several programs already investigated and proven effective for many chiropractors across the state; and, in some cases, across the country. These programs can help your office with day-to-day activities like collections, coding, and credit card processing. Some programs can even help you generate extra revenue for your practice.

The newest member benefit program is a discounted credit card processing program. If you think you are paying too much to process credit cards in your office, you might want to compare your rates with those offered through Central Bank. The MSCA negotiated a low rate that is being offered only to the members of our association.

Of course, the best overall reason for trying one, or all, of the member programs available is the direct revenue stream back to your state association. The MSCA receives cash rewards which can be directed toward the many legal, insurance, and legislative issues needing our attention in order to protect and promote chiropractic in Missouri.

When you pay your 2008 membership dues, you will receive a “Membership Packet” through the mail. Please take a serious look at the programs included in your packet. Taking advantage of even one of these programs will help promote your profession.

THE GOVERNMENT REPORT

Step Up and Fight the Fight

Well, the 2008 legislative session is getting underway. The invasion of Jefferson City by legislators, staffs, lobbyists, special interest groups and news media is in full swing. They come with different goals in mind and go home in mid-May with varying results. Regardless of the individual outcomes, collectively what takes place in Jefferson City over the next five months will, in one way or another, affect how the citizens of Missouri live their lives.

So, you say “So what, there’s nothing I can do. I am but one person with one voice and one vote?” Well, fortunately, you couldn’t be further from the truth. As a chiropractic physician, you belong to a profession that has a loud collective voice in the State Capitol. The question is, do you belong to the two organizations that provide the profession that voice -- the MSCA and MSCA PAC? The professional staffs of these two organizations work 24/7, year round, to protect and advance chiropractic in Missouri. The dedicated members generously contribute by giving of their valuable time, energy, expertise and dollars. Some can afford it, some can’t, but they do it anyway.

If you are standing back and saying, “Well, I don’t need to get involved and become a member of the MSCA and MSCA PAC because they’re doing all the work anyway,” you are doing those dedicated professionals a great disservice. It is not their responsibility to bear the entire burden; but they do it anyway.

So step up! Help us fight for greater patient access, fair and equitable reimbursement, primary care status and the respect this great profession deserves. Step up and join us in the fight to protect and advance chiropractic in Missouri.

INSURANCE REPORT

Medicare
As I reported in the last newsletter, we will have a new Medicare carrier in 2008. I would like to correct what I wrote last month as to the effective date. My current understanding is that the change goes into effect in March.

The reason I say my current understanding is that Pinnacle is still having CAC meetings through June, 2008. Be on the alert for information about the new company’s policies and how they will be handling their
chiropractic claims. I will disseminate the information as soon as it becomes available. Unfortunately, the four-state December meeting that was planned to discuss the new changes had to be cancelled due to weather and will be rescheduled. Remember that Medicare will be phasing out legacy numbers May, 23, 2008.

Miscellaneous Insurance News
The drop dead date carriers need to be compliant with accepting only NPI is May 23, 2008.

Many carriers are accepting only NPI claims in preparation for the mandatory change so make sure that you have notified all of the carriers of your NPI number. Some carriers are requiring special forms to report the NPI. It is better to check ahead than to find out in 2008 by having denied claims.

MSCA Insurance Committee continues to collect data concerning the problems you are having with the insurance carriers. Examples of some issues are coding issues, delay of claims, not paying claims, and making you jump through too many hoops to get reimbursement. If you file a complaint with the Division of Insurance, we would appreciate a copy of the complaint. The Division of Insurance told me that having your patient file the complaint gets quicker action because of the lack of staffing in the provider side of the complaints.

Another avenue for complaints is the Department of Labor through the ERISA appeals process. This would apply to self-funded plans. We will be providing information on how to file ERISA appeals in future newsletters; or, you can call the MSCA for information. The ACA website also has information on filing appeals through ERISA.

Send correspondence to: MSCA Insurance Committee, 500 Mae Court, Fenton, MO 63026 or email freihaut@ruralcom.net.

Insurer's Claims Practices in the Spotlight
A November 8, 2007, article in The Kansas City Star highlighted a local automobile accident case which had far-reaching implications. A local Jackson County judge fined Allstate $25,000 per day for failure to produce documents prepared by consultant McKinsey & Co. Many plaintiff lawyers and at least one consumer group contended that Allstate has undercut the morale and ethical underpinnings of 150 years of insurance practice by engaging in the strategy of reducing claim payments in an effort to make bigger profits.

