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Unacceptable

Unacceptable. How did we ever let healthcare in the USA get this bad?

The way physicians are being treated and bulldozed by the government and third party carriers right now is despicable. Although there are glimmers of hope here and there, it looks like there are now attempts to hijack even more aspects of patient care.

One fact though will never change. It sure as hell is not going to be government directives that does not get to the core of patient behaviors, lifestyles and choices.

We must become the change we are seeking! Position YOURSELF as the go-to doc, give patients what they need and will gladly pay for, and you’ll never be worried about the future.

Sadly we are living in a democracy lead by tyrants and zealot ideologues, many have turned out to be exactly as founding father Thomas Paine warned about.

What ultimately stands is anybody’s guess. But, it’s likely there will be attempts to saddle physicians with more regulation, red tape, tax your children’s children, and now maybe even your investments!

Let’s stick together and support only those physician organizations that truly have our best interests as their guiding principle.

___________________________________________________________________

Patti Hayes is CEO of Perfect Practice Web, and has 30+ years experience in practice management.

Our team may be reached for a free 15 Min “Strategy Session” by texting 339-793-8610 – just be sure to leave your name and time zone and we’ll get back to you 9-5 EST Monday-Thursday.

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Start your office day right!

If you haven’t already tried this tip, I suggest you adopt it for 2 weeks, and tell me if it does not make a huge difference. 10 minutes before starting a patient shift, gather all your team in a private area. Have a copy of your Schedule, New Patient Log, and Missed appointment log. Go over each briefly, with the entire team. Make sure full communication is present amongst your players. Make sure your Team Captain (even if its you) are acting as the moderator.

Just doing this alone can have a huge impact on your practice.

Here’s a challenge to all clients and guests. Try this your next full week. Then email us or post to our Blog the results. I look forward to sharing your experiences.

The Next Set of Private Practice Roadblocks

 

 

 

This week in our Perfect Practice Tips series we’ll continue examining the six most common roadblocks to successful private practice management.  Let’s talk about the next two obstacles doctors frequently encounter:

Roadblock Three: Reimbursement Issues

You cannot survive if you fail to pay close enough attention to your Finance Department. If you choose to participate in any third-party plans, you must thoroughly understand what constitute covered and non-covered services, exactly what the expected reimbursement will be, and how long it will take for you to be reimbursed. You also need to be sure that your participation in these plans will not automatically obligate you to participate in other plans without your knowledge and consent.

Don’t make the mistake of failing to put a system in place for collecting payment from self-pay patients, or for collecting on non-covered services. This is where you really need to do your homework. You must thoroughly understand what patients today are looking for in a private practice owner, and you must know what services they will gladly pay for.

Roadblock Four: Patient Report of Findings and Care Plans

This is another potential obstacle.

Significant attention must be paid to how the patient report of findings and care plans are presented to the patient and administered. Right from the start, your entire team needs to communicate to the patient that compliance with your recommendations is essential if the patient expects to achieve a good result. Simply, truthfully and thoroughly explain to the patient why you have suggested a particular treatment plan.

Thoroughness during the patient’s first visit has a huge impact on a patient’s future compliance. Perform any essential diagnostic tests before treating your patients, regardless of third-party incentives not to do so. Patients and their families long remember the doctor who makes an accurate diagnosis, and who presents a care plan that gets the patient better within reasonable a time frame and facilitating the patient’s financial obligations.

We invite you to join us daily on our blog for continued discussion of these principles.

If you would like to know more about our how to create a Practice by Design, please visit our website at http://PerfectPracticeWeb.com

Motor Neuropathy- A Different Game Plan

If you read the NeuropathyDR® blog frequently, you know that we tend to focus on bringing you the latest research and methods as they apply to treating neuropathy pain.  As you are aware, though, with peripheral neuropathy, pain is only one component.  This week, we’re going to talk about how neuropathy can affect a patient’s muscles, also called motor neuropathy.

There are essentially three kinds of motor neuropathy.  The first is the overall weakening effect of the muscles, especially in a patient’s extremities, which often accompanies peripheral neuropathy.  This can occur because the nerves which control motor function in the muscles have become damaged, or—in the case of a compression neuropathy—constricted.  The second kind is called multifocal motor neuropathy, and takes place when a patient’s immune system itself begins to attack their own nerves, as can happen after a series of infections or after an illness.  The third kind is Hereditary Motor Sensory Neuropathy, which, as the name suggests, is genetic in nature.  Hereditary Motor Sensory Neuropathy, or HMSN, occurs when there is a naturally-occurring deterioration in the nerves that control a patient’s muscles, causing those muscles to not be used, become weak, or even atrophy.

Motor neuropathy usually starts in the hands and feet, and can affect the full extension of a patient’s fingers and toes.  In addition to the dexterity problems this obviously causes, it often also has a visual appearance of “clawlike” fingers.  The condition is degenerative, getting worse over a period of months and years.  Twitching and spasms can also happen in affected limbs.  While motor issues associated with peripheral neuropathy usually accompany pain, tingling, and numbness, multifocal motor neuropathy involves no pain (only the motor nerves are affected).  Generally, none of the varieties of motor neuropathy are life-threatening.  Nevertheless, they can all severely impact your patients’ comfort and quality of life, especially if they are left untreated.

