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Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
June, 2002, Vol. 02, Issue 06
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.
You see? It wasn't as bad as you thought. When you were able to convince management that the "open book" policy might work for your spa, and that it was a good idea to disclose some of the costs of doing business with the therapists, everyone calmed down a bit. Now the therapists are happier doing the same work they were before, and they feel more a part of the big picture, too.
The open-book policy can be a good one for many spas, and you've seen it work. But now the therapists have just one last bone to pick as far as what they want from the spa, and on this topic I'm going to have to side with them. They want the spa to pay for part of their continuing education in the field, and I think that's right.
Of course, once again you're stuck in the middle as the spa treatment supervisor, needing to appease the therapists on the one side, and management on the other. I think there might be a solution that will make everyone happy.
Retention vs. Detention
I know you might have trouble convincing the spa ownership to invest in furthering the education of their therapists. The first thing you're likely to hear is something along the lines of, "Why should we pay for them to get more training, when then they might just take off and work for a competitor? We'll end up paying for their education and another spa will swoop in and pay them slightly more per treatment, thereby receiving all the benefits of our generosity."
That is a viable concern on the part of your spa management and owners, but guess what? There are countermeasures the spa can employ to minimize worries of this kind.
First of all, certain spa managers and owners need an attitude adjustment. Specifically, they need to alter their concept of the phrase "employee retention." For many managers and human resources departments, retention means something more like "detention." Due to the high costs of hiring and training new people, they will do anything they can to keep the employees they already have, but instead of coming up with inventive ways to make their employees want to stay, they try instead to instill in them a fear of leaving. "What if you loose your insurance?" they say. Or "That other spa might fire you within the trial period. You'd better stay here where you have security." Employees can end up operating out of fear rather than motivation. They feel trapped rather than inspired - detained rather than retained.
Spa management can get around this problem by encouraging their therapists to learn new skills that would make them valuable to competitors. Yes, that's right. It's counter-intuitive, but it works. And the way it works is through incentives and recognition.
Incentives and Recognition
As you well know, Lou, what massage people want most, in addition to good pay and the satisfaction of helping people one-on-one, is some recognition from the people with whom we work. We want our skills and abilities recognized and appreciated.
Some spas offer to assist their therapists with the expense of continuing education, and then when they come back to the spa to use their new skills, they are given special recognition as they move toward becoming "advanced therapists." An advanced therapist is someone who can perform most or all of the modalities offered by the spa and who has been with the spa for a certain period of time. Someone who can perform Swedish, neuromuscular, stone massage, reiki, reflexology and Lomi-Lomi, for example, will help the spa by being available to cover many guest requests during all possible shifts. This person becomes highly valuable and deserves to be considered an advanced therapist, as long as her skill levels are satisfactory in each modality.
That's the recognition part.
The incentive part has to do with pay, of course. Once a therapist reaches the "advanced" level, he or she is paid a little more per treatment, which makes sense because the spa usually charges more for these services as well. In addition, if the spa helps out with the tuition for the classes taken, that adds another incentive to stay with the same company. Imagine working for people who actually want to help you become more qualified so you can earn more! This is the situation at some spas, and the therapist turnover rate in these facilities tends to be much lower than the average.
How Much Is Enough?
There are differing thoughts on the matter of how much is enough when it comes time for a spa to actually shell out money for their therapists' education. Many spas opt to pay for a trainer to come on site and offer classes to the entire staff, which is often more cost-effective than subsidizing therapists' individual classes. However, those that do offer a form of "scholarship" usually give a certain percentage, not the entire amount of the class. A 50/50 split is typical. Sometimes the spa only pays a quarter of the class fee, or a flat rate, such as one hundred dollars per class.
Really, any amount, even just a $50 voucher toward a class, is enough, as long as it demonstrates management's commitment to furthering the skills of their staff.
You also need to be realistic when it comes to what the spa will be willing to provide. You can't expect the moon. I can think of no spa that would offer their therapists a full ride to the Rolf Institute, for example. Financial help is only given for classes and workshops that will give therapists skills they can put to use in the spa immediately after training. If a therapist wants to learn Thai Massage, but it's not on the spa menu, it wouldn't make sense for the spa to subsidize part of the training. However, if several therapists are interested in a new technique, that may be a good opportunity to expand the menu at the spa and add the new modality.
Recognition of Specialists
Of course, some therapists want to stick with what they know best. Becoming an advanced therapist who knows several techniques is of no interest to them. They'd rather hone their skills in one area or technique. In this case, the spa can provide some assistance and incentive for the therapist to take advanced courses within the modality, becoming an advanced practitioner in one specific technique. Often, therapists who get proficient enough in a certain modality end up leaving their place of employment to set up their own studio or clinic, and that too should be encouraged!
Put the Money Where It Matters
Do you see where I'm heading? In my last letter, I told you that therapists need a refresher course on the bottom line of spa operations so they don't get unrealistic expectations about their salaries. I believe therapists, especially newer ones, should be happy to receive a reasonable wage even a little lower than what they might expect. Then at the same time the spa can offer some incentives and recognitions for those therapists who improve and help the spa over the long haul, nurturing those who are willing to commit to the growth and success of the overall enterprise. The cost of subsidizing some training will be lower than trying to keep therapists on board with higher salaries, and it will foster an environment of loyalty.
Even if therapists eventually leaves you to open their own business, you'll have created such good will that they will probably have someone to recommend to you to take their place.
My advice is to tell your spa owners it's smarter to put the money where it matters, in recognition and incentives, rather than an ill-advised raising of pay to try and "detain" a team of therapists.
Talk to you later,
Steve Capellini, LMT
Click here for previous articles by Steve Capellini, LMT.
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