Navigating Health Reform

2014 is a year of unprecedented change in the field of chiropractic. Along with the impacts that health reform may have on reimbursement, the field is transitioning to new ways of documenting, reporting, and coding. It can be difficult for doctors to adapt to dramatic administrative changes, while continuing to offer patients the highest quality of care, if they do not have a solid system and reliable team behind them.

Mark Sanna, D.C., CEO of Breakthrough Coaching, works with chiropractors to build these teams and systems based upon best practices and objective data, which allows doctors to provide better and more focused patient care. "With the dramatic changes occurring this year, we're focusing on helping our clients manage the change," said Sanna. "Having a great team in place is the best way to make this possible. We aim for 'the pillow factor,' which is the ability to sleep well knowing that all of the administrative aspects of your practice— documenting, reporting, and coding—are compliant, and that this allows you to keep your focus on your patients."

One of the biggest changes the profession faces is a switch from the ICD-9 coding system to ICD-10. This is the most dramatic shift in coding that will have taken place in most chiropractors' careers. In an effort to be more specific, many codes will be replaced with as many as six new variations. This change is great for third-party payers, but invites more room for error for providers.

The standard health insurance claim form is also being adapted to push for specificity by increasing diagnoses from 4 to as many as 12. In addition, the incentive to switch to electronic patient records and reporting will be replaced in 2015 with a penalty for failing to do so.

In order to help chiropractors adjust to these changes and provide the best possible patient care, Breakthrough Coaching offers what Dr. Sanna calls "360 degree coaching." The coaching provides assistance with case management, documentation and coding, as well as marketing and HR services (team hiring, training, etc.). While Dr. Sanna stresses the need for a solid administrative team behind every chiropractor, he also is adamant that there is a need for functional testing in every chiropractic clinic.

"Breakthrough Coaching's approach to case management is completely functional based," said Sanna. "The field's history is one of pain relief, but chiropractors need to shift their mindset towards function. Through the use of objective data, the functional approach also allows you to track a patient's progress, and answer important questions: how is the patient functioning? How is the care helping? When have they reached maximum improvement? Often, pain will be alleviated, but functional deficits still remain, which means the patient wasn't fully treated."

The push for a functional approach is also tied to the changes in reimbursement. What was once a fee-for-service model is now transitioning into a quality-of-care model. The Centers for Medicare and Medicaid Services (CMS) requires chiropractors to perform and document three quality measures: (1) pain; (2) outcome assessment; and (3) blood pressure. Reimbursement is specifically moving towards managing outcomes.

"The level of the quality of care you deliver is how you'll be reimbursed, not how many services you perform," Sanna said. "How quickly did the patient get well? How did you document the care? What are you doing to determine Activities of Daily Life (ADLs)?"

And it isn’t just Workers' Comp patients that require the transition to a functional based model for care. At Breakthrough Coaching, functional evaluations are a core part of the examination for every patient.

"You need to set objective goals for patients that are easily understood and communicated," said Sanna. "With objective tools and software like JTECH's, a patient can see and understand their deficit, progress, and goals. It provides a level of expertise beyond just the doctor's opinion. Chiropractic medicine is known as being high-touch, but with these objective tools it can also be high-tech."

Dr. Sanna sees this combination as a boon to the profession as it elevates them above the competition. With only 8% of the population accessing chiropractic care on a regular basis—a statistic that has not changed in over 100 years—the field needs to move beyond the common perception of who chiropractors are and what they do, in order to sift public opinion.

"Our competitors are not just other chiropractors, but other healthcare professions as well. Physical therapists, occupational therapists, nurse practitioners, and MDs are all options for care," said Sanna. "The field has a huge opportunity as it moves into the quality based model of care. If we document our objective functional results and highlight the combination of high-touch and high-tech, we can begin to change perceptions and gain an edge over fields that are traditionally seen as too hands-off and technical."

Part of the challenge is to remain relevant. In a world that is increasingly moving online, it is important for clinics to adapt their marketing strategies and take advantage of the new medium. In order to do this, they need to understand their markets and the way that the various internet advertising systems work.

"Most business used to come from patient referrals and offline promotions," said Sanna. "Now, even if a patient is referred by an enthusiastic friend, they will still Google you and your practice before they commit. It is important to be savvy and know how to use the internet and social media to both advertise and manage your online reputation. Many chiropractors still have canned websites, which simply won't work anymore. Doctors need to start thinking like patients, and gear their online presence towards this viewpoint."

Another thing that patients are increasingly interested in is convenient, high-quality care, at a great price. The future of chiropractic, according to Dr. Sanna, will meet this desire through the avenue of multi-disciplinary clinics.

"The most successful clinics will be those in which multiple professions are co-managing a patient's care. The chiropractor will consult with a PT, OT, PA, or MD all in the same location. The care will be more efficient and effective than when a patient visits a chiropractor on one side of town, an OT on the other, and an MD on another, and no one is talking to each other. The solo practice is going to continue to decline, and chiropractors who understand that the multi-disciplinary model supports the profession—rather than seeing it as having a diminishing effect—are going to be the doctors with the most success."

For more information about Dr. Sanna and Breakthrough Coaching, visit

Breakthrough Coaching

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