For more information regarding this article, contact Joe Lambe at The Kansas City Star, telephone number 816-234-4314. You may also email him at jlambe@kcstar.com.

Dr. Gay currently is the founder and director of Ultimate Practice, a chiropractic consulting and practice management company. He has authored several books, as well as numerous CD and video products for the chiropractic profession. Dr. Gay can be reached at 1(866) 797-8366, or timothygaydc@ultimate practice For more information on Ultimate Practice, visit their website at ultimatepractice.com.

AUXILIARY REPORT

The MSCA Auxiliary is developingemail databaseCAs, Office Managers, and Spouses of chiropractors in Missouri. If you would like to add your CA, Office Manager or Spouse to this list, please submit their information. We promise not to overwhelm them with insignificant information and details. Instead, we will offer information on seminars, meetings and events which might be of interest.

The Auxiliary takes an active role in planning and carrying out the many activities of the MSCA and PAC. We encourage your staff's membership ($25/year)in this invaluable organization. However, submitting your information does not obligate you, or your staff, in any way.

Please include the name of the doctor and each CA’s name and email address and send to mscaaction@ embarqmail.com or fax to: 573-635-1470.

DISTRICT 1 REPORT

By Michael Finley, DC

Mark your calendars for "Legislative Day," February 12 at our state capital in Jefferson City. District 1 is planning to charter a bus from Logan College for this event. The bus is free; and we will educate everyone on board about the latest issues and how to "lobby" your representative. Watch your e-mail for more details.

No District 1 meeting in December.

The next District 1 meeting will be January 28. District 1 is in need of alternates for Board Meetings. All MSCA members are eligible to be an alternate. Contact any of our representatives for details. Contacts are listed on the MSCA website.

DISTRICT 2 REPORT

Over 200 attendees were present at our recent 36-hour Holiday Extravaganza Seminar, December 7, 8 and 9, 2007, at Holiday Inn Northeast in Kansas City. A similar number is expected for our 36-hour Early Bird Seminar Series held at the same location February 7 through 10, 2008 at the same location.

The February seminar kicks-off on Friday, February 7, with 12 hours of Meridian Therapy/Acupressure with no other than that of: Drumright and Crow’s Excellent Adventure. Yes, the acupuncture boys have been busy this summer traveling all the way to China. They gathered both ancient and recent clinical acupuncture pearls to be dispersed at this seminar with slide shows, demonstrations and physical participation. The Differential Diagnostic Rounds awoke even the sleepiest doctor in the house and is back again this February`08. You will be able to obtain all 24 hour credits either Friday and Saturday - February 7 and 8t or Saturday and Sunday - February 8 and 9. Please go to the MSCA website at www.mscainfo.com. Click on the District 2 pages for more current information about the seminar. For additional seminar registration and information please call Dr. Russ Matthias in Blue Springs at 816-228-5113. For vender booth registration and information please call Dr. Linda Buckmiller in Smithville at 816-532-8966. Some restrictions may apply and space is very limited.

Be entered in a drawing for prizes by bringing your family’s best cook book recipes (one or two) for the MSCA District II Chiropractors Cookbook of Healthy Alternatives, which will be published in time for distribution at next year’s (2008) Holiday Extravaganza Seminar. You may email the recipe to me at docmanfredi@Yahoo.com. All proceeds of this publication will be awarded to the Kansas City Chiropractors Legal Action Fund (KCCLAF).

DISTRICT 3 REPORT

We had an excellent turnout for our 6th Annual Natural Healing Symposium and raised a tidy sum for the MSCA. We had many excellent speakers. Our featured speaker was Lyra Heller, who is one of the founders of Metagenics.

DISTRICT 4 REPORT

By Loren Smothers, DC

District 4 and Rivercity Imaging are joining forces to sponsor the “Winter Bliss Seminar” on Friday, February 22, and Saturday, February 23. The seminar will provide 18 hours of classroom training, as well as 6 hours of audio instruction, for a total of 24 hours of continuing education credit. Our instructors are very well known and respected experts in various aspects of chiropractic care: Dr. Patrick Gentempo, Jr., Physical Diagnosis; Dr. Duane Marguart, X-ray; Dr. Angel Tribuno, Boundary Training; Dr. Joel Miller, Pediatrics: and Dave Mager, General Studies. Lunch will be provided on both days.

