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Dynamic Chiropractic – March 26, 1993, Vol. 11, Issue 07

Practice Management

By Richard E. Vincent, DC and Lawrence Markson

I would like to take this opportunity to thank Editor Don Petersen and Dynamic Chiropractic for the establishment of an ongoing column that will deal with issues relevant to chiropractic business management.

In order to function as effective, productive practitioners, we must recognize that there must be a symbiotic relationship between clinical excellence and adherence to the sound principles of business management. We must realize that although we are in the profession of chiropractic, we are also in the business of health care.

This column is intended to provide its readers with contemporary information that allows them to become more informed and, therefore, able to make those everyday practice decisions based upon solid data. The authors of this column are all members of the Society of Chiropractic Management Consultants, and are committed to the highest standards. We welcome your questions and comments.

Richard E. Vincent, D.C., FICC
Burlington, Massachusetts


A Practice Manager's View of Chiropractic in a Changing Health Care Environment

In his classic, "A Tale of Two Cities," Dickens wrote:

"It was the best of times and it was the worst of times. It was the age of wisdom and it was the age of foolishness. It was the epic of belief and it was the epic of incredulity. It was the season of light, it was the season of darkness. It was the spring of hope, it was the winter of despair. We had everything before us, we had nothing before us. We were all going direct to heaven or we were all going the other way."

That was in 1789. In 1895, nearly a century ago, it was the story of the chiropractors who first began to put forth our chiropractic principles. No less, in 1993, it is the same. Nothing changes, yet everything is changing.

What a year it will be. The election is over and the one clear message that emerged was change. The nation wants change in just about everything, but, particularly, in America's health care delivery system.

My purpose is to perhaps place in perspective the tremendous metamorphosis that is happening, how our profession is positioned now, and how this relentless evolution will be affecting our entire future.

Is it the age of great opportunity or is it the age of great fear? Is it the age to capitulate, or is it the age to stand and fight for this precious principle of ours?

If our goal is to earn the public's trust and respect, and to insure our role in the future, we must act right now, while plans to reinvent the american health care system are being formulated. Chiropractic must not lose this window of opportunity -- yes, opportunity. However, we will lose it if we don't make essential "practice management" corrections in this great profession.

For example:

It is essential that all of our chiropractic colleges teach chiropractic philosophy as part of a core curriculum. From a practice management point of view -- indeed from every point of view -- it is this very philosophy that makes us unique and so vital and necessary in an era when other health care disciplines are no longer trusted.

It is essential that our doctors have the ability to articulate our principles and our purpose to the public at large, and do so in a way that Mr. and Mrs. America can understand and respond to.

It is essential that we have a sensible protocol for our entire profession to accept and flourish within, and it is essential that all sound chiropractic concepts and beliefs be available to us for study, consideration, and action within that sensible protocol.

It is essential to make a unified and concerted effort -- backed by our professional associations (including The Society of Practice Management Consultants) -- at educating the public to the multiple short and long-term health benefits derived from having a nervous system that works properly, thanks to the talent and skill of a qualified and competent chiropractor.

We Turn Out Doctors, but Don't Prepare them to Manage Efficiently So That They Can Practice Effectively

It is essential that our practitioners have fundamental practice management skills.

It is essential that low self-esteem DCs be prevented from hurting all of us by using immoral, unethical, and dishonest methods of practice, because they believe that's the only way they can survive.

It is essential that there is professional oversight to monitor and end overutilization of visits, fraudulent billing practices, bait and switch techniques, insurance fraud, low-class advertising, give-it-away-free schemes, and/or any other procedure or tactics that cause us to "lose" in the long run. And you've seen all of it. I certainly have.

We must have integrity that comes from within. It is not enough to be well-behaved just because regulatory agencies threaten censure or penalty and legislatures threaten us with restrictions.

It is essential to discourage DCs from becoming the shills of unscrupulous attorneys, the lackeys of insurance companies and the servants of the almighty buck. This is a time for chiropractic to grow and glow -- not a time for sleaze!

Let's Reinforce and Respond to Those Things Which Make Chiropractic a True Beacon for Outstanding Health Care

As a practice management professional and as an involved, concerned DC, I will continue to call for and work for a central core of chiropractic strength that emphasizes what is right about chiropractic.

For example:

It is right to proclaim and provide a first-class, state-of-the-art, natural healing art option to the people of America.

It is right that our doctors and their offices project our professionalism -- have state-of-the-art concepts and equipment, and represent the finest in health care delivery.

It is right that our doctors have professional expertise, procedural efficiency, business acumen, and personality traits geared for success.

Do not underestimate the importance of the communication role that you and your staff play in motivating patient confidence -- it aids in their health care.

It is right, yes, very right that DCs and CAs are constantly trained to set and achieve honorable and worthy goals. Also, they should strive for high standards of excellence that are reinforced with daily affirmations.

It is right that doctors of chiropractic have honest fees, solid policies, respect for themselves and for our profession.

It is right that all DCs learn the financial wisdom to save regularly for taxes, save weekly for themselves, pay their staffs well, and grow toward financial independence.

It is right to protect your family against catastrophe by securing malpractice and other essential insurance.

It is right that chiropractic assistants are trained to paraprofessional status and encouraged to keep learning more to better contribute to patient health care.

It is right that our doctors learn to value their deserved self-image of winners and to function in their practices and their lives as examples of all that is good, wholesome, and honest.


All These Things Are Right and Essential to Motivate and Achieve

Chiropractic in a Changing Health Care Environment

Look at the recent elections. They dramatically showed the difference between the Kennedy era of the 60s where people were inspired to change, and today, where people need and demand change.

Now, I caution you, don't judge your profession in the 90s by the standards of another era. What happened yesterday, a few years ago, or in 1895 has no bearing on today. Times change. They require different responses.

Today's health care delivery system is poised for major change and it demands our attention and action -- mine and yours.

One single factor is going to reshape American health care in the next two or three years. Unfortunately, it is not the quality of care; it is not universal access; it has nothing to do with high technology -- that one driving factor is economics.

Government and the marketplace will try to reduce the cost of health care. However, despite your initial negative reaction, this will actually create a tremendous opportunity for the chiropractic profession.

Here's why. All the research of the past decade proves that medicine is ponderous, costly, and uncaring, and this same research shows chiropractic to be not only clinically effective, but cost effective, and the home-run hitter in patient satisfaction. You bet it does. We are the natural choice when the policymakers look for ways to solve the health care disaster.

Absolutely! But it will not happen unless this profession has a strong, coherent strategy to make sure that it happens.

You've heard a lot of political rhetoric about guaranteeing the public universal access to health care. Don't believe it. The weapon of choice for health care reformers is going to be limitation of access.

HMOs, PPOs, IPAs, and all the rest of the managed care alphabet soup are simply ways to limit access. Will our chiropractic healing art be available within all these programs? Opportunity knocks again, but, only effective, efficient, and unified professionals will have the credibility to grasp it.

Larry Markson, D.C.
Lake Success, New York

Richard Vincent, DC, a graduate of the Chiropractic Institute of New York (1950), is a seasoned veteran in the ongoing social, political and economic evolution of the chiropractic profession. He has served as president of the Massachusetts Chiropractic Society, chairman of the Massachusetts Board of Chiropractic Examination and Registration, president of the Federation of Chiropractic Licensing Boards and president of the National Board of Chiropractic Examiners.


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