They usually come in “hurting all over.” They often are depressed, discouraged and not sleeping well. They frequently arise stiff and sore in the morning, feeling fatigued.
They have suffered bouts of irritable bowel symptoms. They appear anxious and feel chronically “burned out.” According to the American Academy of Rheumatology (ACR), 3 million to 6 million Americans suffer from some form of the disorder fibromyalgia. A majority of them are women of childbearing age. However, fibromyalgia also can affect children, the elderly and men.
Conventional Wisdom
Fibromyalgia is characterized by widespread muscle, ligament and tendon pain, chronic fatigue and multiple areas of trigger-point tenderness. The condition was recognized in previous generations, but was known by other names such as muscular rheumatism, fibrocitis and tension myalgia.
Allopathic medicine does not recognize a cause for fibromyalgia. Current thinking centers on internal imbalances that cause an increase in sensitivity to pain signals. Sleep disturbance, past injury, infection, metabolic muscle changes, hormonal imbalance and stress are other considerations in the etiology of fibromyalgia. Interestingly for chiropractors, abnormalities of sympathetic nervous system function also have been postulated as a factor in its etiology.
Diagnosing fibromyalgia can be difficult, as it can mimic many other disorders. The ACR has established the criteria of at least three months of chronic widespread pain and tenderness in at least 11 of 18 specific trigger-point sites.
Medical treatment involves recommendations for aerobic exercise such as swimming and walking, heat and massage treatments, antidepressant and analgesic/muscle relaxant medications, sleep aids, physical therapy and relaxation techniques of guided imagery. Many physicians also recommend stress-management strategies, improved diet and a healthier lifestyle.
Alternative/Holistic Perspective
Many in the alternative health care community see systemic toxicity as a fundamental consideration in fibromyalgia. They believe physiological disturbances from impaired heart, liver, lung and kidney function are at the root of the problem. As we know, the liver and kidneys are the primary detoxifiers of the body. Thus, systemic toxicity (autointoxication) can be the end result of impaired function in these organs.
As specialists in neuromusculoskeletal disorders, we can forget that life itself, as we know it, is basically an electromagnetic phenomenon. In the East, they describe this essential internal energy reserve as qi. Some even see the liver and kidneys as akin to batteries of the body, with the liver serving as the positive pole and the kidneys as the negative. When these organs are deficient in functioning, the body’s “battery” is said to be run down. Chronic fatigue, low vitality and organic depression are the result, features common in fibromyalgia patients.
Just as the internal composition of a regular battery can influence its charge, the inner atmosphere of the human body can influence its vitality and strength. Scientific evidence increasingly points to the fact that, for maximum health and wellness, we should be primarily vegetarians, with fruits and vegetables making up the great majority (70 percent to 80 percent) of consumed food. Good-quality grains, nuts and oils, dairy and lean meats should make up the other 20 percent to 30 percent. This has an anti-inflammatory effect and creates an alkalized internal atmosphere, which also produces the health benefit of discouraging reproduction of most pH-dependent human pathogens that are acid-loving.
Therapeutic Regimen
Systemic toxicity demands that primary attention be given to the basic processes of adequate hydration and increased eliminations. My personal observation is that very few patients consume sufficient water for bodily needs, which is estimated to be at least 64 ounces (eight glasses) daily. They tend to try and substitute colas, teas and coffee, all of which are diuretic, resulting in little or no net fluid gain. Almost all human biochemical processes require hydrogen. Without sufficient hydration, these processes slow, contributing to fatigue and accentuating the accumulation of metabolic wastes. Under- or frank dehydration also slows bowel motility, which contributes to reabsorption of toxic waste into the general circulation. “Water is medicine” is my advice to these patients, along with a cleansing diet of fresh fruits and vegetables. Enemas and laxatives also might be useful in internal cleansing, especially if a patient has been constipated. For the most severe cases of long-standing autointoxication, I recommend patients consider a series of colonic irrigations.
Manual therapy (spinal adjustment and massage) will prove very beneficial to most sufferers of fibromyalgia. Spinal biomechanical lesions and nerve “impingements” almost always reflexly stimulate some degree of associated regional muscular spasm, which leads to a relative ischemia and toxemia in and around the tissue. Chronic, long-standing myospasm creates adhesions, scarring and fibrosis.