On Friday night, everyone is invited to attend a mini Total Solutions dinner event. There will be an additional cost for this meal. Details will be sent as soon as they become available.

The seminar will be located in Cape Girardeau, at the Drury Lodge, 573-334-7151. The hotel is offering special room rates for this event if you mention that you are attending the Missouri State Chiropractors seminar.

Please contact Dr. Loren Smothers at 573-996-2911 or 573-785-9355 to register now. Seating is limited, register early.

DISTRICT 5 REPORT

Our annual Christmas Party is scheduled for December 15, 6:30, at the Holiday Inn North in Springfield.Our winter re-licensure seminar is scheduled for February 1-3, also at the Holiday Inn North in Springfield.We will offer 12 mandatory, 12 general, and 12 acupuncture hours. More information will follow.

The PAC Report

We had a great PAC trustee board meeting on Saturday, October 13, 2007. As of this date, we have 123 members and are preparing for Legislative day Tuesday, February 12. A PAC golf tournament was discussed, and we hope this will be an annual event with a new location throughout the state each year.

There will be a PAC membership meeting andat Convention on Friday night, August 1, 2008, for all members. We are presently in the process of producing a new application for PAC membership. Stay tuned.

Guests attending were Dr. Quinn James, Dr. Russel Matthias, Dr. John Dennehy and Dr. Chancellor Wayne.We cordially invite everyone to attend the next PAC board meeting, Saturday, January 26, 2008.

MEMBERSHIP REPORT

2007 marks, by far, the largest membership in MSCA history. The MSCA is only a very short distance away from representing the “majority” of chiropractors in our state. This is extremely important when dealing with legislators, insurance companies and other groups or professions.

We have seen in the last few years what the additional membership strength of the MSCA has meant to our profession. There were three major pieces of legislation passed (Lien law, HB121, New Practice Act); the organization of a legal action fund; coordination of several lawsuits; greater financial stability for the MSCA; and the ability to hire additional lobbyist when needed. There are just too many things to list.

To all the members of the MSCA, thank you. I know docs who have been members for over 50 years, and many others who just joined. Now that you’re “in,” stay a member. I know sometimes you might wonder what has the MSCA done for me lately. Go to www.mscainfo.com, attend a local district meeting or board meeting, or call your local MSCA representative to find out. Let’s be real, the MSCA probably will not pass a major piece of legislation every year, or help win a lawsuit, but it’s always there to protect and advance chiropractic.

Increasing membership for 2008 is a major goal, but something else is just as important. New leaders. The one major concern we are having is a lack of new leaders. Remember, the MSCA is primarily a volunteer organization. There are many other things we could be doing, but lack the help. New leaders bring in new energy and ideas. The next time you see, or talk to, an MSCA representative ask, “How can I help?” Remember, many of the current leaders have severed for years, and have been there for you. Give back to the profession. Ask how you can become involved.

Feature Article: Electronic Medical Records: The Time is Here, Face the Fear

As of 2006, adoption of EMRs and other health information technology, such as computer physician order entry, has been minimal in the United States. Less than 10% of American hospitals have implemented health information technology (HIT), while a mere 16% of primary care physicians use EHRs (electronic health records). The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.

This situation exists despite a number of concurrent trends suggesting that it is imperative for healthcare professionals and institutions make haste in converting from traditional handwritten, paper-based procedures to electronic methodologies – commonly referred to as electronic medical records (EMR) -- along with associated systems for business management. The Health Insurance Portability and Accountability Act (HIPAA) is currently the elephant in the reception room and for several years the matter of compliance has caused many a sleepless night. Other types of regulation, licensing and oversight issues also intrude, and third party reimbursement issues are a constant.

Given the prevalence and persistence of such factors, logic would suggest that practitioners would long since have been clamoring at the doors of technology houses for electronic solutions to their records, documentation and operational problems. Obviously it hasn’t happened.

And historically, it has happened even less frequently in the chiropractic profession. It is not hard to identify some of the reasons: most chiropractic offices are relatively small and chiropractors often lack business training. Many struggle to balance business and science in their professional lives.

To someone familiar with technology and its application, the answer is obvious – get electronic solutions and use them. Unfortunately, there exists a climate of fear. Prominent among the fear factors are the lack of I.T. awareness, insecurity about information sharing, risk to existing records and the cost and difficulty of conversion, fear of change (a BIG one for everyone!), doctors’ fear of their own technological limitations, fear of financial costs, and trepidation over standardized versus custom terminology.