There is no substitute for appropriate PT and Rehab in Motor Neuropathy

When we met our patient Robert, he complained of a steady and declining loss of strength in his feet, which he had experienced over the past 4 years.  Robert had had cancer during that time, culminating in having his prostate removed.  His motor neuropathy caused Robert to have trouble walking or standing for long periods, and he even had trouble feeling his feet on some occasions.  He also complained of shooting pain, tingling, and soreness in his feet, all typical calling cards of peripheral neuropathy.  Since in cases of multifocal motor neuropathy, the sensory nerves are usually unaffected, Robert’s pain and numbness ruled that out.  Sure enough, when we performed a battery of tests, we found that Robert’s sensation to vibration was all but absent in several places on his feet.

Robert did not respond with the typical level of relief we usually see after treating a patient with electro-stimulation.  Over the course of three treatment sessions, Robert’s level of strength and comfort in his feet did not change in any meaningful way.  While this is unusual, it highlights an important theme: neuropathy is a complex problem with many symptoms and manifestations, and no single therapy technique or tool—even those with a very high rate of success—can stand on their own as a complete treatment.  For us to help our patients effectively, we have to encourage broader, overall adjustments to their lifestyle.

We designed just such a treatment for Robert, intended to produce more long-term benefit, as his short-term progress was not substantial.  Motor neuropathies require an extensive level of treatment, sometimes pharmaceutical and sometimes homeopathic, and usually involving some level of regular exercise and controlled diet.  Robert is currently improving steadily, and is seeing his NeuropathyDR® clinician as prescribed to monitor his condition and progress.

If your patients are complaining of weakness or pain in their limbs, they might have peripheral neuropathy.  If so, we can help you provide the best care possible.  Contact NeuropathyDR® right away and we will help you answer their questions and train you to provide therapy and treatment for specific neuropathy symptoms.  We can even put patients in touch with you who will benefit from your help managing their neuropathy.

http://www.ninds.nih.gov/disorders/multifocal_neuropathy/multifocal_neuropathy.htm

http://www.ninds.nih.gov/disorders/multifocal_neuropathy/multifocal_neuropathy.htm

 

Can You Really Help Guillain-Barre Syndrome?

One of the more rare acute types of peripheral neuropathy you will encounter in patients will be Guillain-Barre syndrome, also sometimes called Landry’s paralysis or Guillain-Barre-Stohl syndrome.  This autoimmune disorder causes the immune system to deteriorate the nervous system, which in turn causes the muscles to weaken very fast.  Due to its autoimmune nature, Guillain-Barre tends to present most frequently in people who have recently recovered from another type of infection, like a lung or gastrointestinal sickness.

The condition only affects about one or two in every 100,000 people, far fewer than most of the more common neuropathy types, and it most commonly targets patients between 30 and 50.  Because signals travelling along the nerves of a patient with Guillain-Barre are slower, it can sometimes be detected through nerve-conduction studies, as well as by studying the cerebrospinal fluid.

Most patients with Guillain-Barre present with ascending paralysis (loss of strength in the feet and hands that migrates towards the core), along with typical polyneuropathy symptoms such as pain and tingling in the extremities.  Perhaps most serious of all, Guillain-Barre syndrome often presents alongside autonomic neuropathy, making it very dangerous to the overall health of a patient’s internal organs.

There is still a lot we don’t know about Guillain-Barre syndrome, such as why it attacks some patients after an infection and not others, or what actually sets it in motion to attack the nerves.  We currently refer to it as a syndrome, as opposed to a disease, since there is no disease-causing agent we can prove to be involved.  As of yet, there is also no known cure, but with proper treatment, clinicians who are trained in the NeuropathyDR® methodologies are able to manage its symptoms and restore quality of life to their patients who suffer from it.

Our patient Louise was diagnosed with Guillain-Barre Syndrome over 20 years ago.  The onset was sudden; Louise just woke up one morning and her foot felt funny; by the end of the day she was having trouble walking unassisted.  In only a few days, Louise needed two canes just to get around.  For two decades, this was how she lived; in constant discomfort from the neuropathies common with Guillain-Barre, every day worried that the condition would degenerate and that her legs would just stop being able to bear her weight (even with support).  Even simple things like crossing her legs or driving were difficult.  Fortunately, Louise found a NeuropathyDR® clinician who was able to help!

By the time she came to us, Louise had been living with Guillain-Barre and its complications for more than 20 years.  Her mobility had continued to deteriorate, and she was now also experiencing pain in her lower back and difficulty turning her neck.

You can offer your patients the best chance possible with proper training...

We treated Louise with our NeuropathyDR® methods of adjustive procedures to restore mobility in the affected joints, as well as ultrasound and the use of electronic stimulation to affected nerves.  Over a five-week period, Louise’s painful neuropathy symptoms subsided drastically and mobility began to re-emerge in her legs and back.  At a checkup two months later, Louise was starting to regain feeling and continuing to improve!

After her treatments with NeuropathyDR® , Louise wrote to us that, in light of her newly-regained mobility, she finds herself afraid to hope that she will get feeling back in her legs after all this time.  She has been following-up with her clinician as scheduled, and her condition is continuing to improve.  There is hope that you can help your patient, no matter how long they may have been living with Guillain-Barre or any other type of neuropathy.

If you treat patients who have been diagnosed with neuropathy, or conditions that contribute to it such as Guillain-Barre syndrome, we want to help you treat their case more effectively.  NeuropathyDR® is an invaluable resource to clinicians; we have the information and training you need to be your most effective.  We can even help refer patients to you in your area who could benefit most from your care. Don’t wait to start helping your patients get—literally—back on their feet;  contact us and we’ll get started!

