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118: The Problem with Chiropractic Exam

chiropractic practice strategies Apr 09, 2023
Kats Consultants
118: The Problem with Chiropractic Exam

118 THE PROBLEM WITH CHIROPRACTIC EXAMS - TRANSCRIPT The problem with Chiropractic exams.


The problem with Chiropractic exams. 


Hi everybody. Welcome to the KC CHIROpulse podcast. I'm Dr. Michael Perusich from Kats Consultants, and I'm joined with my good friend and cohort, Dr. Troy Fox. 


Troy, we were talking about this off camera right before we mm-hmm.  jumped on here and I think you bring up a really valid point that we're seeing this big trend that chiropractors aren't doing a deep enough dive on their exams.


Yeah. I think some of this started, you know, and it's kind of been a trend over the last decade or so, I think in a lot of cases. The X-ray requirements or the amount of x-rays that were being taken in chiropractic a lot. You know, we go back to the eighties and nineties, everybody got an x-ray, right?


And then there was kind of some blow back as newer students got outta school. Well, that's not necessary that you took an x-ray for that. Although, you know, as, as you look at some of the red flag rules, um, I, you know, spinus tenderness qualifies for, it's not hard to find a. , but we're seeing folks that are not taking as many x-rays or the reimbursement just wasn't there.


Right? And so they're sending them onto the hospital or whatever to have the x-rays taken because there's just no benefit to 'em financially. And they didn't wanna maintain an x-ray machine and the license and all that. But beyond that, I think what's happened is there's been a slow slide in some cases of folks.


Have relaxed their exams as well. Yeah. And I think that's, I think that's an alarming trend. And, and you and I could probably tell several stories about times when we took x-rays of patients. One of 'em was my own staff that Yeah. Ended up, ended up having cancer that had metastasized. Yeah. And found it when we took x-rays, so, It was because there was an exam there to begin with, so I would say one, let's do exams two.


The other thing I think of is, let's make sure we're doing exams on our staff. , if you're gonna, if you bring new staff in and hey, they're gonna get under chiropractic care, let's make sure that we set the example by doing a complete exam on 'em. It's not just a cursory exam because, oh, they're already a staff member and they're here in the office.


Just, you know, jump on the table kind of thing. Right. No, it's, it's, it is so true. And I think, excuse me, one of the, one of the reasons why I think we've seen this slide, which your term, which I think is valid, is because. We don't get reimbursed sometimes for exams. We don't get reimbursed sometimes for x-rays.


You know, you take Medicare, you know, we only get reimbursed for the adjustment. Uh, you take progress exams. A lot of insurance, insurance companies.  aren't reimbursing for progress exams, so we just take that as well. If I'm not gonna get paid for it, I'm not gonna do it. But what we have to remember is there's a standard of care that you have to live up to and that standard of care.


Itss the delicate balance between providing good care as a doctor to a patient to do no harm.  and balanced against really what could be deemed as malpractice. Mm-hmm. . So when you agree to accept that patient into care, you're agreeing to accept that patient's problems mm-hmm.  and to help them with their problems.


Mm-hmm. . Now do we help 'em with all of them? You found cancer on a patient. I've had that happen as well. Do we help cancer? No. But do we diagnose to the point, do we evaluate to the point where we can help patients uncover those things? Yes. And we should be, and if you're one of those doctors out there, You've been in practice for 10 or 20 years, or as long as you and I have mm-hmm.


Um, and, and you, you tell me that you've never seen anything like that. Um, I'm gonna say we need to dig a little bit deeper with our exams. Mm-hmm. , and I'm gonna get on my high horse here for just a second. Do it. You and I also see doctors doing such a limited exam and their diagnosis shows it.  and so then they've got a very limited diagnosis.


You get 12 positions on that c m s form when you're doing your billing. Mm-hmm. , I hardly ever remember not using all of them, especially a patient who came in with at least two symptoms and neck getting low back, for example. . Mm-hmm. , dig deep. You don't flush those diagnoses out. You know those, that also helps you keep the patient in care longer when they need it.


You know, if you have a limited diagnosis, but the patient's got a lot going on, you're only gonna get a handful of visits for that patient. Insurance company's gonna cut you off probably, and then the patient may not stay in care because of that. And now you've done the patient a disservice cuz they didn't get the outcomes that they.


right. And I think as you look at it, doing a complete exam means doing a complete exam. Not only in the area where the patient's main complaint is, but I think we have to listen to patient history. We have to listen to what's going on with them right now. That may seem inconsequential, right? So sometimes somebody will come in and they'll talk about how.


They're having neck and neck and upper thoracic pain. But I also see that when I'm looking through some of your documentation that you filled out before you came into my office, that you've had some pretty substantial digestive problems. You know, there may be something that.  is it, is it possible that I may need to do some palpation of the abdomen?


Mm-hmm. ? I may, or it may be a situation where I find out that you've already had all kinds of testing done and I may not need to do my own examination, but there may be a piece of nutrition, something as simple as probiotics I may need to use with you. So it's not always that I have to get down and dirty with every single square inch of that person's body.


To look through it, but I do need to make sure that, one, I'm doing a, I'm doing a complete exam, at least on the areas of interest that are primary, and if I see areas that are important, but maybe not urgent to the patient. I'm already there, right? Why would I not go ahead and document that? I took a look at that problem.


It looks like this is more of a nutritional problem. We're gonna recommend some probiotics or whatever. Maybe something simple like that. And sometimes we run into situations where it isn't something that we deal with. , but it's a really nice time to collaborate with other professionals in the area at that point and make that qualified referral and that professional that you're working with is gonna appreciate that, number one, and they're gonna have a deeper respect for what you do because Amen.