Knowledge makes you free
Knowledge is the universal key that frees doctors from these fears, so let us bring them out of the shadows and look at them in the light of understanding. First, just what are these “electronic medical records” we are talking about?

Electronic records in healthcare are considered part of a higher level I.T. category called “healthcare informatics,” and are a combination of computation and computer science and medical record keeping. An electronic medical record (EMR) is a medical record in digital format that is, an electronic data file. Advantages of keeping records in digital format include:
access to patient data by clinical staff at any given location accurate and complete claims processing by insurance companies
the ability to automate clinical notes the ability to quickly establish and maintain schedules for personnel, patients and office resources.

Originally focused on professional activities the term “EMR” has in popular usage grown to include systems which keep track of other relevant medical information, most specifically the practice management system. The practice management system controls the medical office functions that support and surround the electronic medical record.

All I.T. solutions carry some potential for vulnerability and EMR systems are no different. Nevertheless, when security policies are maintained and monitored effectively, EMRs are as secure as banking records, to cite one example.

The Fear Factors
Interoperability and record-sharing
Without interoperable EMRs, practicing physicians, pharmacies and hospitals cannot share patient information, which is necessary for timely, patient-centered and portable care. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), in order to address interoperability issues and to establish a National Health Information Network (NHIN). Congress is currently working on legislation to increase funding to these and similar programs.

Adding paper records to EMRs
The digital scanning process involved in conversion of the physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.

Social and organizational barriers
According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), and creating a collaborative environment that fosters communication between physicians and information technology project managers.

Technology limitations
Limitations in software, hardware and networking technologies has made EMR difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Prior to the recent introduction of IEEE 802.11 g and n wireless technology the access to large files such as MRI and X-Ray images was slow. With these new wireless technologies data can be securely transferred at speeds of up to 108Mbps, across extended distances and in older buildings built with brick or concrete walls. Tablet PC technology has significantly improved over the recent years with the introduction of Windows XP Tablet PC Edition, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions.

Price
One of the major barriers in adopting an EMR is price. The average price for an EMR solution today is around $35,000 per provider. It does not have to be that expensive!

Canned Documentation
Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is because the majority of EMR systems are based on templates that are initially general in scope. In many cases, this involves extensive, expensive customization. The alternative is the production of documentation that is overly similar document-to-document, suggesting that the physician is less than conscientious in the conduct of exams and the production of notes and reports.

Facing the fears
Take the time to identify a system that is designed exclusively for the chiropractic profession, and which accommodates all of the physical and non-physical barriers of the current issues mentioned above.
Interoperability and record-sharing Such a system can take any digital and physical patient file and import it to the patient folder for ease of access. X-Rays, MRI reports, ROM tests, etc. will be one click away from the patient record.

Adding paper records to EMRs
As mentioned above, there is no way so far to perform this process other than scanning the paper records to convert them to digital files. The interoperability function mentioned above may involve an investment in time, but once you’ve made the investment, you have overcome the major barrier to converting your practice to a paperless environment.
Social and organizational barriers EMR does change the way how you manage your office by improving the workflow and productivity. Admittedly, there is learning curve to the system and in considering any EMR solution you must be open to change. The word change is scary, but it is also a good word.

Technology limitations
An ideal solution will work with the most popular computing platform and network environment, and if it can enhance portability through use of a Tablet PC, so much the better. Such implementations can deploy a secure wireless connection between the network server and the Tablet, meanwhile keeping your information safe.

Price
When used to its full capacity, a standards-based system can drive a return on investment of less than a year. The price problem goes away.

Canned Documentation
Explore a solution that is based on concept processing technology, which derives its power from the physician’s own knowledge. The more detailed the doctor, the better such a system will document. The system should come pre-populated with professional verbiage from authoritative sources of medical documentation, but users should modify, delete and/or add information and in so doing, make the medical documentation their own. In this manner, no two documents will ever look the same, solving the last problem mentioned above.

Conclusion
When comparing the United States EMR industry with the European Community, Australia and Canada, the numbers are not impressive at all. USA is at the bottom in the list. Nevertheless, solutions are becoming available that allow the chiropractic profession to contribute to an increase the percentage of adoption and to position this country where it deserves to be.