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001704/

http://www.webmd.com/brain/tc/guillain-barre-syndrome-topic-overview

http://www.ninds.nih.gov/disorders/gbs/gbs.htm

http://www.nlm.nih.gov/medlineplus/ency/article/000684.htm

“Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.”

A lot of your patients have heard that there is no cure for neuropathy, and they get discouraged.  As someone in the medical profession, you want to be able to dispel this misconception that your patients will just have to live with their symptoms!  NeuropathyDR® can teach you the non-pharmaceutical means to lessen their pain and improve their life.   “No cure” isn’t the same thing as “no help!”

A great example of a patient we have been able to help with the NeuropathyDR® methodology is Susan.  Susan is a diabetic in middle age who has suffered for more than twenty years with neuropathy symptoms.  Most prominently, Susan has tingling and severe pain in her feet, with the same problem less severely in her hands and arms.  Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.

When she came to us, Susan was taking prescription-strength Advil several times a week for the pain in her hands and feet.  Medication has its place, and can be effective in some cases, but it is too often the first—and last—course of action medical professionals resort to when it comes to neuropathic pain.   NeuropathyDR® promotes newer, non-pharmaceutical methods that have been proven to reduce pain and numbness in cases like Susan’s.  After we applied the NeuropathyDR® protocols, Susan’s symptoms subsided drastically and her quality of life began to improve.

Especially in the short term, we want to help reduce the overall level of chronic pain and restore any mobility that might be lost.  In a case like Susan’s, the NeuropathyDR® protocols target three specific areas of treatment:

  • Specifically-directed manual therapies to correct aberrant motion or misalignment in areas of the spine and pelvis, as well as addressing the soft tissue contractures in the neck, legs, feet, arms, and hands.
  • Our NeuropathyDR® nutrition protocol, consisting of a daily regimen of combined nutrients that have been proven to be supportive of the nervous system in slowing the progression of neuropathy and healing damage.
  • Finally, the application of neuro-stimulation in the affected areas.  We use a waveform treatment in the office and at home that opens up nerve pathways to let them heal.

Susan’s treatments recurred three times a week for five weeks, for a total of fifteen treatments.  Following each treatment, Susan reported that the level of pain and tingling had subsided by two-thirds or more.

Powerful Manual Therapies are Key…

After applying the NeuropathyDR® protocol, Susan noticed a terrific improvement in her lifestyle.  In her own words, her energy level tripled, and the inflammation and pain in her feet had reduced by ninety percent.  Our objective tests, going by a round before and after the treatments, showed that Susan’s spasms in the lumbar and thoracic paravertebral muscles had improved by seventy percent.  Her range of motion without pain had also increased by seventy percent, and her ability to sense heat, cold, and vibration had drastically improved.  Perhaps the biggest lifestyle-boost of all, Susan experienced much less pain when walking after applying the NeuropathyDR® methods for five weeks.

We followed up with Susan three months after her treatments with us, and she was continuing to do extremely well.  She has been diligent about keeping up her assigned home-care treatments, and she visits her clinician as-needed for checkups.  Especially in-light of her twenty-year struggle with neuropathy, the degree of Susan’s success is remarkable.

If you treat patients like Susan who suffer from neuropathy symptoms, we are a valuable resource to help you treat them.  Contact us with specific questions and to learn the NeuropathyDR® methodologies we have developed.  Our protocols are proven to work—don’t let your patients go without proper care!

Helping Your Diabetic Neuropathy Patients

If you have patients who are living with diabetes, chances are you are no stranger to making diagnoses of neuropathy.  While some patients (even those who do have nerve damage) might experience no symptoms at all, about 60 to 70 percent of diabetics experience pain, soreness, loss of sensation, tingling in the extremities, and even digestive problems—or other conditions related to organ complications—all symptoms of peripheral neuropathy.  Diabetes is, in turn, one of the most common causes of neuropathy overall.

A patient’s risk of developing diabetes-related neuropathy actually increases with age and extenuating health considerations (such as being overweight), partially because patients who have problems with glucose control for extended periods of time—25 years or more—are more susceptible.

The best defense against diabetic neuropathy is to get and keep blood sugar under control.

So, what causes a patient who has diabetes to develop neuropathic symptoms?  Research is occasionally unclear on the subject, but it is generally agreed that exposure to high blood glucose (high blood sugar) has a negative effect on nerve condition.  Of course, this is in addition to other conditions or lifestyle factors commonly associated with causing or exacerbating neuropathy, such as injury, metabolic inconsistencies, inherited traits, or substance abuse.

There are a few kinds of neuropathy associated with diabetes, the most common being peripheral neuropathy (this is the type usually referred to when people simply say “neuropathy;” but we’ll get to the other types in a moment).  Peripheral neuropathy is characterized by pain, numbness, tingling, and loss of motor function, among other sensation-related symptoms.  This type is written about extensively, and can greatly impact quality of life for its sufferers.  Most treatments available to medical practitioners target peripheral neuropathy, so the good news is, there are plenty of ways for you to treat this type.

Focal and proximal neuropathy result in muscle weakness and pain, and typically target a specific nerve grouping.  These types of neuropathy are commonly characterized by weakness in the legs, causing difficulty standing and walking.  This type of neuropathy often accompanies peripheral neuropathy, so be on the lookout for patients who experience weakness alongside loss of sensation or soreness.

