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Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
May, 2002, Vol. 02, Issue 05
By Steve Capellini, LMT
Author's Note: The Spa Letters column features news, personality profiles, trends, and plenty of professional possibilities for LMTs in the spa industry. The style is epistolary, meaning the articles are letters to a fictional massage therapist friend of the author.
A-ha! Now you know what I was talking about, don't you? The entire staff of massage therapists, who just a few short weeks ago were your colleagues, equals and friends, are now looking at you with new eyes.You're the one in charge of their destinies, on a certain level, in the enclosed environment of the spa. Sensing your vulnerability in this new position, they're pressing their advantage by staging a mini-revolt. They want more money and have started to complain bitterly about the miserable 50% cut they're receiving from each service performed, plus tips and benefits.
Remember what I said in my last letter about being the boss? Well, now's the time to embark upon that treacherous journey of making yourself into another person: a boss person.
The Boss Trap
Do you remember any previous bosses who everybody agreed were complete jerks? And do you remember speaking to many people from many different companies, at all different levels from top to bottom, complaining about their own bosses? Did you ever think that there was a "boss gene" of some type that selected these people for a combination of power-hungriness and unreasonableness? How could every boss be so bad?
Well, now you know. Be absolutely certain, and make no mistake about it, some of your erstwhile colleagues are now talking about you in the same backstabbing tones you overheard them using in regard to the former supervisor in the spa. I call this the "boss trap," and it's 99% dependent upon the boss/employee relationship, and 1% dependent upon the personalities involved. Now is when you start to really understand what the spa business is built upon - relationships.
How are you going to position yourself in this new dynamic? On the one hand, the therapists are using their close ties to you as a recent member of the staff to plead their case to the management, and on the other hand the management is watching you to see how you'll help run the department as smoothly and cost-effectively as possible. Where are you supposed to land in this salary debate? As a traitor to your own kind? As an ineffectual leader who perhaps should not have been promoted? It's a dilemma, this boss trap.
Openness Is the Best Policy
In answer to the plea for help in your last letter, I'm going to offer another one of my off-the-wall opinions that many people may disagree with. Be assured, though, that some very successful spa owners and managers have used this technique with positive results. It's a policy of openness about money, and it scares many people.
An "open book" policy means you inform the employees about the costs of doing business, the income, profit margins, goals, etc. Massage therapists seem to be particularly affected by money issues, clamoring for their due, a little naïve perhaps at first, but they usually understand the overall situation quickly when shown the reality.
The therapists confronting you now scream, "How can I, the one working so hard all day, get only $35 when the spa is charging $70 per massage? For doing what? Giving me an empty room to work in? Supplying towels? They're ripping us off!" But, were you to show your therapists the true costs of doing business, they, like many therapists before them, might get real quiet, real fast. I've seen it happen.
The Avalanche of Costs
If you can get management to agree to it, try this. Sit down in a special meeting with the therapists and use a flip chart or a slide show to outline each of the costs faced monthly by the spa. This information alone may be enough to steer the therapists onto another course, regardless of final profits or losses.
Show them the costs for original build-out still being paid off to the bank; the huge utility bills; the staggering amount of laundry; and costs associated with that (on a recent spa project of mine the cost just to launder sheets, towels and robes was well over $5,000/month for 9 massage rooms. Share with them the cost of the janitorial service to keep the facility clean; the constant upkeep of temperamental equipment; the unending flow of supplies and products to stock the spa; and the need to purchase new linens at least quarterly to offset the loss due to rampant stealing. Share with them the costs of licenses; permits; taxes; advertising; promotions; printing; office supplies; management salaries; trade show events; workers' compensation; and health insurance.
Put just these numbers in front of your therapists, add them up, place the grand total in big bold letters, and then ask them if they think a 50/50 split isn't absolutely reasonable. I know of several spas that offer less, more along the lines of 30/70 or 60/40, and the therapists are happy, because they know the realities. Spas usually are not profit-intensive businesses. We are all in it for the service, and to follow our passion.
Most therapists, being reasonable, will relent when faced with an avalanche of so many costs, grateful they don't have to deal with them personally, and remembering that's why they chose to work for somebody else in the first place. It's natural for highly skilled therapists to want to be compensated well for what they do, but some of them don't understand the challenges involved with running a large business.
Gird Yourself for the Fight
Don't think it will be easy. My words might make sense to you now, but you will, of course, be dealing with the volatile reality of several "massage personalities" (you know what I mean) and the newly forming relationship between you and your staff. I think it will work, if you can get management to go for it. Remember to tell them other spas have done this successfully, and assuage their fears by assuring them not all numbers need to be revealed, just those related to spa operations. Also, you have to present it in the right way to the therapists. This is where all your skill and diplomacy will be needed. This is your trial, your opportunity to fulfill your new role: to be one of the therapists, and a part of management at the same time.
Good luck! I can't wait to hear how it goes.
Steve Capellini, LMT
Click here for previous articles by Steve Capellini, LMT.
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