In applying any form of manual therapy to those with fibromyalgia, one should take great care in the early stages. Since these patients have heightened sensitization to pain, overly aggressive, ham-fisted approaches to treatment often will backfire, creating such additional suffering pain as to lose a patient. In the early days, many osteopaths and chiropractors recommended sustained anti-inflammatory measures such as repetitive cold packs and a series of hands-on massages before even attempting spinal manipulation for those with severe pain syndromes.
In recommending dietary changes to patients, I have found it beneficial to discuss the “opportunity of illness.” While this sounds counterintuitive, I explain that the reason for the pain signal is to alert them to the underlying condition that needs to be changed for the better. I believe most frank pathology is the result of long-term imbalance in normal physiology, often caused by errors in diet and lifestyle and exacerbated by past injury or chronic inflammation.
Some form of moderate exercise such as walking or swimming is essential to recovery from fibromyalgia. Also frequently beneficial is the discipline of yoga-type stretching. Being out in the open as much as possible while exercising has been shown to be superior to time spent inside on the treadmill. Both walking and swimming mobilize needed lymphatic flow in the body. Arm swings pump this “dirty seawater” back into the veins under the clavicle, where it eventually is cleansed. Of course, the skin and lungs play an important role in metabolic waste elimination as well, so heating a well-hydrated body (hot baths, sauna) to create increased heart rate, perspiration and aerobic breathing also is beneficial.
Finally, “the mind is the builder, or the mind is the slayer” is a well-recognized axiom that acknowledges the health or disease effect of attitude and emotion. Fear-filled, angry folk who habitually engage in what motivational speaker Zig Ziglar called “stinking thinking,” eventually pay a price in their body’s lack of wellness. Taking in lots of information that creates distress and inner turmoil, while feeling completely helpless to improve the situation, is what Hans Selye (who coined the term stress) called “pathologically alarming” to us human animals. Conversely, time spent in reading and positive thought of our highest purposes and ideals can contribute substantially to the healing process.
Fibromyalgia can be healed and left behind in a person’s life experience. Recognizing its multi-faceted causes and taking a comprehensive approach to its treatment is essential to success in your efforts as true healer.
Thursday, May 29, 2008
Wednesday, May 28, 2008
Managing Your Clinic Budget
I’m sure you’ve heard the statement, “Follow the money.” It’s been used in many situations. I thought it time we followed the money and saw where it goes. You might be surprised.
We’ll start with the money coming into your office. We’ll use $1 and see the path it follows. That dollar walks into your office and is handed to your CA. Since it’s handed to a CA, we must not forget certain expenses are involved long before that dollar walks in. Of course, those expenses are referred to as “overhead.” What constitutes overhead? Everything it takes to get that dollar into the office, the expense for that office and the salary for that CA to be there to accept that dollar. Sounds like a lot, and in many instances it is. Many times it’s too much.
What is a good overhead?
Anything below 50 percent is great. Overhead can consume a great number of the dollars that come into your office. The ultimate goal is to get some of those dollars into your own pocket. For this exercise, we’ll assume the overhead in your office is running at 50 percent. This means 50 cents are gone immediately to cover the overhead, which leaves us with just 50 cents. I have seen scenarios in which the balance is 25 cents or even 15 cents – not a good situation to be in.
Overhead can get out of control very quickly. The one situation I have seen that causes excessive overhead is having too many employees. This happens in a busy office when the CA complains to the doctor that there is just too much work for one person to handle. So, the doc hires another employee and now the workload gets split between two people. Does more work get done? Usually not. One way to cure this problem is to have job descriptions for each employee. It should cover every task they should be doing, even down to who answers the phone after how many rings, and who empties the trash cans and when. Every detail needs to be covered. If not, the employee list grows and grows, but no additional work gets done. I always say that when I go into an office and there are more CAs on their side of the desk than there are patients on the other side of the desk, there is a major overhead problem.