Autonomic neuropathy, as the name implies, causes changes in autonomic bodily functions.  These include bowel and bladder functions, sexual responses, and digestion.  Autonomic neuropathy can be life-threatening in extreme cases, as it also affects nerves that serve the heart, lungs, and eyes.  Especially troubling to diabetic patients is the resulting condition of hypoglycemia unawareness, which can obliviate the symptoms most diabetics associate with low glucose.

It is recommended for any diabetic patients to receive at least an annual foot exam.  If neuropathy has already been diagnosed, a patient’s feet should be examined much more frequently.   Additional to diabetic amputation concerns, you should test your patient’s protective sensation by pricking their foot with a pin, or running monofilament across their skin.  If your patient has lost protective sensation, he or she could be at risk to develop sores that might not heal properly, leading to infection.  If you have any questions about the proper methods to use in examining diabetic patients for neuropathy, contact NeuropathyDR®.  We can be sure you have the tools and knowledge you need!

For other types of neuropathy, properly-trained clinicians should perform a check of heart rate variability to detect how a patient’s heart rate changes in response to changes in blood pressure and posture.  Ultrasound imaging is also useful to diagnose autonomic neuropathies and to ensure other internal organs such as the kidneys and bladder are functioning properly.

To control diabetic neuropathy, it is important to advise patients to maintain a tight blood sugar control and a healthy diet (this methodology is advisable for diabetics in general, of course).   Even if a patient does not have symptoms of neuropathy, regular checkups are wise.  NeuropathyDR® can train you to spot warning signs of factors that could endanger your patients’ nerve function or even be life-threatening.  In addition, we can help you treat pain symptoms by providing valuable information about appropriate medications.

If your patients have diabetes, they are at risk!  Don’t let neuropathic symptoms go unchecked.  Remember, the sooner neuropathy is diagnosed, the easier it will be to treat and to slow the progression of this degenerative condition.  NeuropathyDR® clinicians are trained to identify the various types of neuropathy and recommend the treatments that help their patients retain their quality of life.  If you have any questions about treating patients who have or might have diabetic neuropathy, contact us!

http://www.medicinenet.com/diabetic_neuropathy/article.htm

http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/

http://www.diabetes.org/living-with-diabetes/complications/neuropathy/

http://www.mayoclinic.com/health/diabetic-neuropathy/DS01045

 

 

Maximum Patient Benefit and Recovery-CCTxs

Patient Co-Treatment Plans CCTxs

One of the biggest clinical lessons that has come from our work with peripheral neuropathy patients is just how powerful “Patient Co-Treatment Plans” can be.

Traditionally, we might think of patient components of recovery from illness as a relatively passive home care program such as “just take these twice a day” or “do these exercises”.

Clinical Co-Treatment Plans (CCTxs) involve much more specific, multifaceted approaches to patient care, that not so surprisingly yield often greater results in several areas than just professional advice or professional treatment programs alone.

Some of the keys to CCTxs success lie squarely in getting the patient to accept responsibility for all the components needed to foster maximum results. Commonly observed side benefits may include enhanced family support, approval and greater involvement of other health care providers and especially reduced use of pain and psychotropic drugs.

CCTxs typically consist of dietary advice, timed exercise and stretches, massage, oral and topical medications and supplements and in the neuropathy patient, use of the Clinical Co Treatment Kit.

You CAN Learn to Help More Patients with CCTxs

With just a little foresight, the same principles can and should be applied to a vast array of health conditions.

We have found it extraordinarily beneficial to specifically package CCTxs with custom iPhone®/ipad® Apps, DVDs and books, newsletters and exercise books or sheets.

Be sure that any supplementation or medication is always supplied with detailed written instructions. We attach specific, written and sometimes color coded instructions to each bottle or applicator.

But the real key to success is indoctrinating your staff and patient families from the outset that your approach to treatment mandates CCTxs.

You see, when you mandate patient co-operation as part of case acceptance, patient compliance is usually greater. There are also far fewer questions about fees, length and extent of care. The value added benefits of dealing with your office as opposed to a competitors becomes readily apparent. Most of all, your role as teacher with these patients can reduce office stress levels and interrupting phone calls dramatically!

But another less thought of benefit from running your professional health care practice in this way becomes positioning and marketing.

When the community understands the depth of your concern is far greater than making payroll, referrals seem to magically follow. It becomes Disney-sequel- patients can’t resist telling others. New Patient flow tends to come like a freight train with patients and their families who are clamoring for this type of care.

Of course, this is especially true as we move towards a public system of healthcare in which these “touches” have all but vanished forever.

So, how do you actually implement CCTxs in practice?

Obviously, take a look at what’s out there and don’t reinvent he wheel. If you are a neuropathy clinician, we’ve already done all the work for you!

By the same token, if you have an idea, first sketch it out. Be sure to include all the components needed to foster not only patient recovery, but also compliance.

Keep in mind, today, you must build in all the appropriate self-care tools, including books, DVDs, and now especially those that will “push” information in a consistent, replicable manner.  Timed information and self-help content that will also allow for patient (or a family caregiver) self determined interaction.

I’m clearly talking about automated SMS (mobile device text communications) and mobile device apps, which will have an ever-expanding role in private health care practices.

In the coming days, I’ll be showing you precisely how all of this technology can be tied together seamlessly with CCTxs to not only educate your patients, but also become part of the vast repertoire of social media as well as traditional marketing and private practice development and management.

The future success of private practice will mandate such an approach.

Stay tuned to http://neuropathydrprofessionals.com

Designing Treatments for Lupus Patients

 

As physicians, we’re accustomed to a certain amount of variety in treating different patients with the same illness.