You should not adopt an EMR system only because there is a national mandate to implement such a system before 2014. You should do it because you understand that an EMR system will improve your practice to previously unattainable levels and that the end result will be better care for your patients, a better livelihood for your family and a more satisfying career for you.

About the Author
Cesar Barragan formed a company to develop the RAPID electronic documentation solution for chiropractors. The company was acquired by ACOM Solutions, after which RAPID continued to evolve, becoming a complete Electronic Medical Records and Documentation Solution. Barragan continues to enhance the product line while researching new technologies and solutions for the constantly changing healthcare industry.

To learn more details contact ACOM Solutions, Inc. at 1-866-286-5315 or visit www.acomemr.com today!

The Dinosaur and the Computer

Previous to the mid 1980s, practices were paper friendly and there was no real need for new technology. Doctors that graduated before 1985 could monitor their practices simply by turning a page on a scheduling book and using some color pens to differentiate the type of patients.

I am one of those doctors from that dinosaur era. The fears of the computers in my office were an indication of me not knowing enough about how to use them. Somehow the term computer friendly did not compute.

After the chiropractic Stone Age, there was a new generation of chiropractors that understood the importance of getting information and knowledge out to their patients and colleagues at a faster pace by utilizing this new technology called the computer. Since, we have become more and more dependent on its use in practice. And the dinosaurs are going to have to change with the technology.

Lets look at just a few of the benefits of this magnificent technology: 1) Being able to use current software to statistically monitor the practice. At the touch of a button you can have the five most important practice statistics at your fingertips; 2) With the proper software, you can schedule patients, keep accurate billing information, set up patient calendars, use mailing lists to send information and generate practice accountability; 3) Speed. The faster the computer, the more time it allows the CA to complete high priority duties; 4) Accuracy. When the data is input properly the first time, there is no need to go back to check and recheck what has already been done; 5) Efficiency puts all the components together that continue to keep an office running smoothly.

Now that we have seen the up side to computer utilization, let’s look at some of the pitfalls: 1) Make sure that everyone who uses the computer has been trained and understands the procedures and systems. Cross train and have more than one person with the knowledge. Annual training sessions with the software company should be negotiated into the package at time of purchase; 2) Crashes. If a computer crash occurs, essential data may be lost. This can take time and money to retrieve or worse yet, your program and all related data may be permanently lost if you don’t have a properly maintained backup system; 3) Learning the basic fundamentals of what the program is capable of will minimize the effectiveness of your investment. Scratching the surface or just getting by will help somewhat, but that should not be the purpose behind having a computer in the office; 4) Eliminating at least one person in the office because of the efficiency of the computer is a myth. Even though the capability is high on formulas and statistical analysis it still takes a trained individual.

The computer may have its ups and downs, but in our current practice environment, it is a must. There are doctors across the country that have absolutely no idea as to how to run the computer systems in their offices or how to use the information they provide.

If you want to be a dinosaur it is OK, but at the very least, know the right questions to ask to get the information on how your practice is functioning. You should have an understanding as to how much is being billed out, how much is collected and how much is outstanding in a weekly aging analysis. Your system should give you an accurate accounting of what patients have dropped out of care and who needs to be recalled.

These are just some of the basics, and dinosaur or not, the most important thing is to have people that know how to use the computer and understand what you need to be in the loop because it is your practice. Computers and new technology are here to stay. But unfortunately, only 26% of chiropractors have an e-mail address. Professional websites are also underused as a tool to get our message to the public.

It is up to us as a profession to provide not only the best chiropractic care but the highest level of service and information to our patients so they can help us spread the word of chiropractic to the world. The dinosaurs need to educate themselves on the value of this technology and start using it to a higher degree in practice and patient education. If this dinosaur can do it so can you.

CA’S CORNER

Attitude, Ability or Training

It’s not fair - insert large tear stains here - nobody told you that you would have to be an office manager. (For that matter, no one told you that you would have to be a salesperson or billing company either, but that’s a discussion for another day.) You thought you would graduate from school, hang up your shingle and the patients would come flooding in and staff would magically appear, right?

Unfortunately, in order to have a successful practice, you must acquire many skills including knowing how to hire, train, manage and fire employees. Even if you hire an office manager to manage the staff for you, and I don’t generally recommend it, you still have to manage the office manager.