OK, so we now have our 50 cents left. So what do you do with it? Not much, because your partner now wants to be involved. This partner is not one who works in the office to generate more dollars. This one just wants a cut of every dollar you bring in. This one actually is a relative, but not your spouse or kids. It’s “Uncle Sam,” better known as the IRS. It wants its “fair share.” The sad thing is that most people not only give the IRS its fair share; they give them additional dollars as well, and the IRS never complains when it gets too much. The complaints come when it doesn’t get its fair share! We’ll assume the fair share in this example is 25 cents to cover federal, state, city and any other local taxes. That’s enough!
Now we are left with 25 cents. A dollar walked in the door and before you could put it into your pocket, 75 cents disappeared – gone, vanished, never to be seen again. Sad but true. It’s amazing when you think about all the effort that goes into getting that dollar in the door and before you know it – poof – all that’s left is just 25 cents.
So, if all that’s left is just one quarter, what do you do with it? Well, before you start dreaming about some exotic cars or trips, let’s not forget there is another “overhead” to deal with. Rent or mortgage payments, food, clothing, insurance, car expenses, kids’ education – the list just goes on and on. Now you have all of the “personal” overhead to be covered by that quarter. It takes a lot of quarters to cover that overhead and job descriptions won’t help with this one! I’m tired just thinking about it. How much of that small quarter gets eaten up here? It can consume all of it and then some if you aren’t careful. For this example, we’ll say that 75 percent is needed to cover the personal overhead. That’s 18 cents, which leaves us with just 7 cents of that original dollar to satisfy our dreams and our plans for the future.
Want to retire when you’re age 50? Good luck! You’ve got 7 cents to get the job done. How about that education for your kids at that fancy Ivy League college? Will 7 cents do it? It’s got to. I know this sounds like a horror story, but it’s what happens in the real world. That dollar gets chopped up into a lot of pieces, and the piece you get isn’t very large.
You have to do two things. Number one is to make sure you have a lot of those dollars coming into the office and make sure the overhead, taxes and personal expenses don’t consume too much. The second task is to invest and use what’s left very carefully. Can the job be done on just 7 cents? Yes it can, as long as you take the time to explore all of the options available to you. The goals you have might be large and the amount you have to work with might be small. However, if handled properly, the rewards will be abundant.
With the economy in a tailspin, you really need to pay close attention to those pennies you have left in your pocket. I am not preaching doom and gloom, but what I’m saying is that you need to be very careful and plan ahead. It’s time to review your operations and make sure you’re getting the maximum out of those 7 cents you have left out of every dollar.
Areas You Should Look At
Insurance. Make sure your coverage is up to date and use deductibles to keep your costs down. Some of your policies are business expenses, so you get a tax deduction for the premium. Do you have a list of all the expenses that qualify? If not, get one.
Banks. Do you have a lot of money sitting in the bank? You might want to move some to a money market account to maximize its earnings. When was the last time you spoke to your banker about all the fees you’re paying? It’s time!
Cash. Got any? Put it to work. Don’t have any? Start a cash/emergency fund today.
Credit Cards. Have you called to get your rate lowered? Sixty percent of people who call get a rate reduction. What are you waiting for? They won’t call you!
Retirement. Do you have a plan? You really need to take a good, long look at the nonqualified plan that puts more away for you and gives you a tax-free retirement.
What it all boils down to is that it’s your money, and you need to know where it all goes and why.
We’ll start with the money coming into your office. We’ll use $1 and see the path it follows. That dollar walks into your office and is handed to your CA. Since it’s handed to a CA, we must not forget certain expenses are involved long before that dollar walks in. Of course, those expenses are referred to as “overhead.” What constitutes overhead? Everything it takes to get that dollar into the office, the expense for that office and the salary for that CA to be there to accept that dollar. Sounds like a lot, and in many instances it is. Many times it’s too much.
What is a good overhead?
Anything below 50 percent is great. Overhead can consume a great number of the dollars that come into your office. The ultimate goal is to get some of those dollars into your own pocket. For this exercise, we’ll assume the overhead in your office is running at 50 percent. This means 50 cents are gone immediately to cover the overhead, which leaves us with just 50 cents. I have seen scenarios in which the balance is 25 cents or even 15 cents – not a good situation to be in.