After all, we’re treating individuals.

But when you take on lupus patients, you’re taking the concept of variety in symptoms and outcomes to a whole new level.

Granted, there are specific symptoms to the various types of lupus, but no two lupus patients are the same.

Lupus is an ever changing illness with periods of activity and rest that are as different as the patients they affect.

Those differences can make developing a treatment plan difficult to say the least.

And when you add peripheral neuropathy caused by lupus to the mix of symptoms[1], you have an even more complex set of issues to treat and, hopefully, stay ahead of.

If you have any hope of preventing serious neuropathy complications in your lupus patients, you have to be diligent in monitoring your patients’ symptoms and, even more importantly, your patients have to be very conscious of their symptoms and keep you advised of any changes as soon as they happen.

That means you need to educate your lupus patients on their illness and peripheral neuropathy.

Helping Patients Lupus and Peripheral Neuropathy

Because the peripheral nervous system can be affected by lupus, every system of the body that is regulated by the peripheral nervous system can be damaged[2].

That means the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration.  Your patients need to understand that their body many not be able to regulate their heart rate or blood pressure, they might not be able to properly digest food,  their  kidneys can be damaged and they could develop urinary problems.

And even worse, lupus can cause serious problems with inflammation.  That can lead to:

–          Inflammation of the sac around the heart

–          Diseases of the heart valves

–          Inflammation of the actual heart muscle

–          Inflammation of the tissue around the lungs or pleurisy

Now, imagine having any of these issues and having peripheral neuropathy, too…

The peripheral nervous system isn’t functioning properly and can’t send the proper signals to the brain to let them know they have a problem.

It’s easy to see why this could be serious.  By educating your patients on these possible problems and the symptoms they present early on, they can keep a watchful eye out for any symptoms and get in to you see you before they have a potentially deadly problem.

Treating Lupus Patients with Peripheral Neuropathy

Once you take a very thorough history and physical (preferably one following the NeuropathyDR® protocol for lupus patients), you’ll have a better handle on your patient’s condition.  Pay particular attention to their symptoms, when they began, the severity of the discomfort, and any and all medications they currently take (including over the counter medications, herbal supplements or vitamins).

Once you’ve complete the history and physical, the next step in the NeuropathyDR® protocol will be to order some tests. Depending upon your patient’s actual symptoms and which systems seem to be affected, these tests might include:

∙           Neurological exam

∙           Electromyography

∙           Nerve conduction velocity test

∙           Antinuclear antibody test

∙           Blood tests

∙           Urine test

∙           Skin biopsy

Once the tests are completed and you determine your patient has peripheral neuropathy associated with lupus, you can design a specific treatment program based on your patients’ specific symptoms and adjust it as they enter periods of remission or as their symptoms change.

Lupus is not curable and your patient should understand this from the outset.  Your NeuropathyDR® treatment protocol should focus on relieving pain by reducing inflammation, repairing any nerve damage with nerve stimulation, slowing joint and bone damage and improving your patients’ ability to function with their disease.

Focus on:

∙           Rest and stress management.

∙           Exercise programs designed specifically for your individual patient based on their physical limitations.

∙           Pain medication as needed.

∙           Drug therapy as needed.

∙           Safety precautions to deal with the possible loss of sensation, especially in the hands and feet, due to peripheral neuropathy.

The NeuropathyDR® protocol is ideally suited to treating lupus and the peripheral neuropathy it can cause.

Early intervention with a physician well versed in treating lupus and peripheral neuropathy, like a NeuropathyDR® clinician, is their best course of action.  While you can’t cure them, you can help them achieve a better quality of life and lessen the chance of severe and possibly fatal complications.

When you’re trained and ready to work with them, let them know you’re there.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice web.com to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at http://perfectpracticeweb.com.

 

 

 


Private Practice 2.0: Dominate or Perrish.

In just a little bit, I’ll be on my way to New Jersey to speak at the Referral Ignition Bootcamp my friend Nitin Chhoda DPT is hosting.

This is a closed door session all day Saturday for those who clearly understand that NOW is time to be planning your future private practice strategies. *(if you are local to NYC and still want to sneak a seat, TEXT My Cell at 617-947-2050).

Where Does Your Practice Stand Right Now?

And you know what, as my friend and MD Practice Web partner Dr. Chakrabarti says, “We have way more in common than we do different.” The reality is that there will very likely be much sharper lines drawn between public and private health care systems in the USA. This is demanding a real expansion of the on and offline marketing, management and even staffing techniques we first proposed in 2006. It is also demanding that chiropractors increasingly develop relationships with other private practice owners of the same mindset.

And I am calling this new strategy Private Practice Domination. And thats because those who do really well, in every discipline, chiropractic, medicine and physical therapy will be the dominant forces driving private care in their neighborhoods. Much of this will be specialty care, fitness, anti-aging, and chronic pain.

Seriously. I had this discussion with an oncologist who loves our approach to private practice earlier this week.

But too many practices in all disciplines will likely be shut down. It’s already happening. Disjointed or weak marketing, Medicare and HMOs pulling the plug on major hospitals, community hospitals on the brink of closure.

And too much of the time it’s because staff are not fully conversant in cash sales, dealing with the ” insurance only covers” mentality  (both staff and patients).

All of this needs to be clearly handled in your practice or institution one by one, ASAP.

Make no mistake about it. This is a great time to be in practice. Maybe, better than ever before.

IF you know how to capture opportunity.