It is a sad fact that many office managers end up as de facto union reps, doing a better job of representing the staff than they do you. If you don’t learn to be a good manager, you will find yourself spending more time dealing with staff issues than building your practice. So how can you learn to be a good manager? You can start down the right path with two important thoughts.

First, let’s stop calling them “the gals”, “my girls”, “the staff” or whatever you tend to call your employees. Start calling them, and more importantly thinking about them, as your team. A football team can have a great quarterback, but of what use is the best quarterback in the league without a great offensive line up front to block for him? Sure, you are the doctor, but without someone to answer the phones, greet the patients, schedule the patients and collect the money, where would you be? Your team members are just as important to the success of your practice as you are. The only difference is that you are a permanent member of the team and they are not.

Second, recognize that if a member of your team is functioning at a less than optimal level you can generally narrow it down to one of three factors.

Attitude
Attitude is the choice of each team member. It is your responsibility is to provide a working environment that allows the team member to have a great attitude and the team member’s responsibility to choose that attitude. Attitude includes a person’s general outlook on life, their work ethic, and their personal problems or lack thereof. Employees generally bring a “glass half full or glass half empty” attitude with them when they join your team. A front desk assistant once told me that she couldn’t always have a great attitude and that if she pretended to be in a good mood she would just be acting. I replied that although our preference was a genuinely good attitude, if she couldn’t do that we would settle for the acting.

Ability
Ability is also something that the staff person brings with them to the office. They are either capable of doing the job, or they are not. Ability might include skill sets in reading, math, communication, education, overall personality and general intelligence. For instance, certain employees have math skills, whereas others are math phobic. No amount of training will enable a math phobic person to be able to quickly and consistently balance the books at the end of the day.

Training
Training is the factor that rests squarely on the shoulders of the doctor and, in my experience, is the most common reason a team member does not perform at the level they are capable. Do you have written job descriptions, policies and procedures? Have you scheduled a specific time each day or week to train and to review procedures? Do you role play your office dialog? Do you have regular team meetings? Are your expectations clear?

Ultimately if you have a team member that is not working out, you want to make sure that you have done all that you can do before you consider letting them go.

Although you can’t control a person’s attitude or ability, you can improve your hiring skills thereby increasing the odds that you will hire a person who has the attitude and ability you are looking for. Further, you must develop the procedures and systems that will help you to train your team members, so they will take the very best care of your patients possible.

News & Views

Update: Aetna's Policies on Adjusting Instruments and IFC
Since February 2007, ACA has been in communication with Aetna regarding many of its policies with which we have concerns. One such policy identifies the use of handheld devices by chiropractors for manipulation as well as interferential current (IFC) as “investigational and experimental.”As such, these procedures will no longer be reimbursed under Aetna policies.
Aetna has been presented with extensive information, including Medicare policies in connection with handheld devices, to demonstrate that such procedures are not investigational or experimental. According to the Medicare Carrier Manual, “Manual Manipulation-Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine.”

ACA Contacts Insurers To Address Concerns
In October, ACA’s Insurance Relations Department kicked off an effort to reach out to insurers. Department staff members telephoned insurer contacts from the Claims Solutions Work Group to discuss any problems they may be experiencing in regard to chiropractic claims. Through these calls ACA hopes to make the chiropractic claims process more efficient for both providers and insurers. To this end, is offering insurers resources to educate their employees on chiropractic care. We are also developing web resources to assist insurers in processing chiropractic claims. We are hopeful that these efforts will effect positive change in the sometimes difficult relationships between insurers and providers.

Stand Up and Be Counted! Health Care Industry Data Crucial to 2007 Economic Census
This month, more than 4 million American businesses – including many run by doctors of chiropractic – will receive 2007 economic census forms as part of the nation’s most comprehensive measure of business and industry. According to representatives of the U.S. Census Bureau, the participation of health care and social assistance businesses is especially crucial in the census, which is conducted every five years. “Important economic indicators, such as gross domestic product, are directly related to the quality of the data we get from businesses in every industry and every locality,” Thomas Mesenbourg Jr., the Census Bureau’s associate director for economic programs. Data obtained can be helpful for business owners, who look at benchmark values from the economic census to make informed decisions about expanding into new regions or markets, to see where they stand in the marketplace to research market shares, salaries, product and sales trends.