Overhead can get out of control very quickly. The one situation I have seen that causes excessive overhead is having too many employees. This happens in a busy office when the CA complains to the doctor that there is just too much work for one person to handle. So, the doc hires another employee and now the workload gets split between two people. Does more work get done? Usually not. One way to cure this problem is to have job descriptions for each employee. It should cover every task they should be doing, even down to who answers the phone after how many rings, and who empties the trash cans and when. Every detail needs to be covered. If not, the employee list grows and grows, but no additional work gets done. I always say that when I go into an office and there are more CAs on their side of the desk than there are patients on the other side of the desk, there is a major overhead problem.
OK, so we now have our 50 cents left. So what do you do with it? Not much, because your partner now wants to be involved. This partner is not one who works in the office to generate more dollars. This one just wants a cut of every dollar you bring in. This one actually is a relative, but not your spouse or kids. It’s “Uncle Sam,” better known as the IRS. It wants its “fair share.” The sad thing is that most people not only give the IRS its fair share; they give them additional dollars as well, and the IRS never complains when it gets too much. The complaints come when it doesn’t get its fair share! We’ll assume the fair share in this example is 25 cents to cover federal, state, city and any other local taxes. That’s enough!
Now we are left with 25 cents. A dollar walked in the door and before you could put it into your pocket, 75 cents disappeared – gone, vanished, never to be seen again. Sad but true. It’s amazing when you think about all the effort that goes into getting that dollar in the door and before you know it – poof – all that’s left is just 25 cents.
So, if all that’s left is just one quarter, what do you do with it? Well, before you start dreaming about some exotic cars or trips, let’s not forget there is another “overhead” to deal with. Rent or mortgage payments, food, clothing, insurance, car expenses, kids’ education – the list just goes on and on. Now you have all of the “personal” overhead to be covered by that quarter. It takes a lot of quarters to cover that overhead and job descriptions won’t help with this one! I’m tired just thinking about it. How much of that small quarter gets eaten up here? It can consume all of it and then some if you aren’t careful. For this example, we’ll say that 75 percent is needed to cover the personal overhead. That’s 18 cents, which leaves us with just 7 cents of that original dollar to satisfy our dreams and our plans for the future.
Want to retire when you’re age 50? Good luck! You’ve got 7 cents to get the job done. How about that education for your kids at that fancy Ivy League college? Will 7 cents do it? It’s got to. I know this sounds like a horror story, but it’s what happens in the real world. That dollar gets chopped up into a lot of pieces, and the piece you get isn’t very large.
You have to do two things. Number one is to make sure you have a lot of those dollars coming into the office and make sure the overhead, taxes and personal expenses don’t consume too much. The second task is to invest and use what’s left very carefully. Can the job be done on just 7 cents? Yes it can, as long as you take the time to explore all of the options available to you. The goals you have might be large and the amount you have to work with might be small. However, if handled properly, the rewards will be abundant.
With the economy in a tailspin, you really need to pay close attention to those pennies you have left in your pocket. I am not preaching doom and gloom, but what I’m saying is that you need to be very careful and plan ahead. It’s time to review your operations and make sure you’re getting the maximum out of those 7 cents you have left out of every dollar.
Areas You Should Look At
Insurance. Make sure your coverage is up to date and use deductibles to keep your costs down. Some of your policies are business expenses, so you get a tax deduction for the premium. Do you have a list of all the expenses that qualify? If not, get one.
Banks. Do you have a lot of money sitting in the bank? You might want to move some to a money market account to maximize its earnings. When was the last time you spoke to your banker about all the fees you’re paying? It’s time!
Cash. Got any? Put it to work. Don’t have any? Start a cash/emergency fund today.
Credit Cards. Have you called to get your rate lowered? Sixty percent of people who call get a rate reduction. What are you waiting for? They won’t call you!
Retirement. Do you have a plan? You really need to take a good, long look at the nonqualified plan that puts more away for you and gives you a tax-free retirement.
What it all boils down to is that it’s your money, and you need to know where it all goes and why.
Tuesday, May 27, 2008
Chiropractic Clinical Compass
The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is poised to release two additional elements of its ongoing best-practices initiative, The Chiropractic Clinical Compass.
