Making Money With Active Care (Part 2)

Editor's Note: Part 1 of this article appeared in the July 2016 issue.

Your Active Care Protocol

In an active care protocol, most patients will receive a chiropractic adjustment plus 2-3 units of active care. In the limited insurance reimbursement payment model, combined with a DMPO discounted fee schedule for non-covered services, the total average fee per office visit will range from $55-$75.

The length of an office visit will be approximately 45 minutes. This includes 38 minutes of active care plus an adjustment. This increases the perception of value of the office visit.

A patient who just drove across town and sat in your reception room is not going to be easily satisfied with an office visit that lasts only 20-25 minutes before they have to turn around and leave again. Adding active care to your treatment protocol increases patient retention due to this increase in perceived value.

It's important to note that 8 minutes is the minimal billing time for an active care procedure, but it need not be a consecutive 8 minutes. The provider could be with a patient for 2 minutes and then with another patient for 2 minutes, and then could return to the original patient for the balance of the time.

In order to bill 38 minutes (three units), the provider must be face-to-face with the patient for 38 minutes. Active care procedures are one-on-one supervision codes and you must be diligent with compliance in this area.

Be mindful of your patients' waiting time. Patient retention decreases considerably the longer a visit goes over the 45-minute mark. I teach our clients that once the patient is out of the acute phase of care, there is no significant therapeutic difference if the patient receives their chiropractic adjustment before or after the active care procedure.

It is rare for active care procedures to be the limiting step in creating a practice bottleneck. Your front-desk assistant can manage patient flow in the practice by guiding the patient to receive whichever procedures will result in the least wait time.

With patients' busy schedules, it is important to let them know that you respect their time and do your best to keep waiting to a minimum. Having patients sit in the reception room reading magazines with three patients in a line ahead of them to see the chiropractor doesn't build perceived value.

Equipping Your Active Care Suite

Making the decision of whether to include high-tech (e.g., weight stack or mechanized) equipment or low-tech (e.g., bands and stability balls) depends upon two factors: budget and space. Some practices with extra space and a flexible budget may decide upon high-tech equipment due to the increased perceived value it brings. Even a few pieces of high-tech equipment can have an upscale, impressive look.

In reality, there is no difference between the CPT codes used or level of reimbursement for high- versus low-tech equipment.

When purchasing active care equipment, be sure you purchase the right equipment. You can buy a whole suite of equipment and not use much of it if most of your patients will be training in flexion and extension protocols.

The typical chiropractic office layout of the past few decades includes multiple chiropractic adjusting rooms with dimensions of about 10 x 12 feet. You can convert one of these rooms into a highly functional active care suite with all of the low-tech active care equipment you will need for a few thousand dollars.

Hanging mirrors on one of the walls increases the perception of the size of the space and also acts as a visual assist to help patients maintain proper form when exercising.

Staffing Your Active Care Department

Staffing your active care department depends upon your state's scope of practice. A small number of states require the doctor to perform all active care services. In other states, these procedures can be delegated to chiropractic assistants who receive training in the procedures from the supervising chiropractor.

Many practices hire athletic trainers to staff their active care department due to their knowledge and training in the procedures.

In some states, it is beneficial to consider adding a licensed physical therapist and physical therapy assistant to your practice team. Before hiring a PT, it is important to determine the insurance allowables in your state.

You must determine if both chiropractic and physical therapy services are paid out of the same benefits package. In this case, physical therapy may use up the chiropractic benefit.

In other states, chiropractors and PTs receive the exact same reimbursement, which also may limit the economic benefit to the practice.

Perform an analysis of the Medicare and federally funded insurance patients in your practice and determine the number of visits it would take to support a PT. In many cases, if you have a significant number of Medicare patients receiving active care at a discounted DMPO fee, it could make good financial sense to hire a PT.

It is important to note that Medicare requires patients to have a current prescription from a medical doctor in order to have physical therapy services reimbursed. This prescription is most commonly obtained from the patient's primary care provider and must be updated a minimum of once every 30 days.

Check your local laws to determine if your state's practice act allows chiropractors to employ PTs. Some states prohibit this relationship.

When staffing your active care department, in every scenario (CA, AT or PT), it is essential to hire staff who are upbeat and athletic, with an outgoing, sparkling personality – people who can move!

Rather than running an employment ad, my clients have found it helpful to take a trip to their local gyms and health clubs to speak with the manager on the floor. Speak to the ATs and let them know what you are looking for.

Many ATs must supplement their income by working outside of the health club environment and would love the opportunity to work in the professional setting and get consistent work provided by a chiropractic practice.

I recommend a multi-pronged approach when searching for a physical therapist for your team. PTs are highly-sought-after professionals in certain areas of the country and at times, you may need to work with a professional headhunter.

My clients have found that the area of home health is an excellent source of PTs, as the work is difficult and the setting is challenging. Working in a chiropractic practice can be an enticing alternative for these individuals.

All states have a public record of all licensees. You can mail a recruitment letter to the PTs' home addresses targeted to the area near your practice.

This approach is effective for attracting the attention of candidates who may not be actively in the market for a job, but who would consider a change if the offer were presented.

Don't Be Passive About Active Care

Your practice is filled with patients with acute and chronic conditions that are treatable and preventable with active care. Yet according to a recent survey, only 50 percent of chiropractors offer their patients ancillary services such as active care exercises or functional testing.

The objective documentation of functional improvement is the undeniable way to establish medical necessity for the care you deliver.

Setting functional goals motivates patients to continue with necessary care beyond pain relief, and increases compliance and retention. Adding active care to your practice is good for your patients and good for your bottom line.

Dr. Mark Sanna, a 1987 graduate of New York Chiropractic College, is a member of the ACA Governor's Advisory Board and a member of the President's Circle of NYCC and Parker College of Chiropractic. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com).