More to come in the next few days…

A really BIG day for DCs Today…

If you have been following us on
Facebook and Twitter you know how important
it is to bring your practice up to crisp, modern standards.
With modern, focused communications, and a clear
message.

In case you doubt this, just look at what your
most prosperous hospitals, pain centers, local
walk-in clinics and PTs are doing both on and off line
to engage patients, and garner TONS of self pay
patients and medical referrals.

Because these strategies work!

Now, It makes no difference where you are
and don’t tell me “but my practice is different”.

Because right now in my clinic, my AVERAGE
neuropathy (and indeed many chiro care
patients) are driving well over one hour
to see me, one way.

In fact, yesterday, I had my first interstate neuropathy patient.
Thats why I am so sure this stuff is SO POWERFUL…

Well, today is a huge day of opportunity for YOU TOO.
BECAUSE, I am sharing all of this with you FREE.

Just go to 20,000,000 Patients Need Your Help!

The War of Art* and getting unstuck…

Just wrapped up the weekend with a gorgeous Patriots Day sunrise this AM. Yup, it’s still a holiday is Massachusetts.

The weather wasn’t the best Saturday and Sunday but I did get the boat ready plus lots of stuff done for the week. Also had some great fun playing with fishing gear, speaking with local captains and shops too, as the season as they say is upon us.

And I did read two books in between the downpours, NeuropathyDR and PPW website and content changes for this week, and some prep work for Referral Ignition, a new program Nitin and I are joining forces on.
So all and all very productive.

But some people still think I am nuts. You see, I have always been able to get lots implemented, and have refined time management as an art form. To me it’s just a natural thing. That’s why Perfect Practice Web was born, the blueprint of efficiency and productivity in modern private practices.

But to many, getting all the stuff done for a powerful practice that needs to be, plus doing the fun stuff too is a struggle. That’s likely no surprise to any doc.

But it simply comes down to *“The War of Art”, as written by Steven Pressfield.

If you haven’t read it, you really need to.  He talks a whole lot about resistance, the entire lot of behavioral issues that stand between us and our biggest aspirations. This one might help with getting your big dreams actually accomplished.

And regarding your big dreams, I have some open call times Monday and Tuesday for our Clients and surge of new docs, welcome all!

There are some really great opportunities TODAY for all in our NeuropathyDR™ and Foundations Programs, so take action and really live those big dreams!

Call Jes 781-754-0599 to schedule some talk time. Or visit us on-line

Blueberries, vegetables and exercise, or cigars, sex and coffee…

The Secret of self-actualized life- is it blueberries, vegetables and exercise, or cigars, sex and coffee…

This past weekend, I finally got to wind down after our months long SuperConference build-up. It was a great event; most docs were ecstatic with the content and opportunities, despite the very harsh realities of private practice today. It was great to be with all my special friends who helped make this event so powerful.

In any event, another very special friend Dennis invited me on the water all day Friday and Patti and I to his Yacht Club Friday night. (Turns out, we’ll be joining!)

Friday morning, the fishing was great again, just off the Boston Harbor hotels, and airport runways. It’s a fabulous place, with tons of revolutionary war (and before) history, forts, burial grounds, etc.

Friday night, the four of us cruised the inner harbor, back on land for a couple drinks then had a fabulous dinner back at the club and tons of laughs together.

Then, Dennis asked me if I wanted to smoke a cigar with him. I must have had one hell of an expression, because he immediately began to tell me about studies on cigar smoking and longevity???

Huh? I read research every morning, but I missed that one!

So Dennis says “Its stress that kills us. Those that socialize, and have fun, maybe smoke a cigar and sip Scotch together, laugh and stay engaged, live longer, happier and healthier lives”.

So don’t you know it, look up the studies on centenarians in Cuba, and other countries too?

My take after reading these studies? They live simply, stay engaged in life fully for the moment only, and have moderate habits, nothing to excess. Interestingly, in Cuba, they smoke cigars, drink coffee, and still enjoy sex.

But most of all, they ENJOY all of life. Especially simple pleasures, friends and family. Most every day.

And thats it.

Boy, can we screw this one up, big time.

Look at the craziness some of us see everyday, people stressed out, never disengaged, or never shut off the cell phones and TV, bitch about everything, live sedentary, not outside enough.

Or some Docs that continually stress, never disengage long enough to really figure out who’s in charge of their life and practice, who they care or work for. No good systems or organization that really serves them, and their goals and dreams.

What a mess we are capable of creating!

But, there is an antidote. And it’s the very first step I often end up taking with new clients.

That is, to develop and work on and truly develop the essence of Practice by Design ™.

But if it’s really this simple, why do so many of us as very intelligent docs especially every practice day struggle with it?

I’m not really sure, but I can tell you a few things.

First, YOU have got to have complete design control in practice. This is really the most valuable part for me personally while working with my docs.

Next, staff needs firm, but still fun environments and goals. Very easy systems that still work (by design) when we all have those “no brain” days. And the government has made this one harder.

Three, patients need guidance, and the choice to accept or reject advice. When you can see them, what your game rules are. This must of course include finances. And, if they choose to reject your advice, why would you ever keep them under your care?

And you know what, it can be as simple as these three basic
rules!

But you must have the certainty, intestinal fortitude and underlying tools to pull this all off.

To that end, as Mr. Spock admonished me 40+ years ago, “live long, and prosper.”

Another Lesson on Systems…

A powerful lesson on systems from M. Mitchell Waldrop in his book, Complexity referred to in Deep Survival by Laurence Gonales, a must read book!