Both documents will be available online for 60 days for stakeholder review and commentary following their release.
As of press time, “Chiropractic Management of Low Back Disorders,” a summary report, is scheduled to be posted online June 1, 2008, while “Manipulative Therapy of Lower Extremity Conditions,” an evidence synthesis included in the “Chiropractic Management of Lower Extremity Disorders” chapter (chapter five), is scheduled to be posted on June 15.
Acceptable commentary includes a discussion of the conclusions, submission of additional literature for review, and/or editorial suggestions. As with previous chapters, once comments are received and any revisions are made, the documents eventually will be published in their final forms as clinically relevant information for the chiropractic practice.
Thus far, the council has released four draft chapters for stakeholder review and comment. “Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints,” the first chapter comprising the Clinical Compass, was released in May 2006. “Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; and Conditions of the Elderly, Children and Pregnant Women,” was released in September 2007. “Chiropractic Management of Upper Extremity Pain,” was released in October 2007. And “Chiropractic Management of Soft-Tissue Disorders” was released on March 6, 2008.
Both documents will be available online for 60 days for stakeholder review and commentary following their release.
As of press time, “Chiropractic Management of Low Back Disorders,” a summary report, is scheduled to be posted online June 1, 2008, while “Manipulative Therapy of Lower Extremity Conditions,” an evidence synthesis included in the “Chiropractic Management of Lower Extremity Disorders” chapter (chapter five), is scheduled to be posted on June 15.
Acceptable commentary includes a discussion of the conclusions, submission of additional literature for review, and/or editorial suggestions. As with previous chapters, once comments are received and any revisions are made, the documents eventually will be published in their final forms as clinically relevant information for the chiropractic practice.
Thus far, the council has released four draft chapters for stakeholder review and comment. “Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints,” the first chapter comprising the Clinical Compass, was released in May 2006. “Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; and Conditions of the Elderly, Children and Pregnant Women,” was released in September 2007. “Chiropractic Management of Upper Extremity Pain,” was released in October 2007. And “Chiropractic Management of Soft-Tissue Disorders” was released on March 6, 2008.
Monday, May 26, 2008
Medicare Billing Issues
Sometimes it seems as if the American Chiropractic Association (ACA) and the International Chiropractors Association (ICA) don’t agree on much, but both recently stepped forward to address chiropractic and Medicare billing issues.
Each group sees Medicare billing issues as a significant and potentially dangerous problem currently facing the chiropractic profession.
The ACA is concerned that continued high claims error rates will be used as an argument against allowing chiropractors to provide additional services under Medicare. In an April 4, 2008 letter to state chiropractic licensing boards, ACA President Glenn Manceaux, DC, noted that the Centers for Medicare and Medicaid Services (CMS) is scheduled to issue a special report to Congress in 2009, detailing the results of the Medicare Chiropractic Demonstration Project.
“It is abundantly clear that unless we can convincingly demonstrate that our profession has put into place various educational and training programs, along with policies and requirements that will collectively lead to a significant reduction in Medicare claims errors, then the U.S. Congress will likely reject any proposals allowing DCs to provide additional services within Medicare,” Dr. Manceaux said. “The ACA is fully prepared to wage an intensive battle to secure expanded and permanent chiropractic benefits under the Medicare program; however, we need the support of every chiropractic organization and every chiropractic office across the country.”
For its part, the ICA held its first National Conference on the Future of Chiropractic in Medicare April 24, 2008 in Washington, D.C. In the day-long session, 17 presenters covered a variety of topics such as the Recovery Audit Contractors Program Medicare has implemented, various documentation challenges, the Medicare Chiropractic Demonstration Project and Medicare savings accounts. The ICA also invited three members of the U.S. House of Representatives and a state senator to attend. Rep. Bob Filner (D-Calif.), Rep. Kathy McMorris Rogers (R-Wash.), and Rep. Don Manzullo (R-Ill.), and Sen. Ben Cardin (D-Md.) offered widely divergent views on how national Medicare policy can and should be adjusted to meet rising demands.
