I am a second generation chiropractor and have been practicing in Scottsdale/Phoenix, Arizona, since 1987. While I have loved and continue to love serving patients, I became very frustrated towards the late 1990's. For a number of years, getting reimbursed in chiropractic was quite easy. Almost everyone had insurance and the average deductible was $200, with the insurance company paying 80%. There were no limits on dollar amount or number of visits. For personal injury cases, we would treat the patient, send in our bills, get paid in full at an average of about $3000 and the patient would get a settlement for about three times the medical bills. Back then, our documentation didn't seem to matter! But, when it changed, it changed. Reimbursements were lower, deductibles and co-pays were higher and our PI cases were getting crushed.
Another frustration I had was with explaining to the patient what was wrong with them. The typical examination I performed at the time really didn't show much in the way of abnormal findings. It reinforced to the patient that they were in PAIN and that they wanted to be OUT OF PAIN.
When I talked to my patients about seeking chiropractic care for something OTHER than pain relief, I felt like a salesman, not a doctor:
"Would you like some fries with that adjustment?"
I just knew there was a way that we can SHOW our patients what was wrong with them. If we couldn't actually SHOW them their subluxations, maybe we could show them how their FUNCTION is affected by the subluxations.
I started taking more seminars pertaining to documentation in the late 90's and read anything I could get my hands on that related to reimbursement. I learned that the quality of reimbursement is in direct proportion to the quality of our documentation. So, I learned whatever I could about documentation. I studied the Mercy Guidelines, which actually weren't nearly as bad as we were all led to believe. I studied the AMA Guides to the Evaluation of Permanent Impairment, 4th and 5th Edition. I studied research regarding personal injury. I became certified to perform IME's and determine impairment ratings through the American Board of Independent Medical Examiners. I did this so I would know ONCE AND FOR ALL what an IME should look like. Then, I could tell everyone else!
I found that what we think we need to document is quite different than what we actually need to document in order to get properly reimbursed. The good news is that there are really only 2 things we need to document - our exams and our daily visits!
And so began my mission: to learn how to do a thorough and well-documented examination that tells me what I need to know clinically AND allows me to prove that my patient needs my care. Once I figured that out, my mission became how to effectively document my cases, including cash patients and personal injury patients and everyone in between, on a day to day basis. I mean, let's face it. When a medical doctor prescribes medication to a patient and has them taking a pill 3 times per day, does the doctor call the patient 3 times a day to see how they're doing? Of course not, but it seems that's what we're expected to do.
Once I figured out the exam and the daily note problem, the challenge was how to satisfy - make that, EXCEED the documentation requirements, IN AS LITTLE TIME AS POSSIBLE.
I found that by examining my patients a particular way, they were understanding what I was talking about. I never had to sell chiropractic to them - chiropractic seemed to just sell itself! Well, I got pretty good at it. In fact, I got so good at it that I was asked to teach other chiropractors how to do it. I started teaching seminars to chiropractors a few years ago, hoping to help elevate our profession and help doctors to succeed. I found that I love speaking and teaching doctors, so I've been traveling all over the country ever since. I'm also constantly searching for companies and products that help us to have exquisite documentation in as little time as possible.