“All complex adaptive systems anticipate the future…every living creature has an implicit prediction encoded in it’s genes…every complex adaptive system is constantly making predictions based upon its various internal models of the world…in fact, you can think of internal models as the building blocks of behavior. And like any other building blocks, they can be tested, refined, and rearranged as the system gains experience.”

~

It’s now or never: Fixing Healthcare with Common Sense

Fixing HealthCare with Common Sense

What it will finally take is anyone’s guess. Our candidates for public office are great at talking a good game, and oh what a show Wednesday on ABC promises to be, but what ultimately it will take is a combination of “Common Sense” (written in 1776 from Founding Father Thomas Paine*) and a return of major corporate ethics, with effective, consumer driven oversight and simplified regulation.

Assuming we keep a private, free enterprise system, lets finally put the consumer in charge, just like with other types of insurance. Lets simultaneously expand HSAs and FSA programs and benefits to further breed responsible healthcare consumption.

It is likely the best solution, easiest to implement without burdening us with bigger government. I say let companies like Geico, Progressive and others that market auto insurance direct to consumers into the ring. Let consumer choice drive them to cut costs by uncoupling dollars from non-benefits payment. Give them simple rules to follow, nationwide, exempt from state lines. This could be huge, and would not take any dismantling of our major delivery systems.

Remember, Medicare runs on 4% administrative overhead, but currently private health insurers are closer to 25%. Much of this goes to the questionably ethical profiteering of extreme proportions, exorbitant salaries for executives and contributes to ridiculously poor provider reimbursements.

And, how about adding return of premium benefits to reward the healthiest while not penalizing the seriously ill. This is a tremendously powerful idea that would reap huge benefits for the consumer. It’s already done with disability and some other types of insurance and mutual insurance companies regularly pay dividends to payees. So, Lets make sure that some of insurance premium dollars can be returned if consumers stay healthy.

Lets also finally de-link health insurance from employers and employment benefits once and for all. This has been an absolute catastrophe. Even the Boston Globe recently acknowledged this. The extreme burden on US businesses of all sizes from health care premiums is well known. The trickle down benefits to business, like the automakers, municipalities and others could also be a huge economic stimulus.

Uncoupling health insurance benefits from employment would make consumers ultimately more fiscally savvy and responsible. This could quite likely increase their wages simultaneously as employees would now purchase all benefits outside of their work. Uncle Sam can help with deductibility and tax exemptions, maybe larger in the beginning to help foster the transition.

I also believe that there should be real consumer dollars available for CAM (Complimentary and Alternative Medicine) that can be used in the treatment of our most common and non-life threatening disorders especially if the consumer does not utilize more expensive traditional pathways for the same condition. Back pain and headaches are two very real examples that both happen to be still the most common reasons for doctor’s visits, and are at least in part linked to stress and unhealthy lifestyles.

This mechanism alone would foster consumer education to choose their own healthcare pathways with taking an additional financial hit in addition to premiums.

Any effective system must simultaneously provide equitable reimbursement and other incentives to all licensed doctors of all disciplines as well as ancillary providers for our society to keep great healthcare providers in the system.

This must include simplified reimbursement schedules, equal across the professions for identical procedures. I strongly favor a diagnosis-based system with utilization review only for those cases outlying the norms. This could be a technological piece of cake with a national electronic healthcare database for all Americans.

Of course, there are other issues that need to be simultaneously addressed. These include malpractice provisions (some experts suggest in a separate healthcare “court” in addition to capped awards). Better awareness of poor outcomes vs. malpractice by society at large would really help as well.

Drug costs, competition and widespread availability of tested alternatives to prescription drugs all need to be handled. Again, a consumer driven Wal-Mart type of distribution may be what already does it.

So, how can we help? Lets make sure we educate ourselves first and foremost as to what’s wrong with our current system and push our lawmakers toward better consumer choices. Take a real hard look at their differences on these topics when you vote and support any politician, as some are huge. Let your patients know who these consumer friendly elected officials are in your area are too.

Utilize cost effective preventive screenings in your practice, and advocate the same for our families. Lets make sure we teach our kids and our patients all the rewards of better health choices like non-smoking, stress management, diabetes prevention, relationship choices including illicit drugs and sexual behavior, and permanent weight control.

How it will all turn out is anybodies guess. I continue to be as vocal about these issues with my patients and community, and urge you to do the same.

Not Unlike Thomas Paine did over 200 years ago.

(*Society in every state is a blessing, but Government, even in its best state, is but a necessary evil; in its worst state an intolerable one: for when we suffer, or are exposed to the same miseries BY A GOVERNMENT, which we might expect in a country WITHOUT GOVERNMENT, our calamity is heightened by reflecting that we furnish the means by which we suffer.)

12 Secrets of Private Practice Mastery

I am hosting a free special webcast event, “The 12 Secrets of Private Practice Mastery” with room for a few more docs on Tuesday. You can register at http://practicebydesign.net
Spend an hour with John Hayes, Jr DC DABCO, Author of “Living and Practicing by Design” 2008 Evvy Award Nominee

Really Looked at your marketing campaigns lately?

Missing real leadership in tougher times is driving responses to an entirely new set of on-line ads, that 1 year ago were almost irrelevant. It will tell you what people really want, and need right now.
The same is true off-line.
Really.
I recently took a hard look at what on-line ads are pulling the hardest.
Boy, has that changed!

How many businesses and practices are oblivious to this?

It also explains why private practices, lead by true integrity continue to support the community and are themselves very healthy.