“It is clear that there is a massive amount of work that needs to be done to secure chiropractic’s rightful place in the Medicare program and in any national healthcare reform initiative,” said ICA President Dr. John K. Maltby. “The ICA recognizes that it will take an historic cooperative effort to achieve success and the ICA hopes that the conference represents a first step along that path.”
The ICA also released a white paper titled “The Future of Chiropractic in Medicare.” The white paper states, in part, “Chiropractic’s position in this massive program, while statistically small, is vitally important to the millions of Medicare beneficiaries who seek chiropractic care as their personal choice. According to the U.S. Department of Health and Human Services, Medicare reimbursement for chiropractic services has grown significantly in recent years, from $255 million for 11.2 million chiropractic adjustments in 1994 to $683 million in 2004, for 21 million chiropractic adjustments. For the current year, estimates are for expenditures upwards of $724.”
The authors go on to say, “In the coming period of national debate on Medicare, the chiropractic profession must position itself as an uncompromising champion of patient rights and competition in the Medicare system.”
Each group sees Medicare billing issues as a significant and potentially dangerous problem currently facing the chiropractic profession.
The ACA is concerned that continued high claims error rates will be used as an argument against allowing chiropractors to provide additional services under Medicare. In an April 4, 2008 letter to state chiropractic licensing boards, ACA President Glenn Manceaux, DC, noted that the Centers for Medicare and Medicaid Services (CMS) is scheduled to issue a special report to Congress in 2009, detailing the results of the Medicare Chiropractic Demonstration Project.
“It is abundantly clear that unless we can convincingly demonstrate that our profession has put into place various educational and training programs, along with policies and requirements that will collectively lead to a significant reduction in Medicare claims errors, then the U.S. Congress will likely reject any proposals allowing DCs to provide additional services within Medicare,” Dr. Manceaux said. “The ACA is fully prepared to wage an intensive battle to secure expanded and permanent chiropractic benefits under the Medicare program; however, we need the support of every chiropractic organization and every chiropractic office across the country.”
For its part, the ICA held its first National Conference on the Future of Chiropractic in Medicare April 24, 2008 in Washington, D.C. In the day-long session, 17 presenters covered a variety of topics such as the Recovery Audit Contractors Program Medicare has implemented, various documentation challenges, the Medicare Chiropractic Demonstration Project and Medicare savings accounts. The ICA also invited three members of the U.S. House of Representatives and a state senator to attend. Rep. Bob Filner (D-Calif.), Rep. Kathy McMorris Rogers (R-Wash.), and Rep. Don Manzullo (R-Ill.), and Sen. Ben Cardin (D-Md.) offered widely divergent views on how national Medicare policy can and should be adjusted to meet rising demands.
“It is clear that there is a massive amount of work that needs to be done to secure chiropractic’s rightful place in the Medicare program and in any national healthcare reform initiative,” said ICA President Dr. John K. Maltby. “The ICA recognizes that it will take an historic cooperative effort to achieve success and the ICA hopes that the conference represents a first step along that path.”
The ICA also released a white paper titled “The Future of Chiropractic in Medicare.” The white paper states, in part, “Chiropractic’s position in this massive program, while statistically small, is vitally important to the millions of Medicare beneficiaries who seek chiropractic care as their personal choice. According to the U.S. Department of Health and Human Services, Medicare reimbursement for chiropractic services has grown significantly in recent years, from $255 million for 11.2 million chiropractic adjustments in 1994 to $683 million in 2004, for 21 million chiropractic adjustments. For the current year, estimates are for expenditures upwards of $724.”
The authors go on to say, “In the coming period of national debate on Medicare, the chiropractic profession must position itself as an uncompromising champion of patient rights and competition in the Medicare system.”
Sunday, May 25, 2008
Vitamin D may protect against peripheral artery disease
People with low vitamin D levels may face an increased risk for peripheral artery disease (PAD), according to researchers at the Albert Einstein College of Medicine at Yeshiva University. The scientists reported their findings at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology Annual Conference 2008.
PAD is a common disease that occurs when arteries in the legs become narrowed by fatty deposits, causing pain and numbness and impairing the ability to walk. PAD affects about eight million Americans and is associated with significant disease and death, according to the American Heart Association.