We are, we are doctors. We're That's right. We're not technicians. And I think sometimes we've almost shoved ourselves in the corner, like you said. Because of non reimbursement. It's like, well, this isn't important if I'm not getting paid for it. And, and I think that, that, that is a problem from a stand, well, from, from many different standpoints.


Legal, uh, ethical, I mean, we, we run into some issues with that. Oh yeah. There's a whole handful of things there. Exams are important, and I think sharpening steel with steel by doing exams is also a really great way for you to catch that condition on a patient that you really want to catch. I, I know I'm a little bit older, non-traditional when it comes to taking part four.


Some of you guys, I said that and it struck fear in your heart. She almost had a little mini heart attack right when I said it. . I took part four within the last five years because when I graduated from school, initially I missed the part four cutoff. And they're like, oh, if you're gonna practice in, you know, the state of Kansas, which is where I'm at, then you don't need to worry about it.


And I went, I'm done. I'm outta here. Guess what? ? Yeah. 20, 20 plus years. Or 20, yeah, a little over 20 years later when I had let my license lapse for a period of time. Um, I decided to get my license back and the state of Kansas said, oh no, no, Troy, you need to take part four. And we all know what that is.


It's a big exercise in exam diagnosis and, and then you can tack on a few adjusted positions and lines of drive at the very end. But you're looking at x-rays and you're doing a lot of exams and looking at labs, right? That's the kind of stuff that's so important and you know, I can tell you that most of you guys and gals that are out there right now do a fantastic job of diagnosis.


Mm-hmm. , I'm just telling you, if you've slacked a little bit, pick up the pace because. , I know that if you got three part four, you're a pretty good diagnostician. That's not an easy exam. We all know that, it struck fear in my heart too. It was probably the worst experience of my life. And then when I got my results, it was one of the best experiences of my life.


So , we know that we all have the capability, but I think we need to make sure that we're doing our due diligence with patients. I think we owe 'em. Well, and I think that's a great term to use. Maybe we should use due diligence instead of an exam. You know, you don't, you don't make a big investment. You don't buy a house, for example, without doing some due diligence.


You go in, you check all the faucets, you test everything. You have an inspector go in, you make sure the roof works right? There's no liens, crazy liens against the house, et cetera. Mm-hmm. , you do your due diligence. We need to do our due diligence with our patients too. And I like what you said, sharpen steel with.


keep, keep your doctor senses sharp by doing exams. Do deep exams. One of my favorite things in practice is the exam. Mm-hmm. , I love doing exams. I always did. And by the way, I enjoyed part four . Good for you. I'm the one . Yeah. But, but y. , it does it, it keeps your doctor skills tight and we wouldn't have to go through all of that skill presentation in part four, for example, if it wasn't necessary.


Mm-hmm. , so do the exams. You, you know, if you're in cash practice out there, you're probably sitting there smiling really big cuz you're not having to worry about whether or not you're getting reimbursed, the patient's paying you for it. Mm-hmm. . , if you're having trouble with this, I'm, I'm just gonna throw this out.


Maybe this is a way to kind of wrap up. If you're having trouble with this. This is the kind of stuff that we help doctors with, how to get the head space around your own thought process so that you do things right and you do them with ease. Practice doesn't have to be hard, honestly. Practice should be fun.


You should walk in every day, big smile on your face and know that everything you're.  is right. And that's what we do. We help you stay in that right lane. Yeah. And I'm gonna toot your horn a little bit on this because this is really something that we've been working on lately with our mastermind group, so we don't just assume Yep.


That you have every tool known to man. When you walk in to see us, we hit different areas. And right now it happens to be that Dr. Perusich has led, uh, and is still leading. A weekly mastermind class where we get together as, as docs, and we talk about proper diagnosis. We talk about proper exams, we talk about daily notes, and what should be in them.


In other words, the whole process from the first time you see the patient. Through that first adjustment or a series of adjustments, what should be in the notes at that point? And I think it's a, it's a very important transition. So, it's, it's not just, Hey, how do you get new patients in the door?


That's not what we do as consultants, right? We consult on every area of your practice. I don't care if it's the emotional portion of it, the motivational portion of your practice, whether it's nuts and bolts of what your staff do every day or whether we're helping you. Make sure that you. Proper documentation, and we've talked before on this show as well, that we're more than happy to look at your documentation.


I know, and see what you know, see what it looks like and see if you've dotted all the ice, crossed all the Ts. From an auditing standpoint, it's a very, um,  it. It's a very easy way to do it without feeling like you're being attacked, right? Uh, when you have another colleague that looks at it and goes, Hey, we need to probably clean this area and this area up.


Otherwise it looks pretty good, you know? Or we need to redo the whole thing. Yeah. I mean, if you find that out the easy way and it doesn't cost you thousands and thousands of dollars in audit reimbursement, I think it's a fantastic thing. If you're having troubles, tell 'em where to go. Dr. Perus, all you gotta do is go to cats consultants.com.


It's KATS with a K - K A T S. Go to KatsConsultants.com. We make it really simple. We have got all kinds of free downloads and things on the website. Check those out. But more importantly, go schedule a breakthrough call in the top right corner of the website. You can schedule a call. Just click on the button.


You'll go right to my calendar. . People ask me this all the time, why do you do that? Do you really do it for free? Yes, we really do it for free. Why? Because we care. We care about this profession. We care about chiropractors wanting to have successful practices. We want you to be a success we've been successful in, in chiropractic, and we just, we wanna pass that on plain and simple, Absolutely


All right everybody. We really appreciate you out there, so make sure you check us out at Katsconsultants.com. And most of all, we appreciate you listening to our weekly podcast, KC CHIROpulse podcast, brought to you by Kats Consultants. 


We'll see you guys next time. 


See you.