Firms in more than 1,000 industries will receive forms during the month of December, which must be returned by Feb. 12, 2008.Businesses that receive forms are required by federal law to respond. Information about individual firms is kept confidential and only aggregate industry data are published.

UHC Announces Policy Implementation Delay; ACA Requests Direct Response
As United Healthcare (UHC) reconsiders its policy restricting chiropractic treatment of children, adolescents and headache patients, the ACA continues to aggressively push UHC to rescind its “unfounded” position and explain how it was developed in the first place.“We fail to understand how United Healthcare could have come to these conclusions without having done careful research,” says ACA Executive Vice President Kevin Corcoran.UHC has delayed implementation of its flawed policy pending additional review. Over the next three months, UHC will be reviewing research and information provided by the ACN Chiropractic Professional Advisory Committee (CPAC) and other chiropractic organizations.ACN/Optum Health has begun notifying providers of this reconsideration (through an Oct. 29 letter and an article in the November 2007 UHC Network Bulletin).The decision to review the policy followed an Oct. 25 meeting between UHC policy makers and the CPAC – as well as an unprecedented profession-wide effort led by the ACA demand a rescission of the policy.ACA will continue to closely monitor this issue and develop our next steps as information becomes available.

Health Care Discount Programs
Because of the confusion that sometimes accompanies healthcare discount programs, the ACA House of Delegates passed a resolution at its September 2007 meeting that provides members with guidance on these programs. Over the past few years there has been an increase in the number of health care discount programs. While these programs are not actually health insurance, often use terms similar to those used by insurers. Participation in reduced fees for patients when visiting certain providers. Discount programs sometimes affiliate with Preferred Provider Organizations (PPO) to offer their enrollees access to a specific group of providers. This can also be used as a way to reduce what an insurer pays for out-of-network providers’ services by getting them to accept reduced reimbursement. Affiliation with a PPO, however, does not alter the fact that the discount program is not an insurance program. Providers who are part of a PPO should check with insurers to determine if they affiliate with any discount programs.

MSCA ELECTION

Please read the information below if you are considering running for office, nominating someone for office, and/or voting for these offices, whether in person or by absentee ballot:

ARTICLE VIII: SECTION 4: Nominations
Nominations for elective office must be filed with state office sixty (60) days before the annual convention (Monday, June 2, 2008). Nominations must be accompanied by a letter from nominee accepting the nomination. Nominees will be put on ballot alphabetically. There will be no floor nominations at the annual convention.

ARTICLE VIII: SECTION 2A: Eligibility
No person shall be eligible to any elective office who has not been a member in good standing for at least one (1) year immediately preceding nomination and must be licensed and practicing in Missouri.

ARTICLE VI: SECTION 9: Absentee Ballots
Any member who will be unable to attend the annual meeting may request a ballot at any time prior to thirty (30) days (Tuesday July 1, 2008) before the convention and vote absentia for candidates only. These ballots must be returned to the state office fifteen (15) days (Wednesday, July 16, 2008) before the annual meeting. Ballots will not be opened until convention meeting.

ARTICLE V: SECTION 2: Voting Rights
Voting rights- each regular member shall be entitled to one vote on each matter submitted to a vote of the members. Members must have their dues paid in full or have paid the preceding 4 quarters to be eligible to vote at convention. Associate, student and honorary members shall not be entitled to vote.

Classified Ads

Advertiser Directory

BMI Brown’s Medical Imaging
800.701.9729
www.brownsmedicalimaging.com

GW Heel Lift, Inc.
800.235.4387
www.gwheellift.com

Lawshaw Distributors LTD
800.270.4263
www.invertrac.com

Logan College of Chiropractic
636.227.2100
www.logan.edu

Long Creek Herbs
417.779.5450
www.longcreekherbs.com

Key Company
800.325.9592
www.thekeycompany.com

MRI of Springfield
866.674.7828
www.mrispringfield.com

NCMIC
800.769.2000
www.ncmic.com

Nutri-Dyn Progressive
800.392.5746

OUM Chiropractor Program
800.423.1504
www.oumchiropractor.com

Standard Process
Eastern: 800.532.2128
Western: 816.769.1043
www.standardprocess.com

Vita-Herbs, Inc.
800.325.1108
www.vita-herbs.com

For Advertising Information, please call Jill Snodgrass at 573.635.0979 or email info@dailyplan-it.

The Missouri Chiropractor - January 2008

President's Report

To Whom It May Concern...