Explain to your patient right now, not on day two, three or four, what your findings are and what treatment you recommend specifically for their chief complaint. Your new patient will appreciate your focused attention and will want to enroll into your practice. The two, three and four day reports are not what your new patient wants or expects. My experience has proven that a multi-day report usually results in a negative first impression.

Getting Patients to Enroll

Due to the recent decision by Blue Cross / Blue Shield of Pennsylvania (and many other states) to reduce chiropractic visit limits from 20 a year to 8 a year, leaves you with only one option that will convince the new patient to enroll into your practice. OPTION: Diagnostic testing that will quantify their soft tissue injury or condition. Explain to them that your practice is UNIQUE from other practices because you have a safe and simple diagnostic testing procedure, right there in your office that actually quantifies their soft tissue injury or condition rather than assuming what the condition is simply based on their pain and symptoms.

Show them a sample report and explain that this is a new and advanced computerized muscle testing system that shows the deficits of the five categories being tested.

1. Peak Force Strength – Maximum effort in pounds (left and right)
2. Endurance – Timed duration of maximum effort (left and right)
3. Power – Peak Force Strength x Endurance
4. Work Capacity of muscle
5. The number of minutes the injured muscle can be worked without risk of re-injury.

Explain further that all test results have been validated with current AMA Permanent Impairment Guidelines including strength Coefficient Variation. And, the AMA Guides 6th Edition actually recommends computerized dynamometry testing.

Now you say, I have two very important questions I need to ask you. First, ask: "Is this report something that makes sense to you and would interest you?" Actually, all of my patients, and all of my clients patients, have said YES. I continue to explain that the first test represents a baseline study that documents their functional impairment and is approved documentation of medical necessity.

Monthly progress testing is performed to document the positive outcomes that are required to access continued medically necessary treatment. As long as positive outcomes are documented, the insurance companies are obligated to pay. With this documentation, you will have access to all of the medically necessary treatment required to return your patient to pre-injury status or maximum medical improvement (MMI).

When the outcomes show a progress of only ten percent or less, it indicates that muscle has reached per-injury status or maximum medical improvement (MMI), and the treatment to the muscle should be discontinued. However, treatment continues on other muscles that are still showing positive outcomes of greater than ten percent. However, if the answer is NO, you have a patient who is not willing to make a commitment that is in their best interest, and will not be a good patient or a good referral source.

The second thing you ask is, "Are you committed to maximizing your recovery?" Most always the patient says YES. Again, if they say NO, you have a patient who will not follow your recommendations and will most likely complain about the lack of results. However, on occasion they will say I can only come once a week. This can be a problem because most rehabilitation guidelines state that rehabilitation should be performed a minimum of three to five times a week. Less than three times a week is considered ineffective and is not eligible for reimbursement. In most cases, three rehabilitation sessions a week can be scheduled if the patient is willing to rearrange and prioritize their free time.

In conclusion, practice management is not just about advertising, screenings, telemarketing and free dinners. It is more about the management of your patient's condition from their initial examination and diagnosis, to their diagnostic testing that documents their functional impairments and establishes medical necessity, to their passive and active treatment protocols that stabilize their condition, then onto the rehabilitation and strength conditioning phase of care. And finally, yes, now is the time to discuss philosophy and wellness care if you choose. As Leonardo da Vinci said, "Simplicity is the ultimate sophistication."

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William C. Wetmore, DC is a Pittsburgh, PA – based Provider Compliance Consultant. He can be reached at or by calling 412-377-2426.