Fixing HealthCare with Common Sense

What it will finally take is anyone’s guess. Our candidates for public office are great at talking a good game, but what ultimately it will take is a combination of “Common Sense” (written in 1776 from Founding Father Thomas Payne*) and a return of major corporate ethics, with effective, consumer driven oversight and simplified regulation.

It is likely the best solution, easiest to implement without burdening us with bigger government. I say let companies like Geico, Progressive and others that market auto insurance direct to consumers into the ring. Let consumer choice drive them to cut costs by uncoupling dollars from non-benefits payment. Give them simple rules to follow, nationwide, exempt from state lines. This could be huge, and would not take any dismantling of our major delivery systems.

Remember, Medicare runs on 4% administrative overhead, but currently private health insurers are closer to 25%. Much of this goes to the questionably ethical profiteering of extreme proportions, exorbitant salaries for executives and contributes to ridiculously poor provider reimbursements.

And, how about adding return of premium benefits to reward the healthiest while not penalizing the seriously ill. This is a tremendously powerful idea that would reap huge benefits for the consumer. It’s already done with disability and some other types of insurance and mutual insurance companies regularly pay dividends to payees. So, Lets make sure that some of insurance premium dollars can be returned if consumers stay healthy.

Lets also finally de-link health insurance from employers and employment benefits once and for all. This has been an absolute catastrophe. Even the Boston Globe recently acknowledged this. The extreme burden on US businesses of all sizes from health care premiums is well known. The trickle down benefits to business, like the automakers, municipalities and others could also be a huge economic stimulus.

Uncoupling health insurance benefits from employment would make consumers ultimately more fiscally savvy and responsible. This could quite likely increase their wages simultaneously as employees would now purchase all benefits outside of their work. Uncle Sam can help with deductibility and tax exemptions, maybe larger in the beginning to help foster the transition.

I also believe that there should be real consumer dollars available for CAM (Complimentary and Alternative Medicine) that can be used in the treatment of our most common and non-life threatening disorders especially if the consumer does not utilize more expensive traditional pathways for the same condition. Back pain and headaches are two very real examples that both happen to be still the most common reasons for doctor’s visits, and are at least in part linked to stress and unhealthy lifestyles.

This mechanism alone would foster consumer education to choose their own healthcare pathways without taking an additional financial hit in addition to premiums.

Any effective system must simultaneously provide equitable reimbursement and other incentives to all licensed doctors of all disciplines as well as ancillary providers for our society to keep great healthcare providers in the system.

This must include simplified reimbursement schedules, equal across the professions for identical procedures. I strongly favor a diagnosis-based system with utilization review only for those cases outlying the norms. This could be a technological piece of cake with a national electronic healthcare database for all Americans.

Of course, there are other issues that need to be simultaneously addressed. These include malpractice provisions (some experts suggest in a separate healthcare “court” in addition to capped awards). Better awareness of poor outcomes vs. malpractice by society at large would really help as well.

Drug costs, competition and widespread availability of tested alternatives to prescription drugs all need to be handled. Again, a consumer driven Wal-Mart type of distribution may be what already does it.

So, how can we help? Lets make sure we educate ourselves first and foremost as to what’s wrong with our current system and push our lawmakers toward better consumer choices. Take a real hard look at their differences on these topics when you vote and support any politician, as some are huge. Let your patients know who these consumer friendly elected officials are in your area are too.

Utilize cost effective preventive screenings in your practice, and advocate the same for our families. Lets make sure we teach our kids and our patients all the rewards of better health choices like non-smoking, stress management, diabetes prevention, relationship choices including illicit drugs and sexual behavior, and permanent weight control.

How it will all turn out is anybodies guess. I continue to be as vocal about these issues with my patients and community, and urge you to do the same.

Not Unlike Thomas Payne did over 200 years ago.

(*Society in every state is a blessing, but Government, even in its best state, is but a necessary evil; in its worst state an intolerable one: for when we suffer, or are exposed to the same miseries BY A GOVERNMENT, which we might expect in a country WITHOUT GOVERNMENT, our calamity is heightened by reflecting that we furnish the means by which we suffer.)

Problems?

My wife and daughter recently brought me home a copy of “I Me Mine”, which is as close to an autobiography of George Harrison as you can get. It’s a great read. I have always respected his strong faith, as well as his music.

Some passages really shed light on how he applied ancient philosophies to modern life.

In the start of our platform series, I spoke at length about the “Gita”, and the pertinence of its philosophy 5000 years after it was written in Sanskrit. George was immersed in the Gita, and its related teachings.

This passage from George will help to remind us all of the daily application of something so basic to our professional lives, but too often forgotten.

“The problems start when you get attached to the problems! That’s when the mind gets involved in too much thinking of whether one is supposed to go here, do this or that: you know-the bullshit…The biggest thing that screws us up in life is the mind, it plays tricks on us and can trip you over”.

So, the lesson here is detachment from outcome.

Make your decisions, let go and move forward after each decision, vowing only to make better decisions as you mature. This is so true in healthcare, being called upon to continually make decisions after dealing with one problem after another. Those docs who never get this have a real hard time moving forward in life and practice especially.

Osteoporosis, Kyphoscoliosis in an 80 Y.O. Lady

An 80 Year Old lady with chronic T Spine Pain,
marked osteoporosis, kyphoscoliosis,
post kyphoplasty X2 is referred by her PCP
for evaluation and treatment.

Which tests do you order or make sure
were done? What are some possible Txs?