People obtain vitamin D by making it themselves (through skin exposure to sunlight), by ingesting foods such as fish and fortified dairy products that contain vitamin D, or by taking dietary supplements. Adequate vitamin D levels are necessary for bone health, but scientists are only beginning to explore vitamin D’s connection to cardiovascular disease.
To see whether vitamin D might influence PAD, researchers analyzed data from a national survey measuring vitamin D levels in the blood of 4,839 U.S. adults. The survey tested these people using the ankle-brachial index, a screening tool for PAD that measures blood flow to the legs.
The researchers found that higher levels of vitamin D were associated with a lower prevalence of PAD. When researchers adjusted for age, sex, race, and co-existing health problems, they found that PAD was 64 percent more common in the group with the lowest vitamin D levels compared with the group with the highest levels. While these findings suggest a role for vitamin D in preventing PAD, they don’t necessarily show that vitamin D truly deserves the credit. It’s possible that vitamin D levels are a marker for other health practices such as eating a healthy diet.
The research was funded by the National Institute of Diabetes, Digestive and Kidney Disease of the National Institutes of Health.
PAD is a common disease that occurs when arteries in the legs become narrowed by fatty deposits, causing pain and numbness and impairing the ability to walk. PAD affects about eight million Americans and is associated with significant disease and death, according to the American Heart Association.
People obtain vitamin D by making it themselves (through skin exposure to sunlight), by ingesting foods such as fish and fortified dairy products that contain vitamin D, or by taking dietary supplements. Adequate vitamin D levels are necessary for bone health, but scientists are only beginning to explore vitamin D’s connection to cardiovascular disease.
To see whether vitamin D might influence PAD, researchers analyzed data from a national survey measuring vitamin D levels in the blood of 4,839 U.S. adults. The survey tested these people using the ankle-brachial index, a screening tool for PAD that measures blood flow to the legs.
The researchers found that higher levels of vitamin D were associated with a lower prevalence of PAD. When researchers adjusted for age, sex, race, and co-existing health problems, they found that PAD was 64 percent more common in the group with the lowest vitamin D levels compared with the group with the highest levels. While these findings suggest a role for vitamin D in preventing PAD, they don’t necessarily show that vitamin D truly deserves the credit. It’s possible that vitamin D levels are a marker for other health practices such as eating a healthy diet.
The research was funded by the National Institute of Diabetes, Digestive and Kidney Disease of the National Institutes of Health.
Saturday, May 24, 2008
Ask a number of consultants to define a wellness practice and you’ll get a variety of answers.
Ask them how to market a wellness practice and you’ll learn about a number of approaches.
Ask them what not to do, and you’ll want to listen closely
Chiropractic Economics asked a number of practice-management consultants what a wellness practice means to them and for advice on what should and should not happen when marketing a wellness practice.
DEFINING A WELLNESS PRACTICE
Consultants define “wellness practice” in a variety of ways. However, one element common to all definitions is education.
Whether wellness hinges on lifestyle changes, making healthier choices, or changing patients’ perspectives of chiropractic from pain relief to a higher quality of life, education assumes a predominant role.
Michelle Geller-Vino, owner and president of MGV Marketing, said a wellness practice “continually educates its patients on becoming aware of and practicing healthy choices to create a successful balance in their lives.”
She added, “Wellness is a choice and a process of seeking more information on how to improve a person’s physical, emotional, spiritual, social, and environmental well-being.”
C. J. Mertz, DC, president and CEO of Team WLP — The Waiting List Practice , agreed, but added that a wellness-based practice should focus on family and provide solutions for thinking well, eating well, and moving well for life.
“A wellness chiropractor will educate patients with tools for lifelong changes,” said John Heggie, DC, founder and president of Lakeside Chiropractic Seminars, Inc.. “This education should include stretching exercises, strengthening exercises, home and office ergonomics, nutrition, healthy eating habits, organic food advice, and stress management.”
Wellness is not just a state of being; it is the doctor’s wellness philosophy reflected in the services offered and embraces the principles of a healthy life, stated Mark Sanna, DC, CEO of Breakthrough Coaching, and Len Schwartz, DC, president and CEO of ChiroPractice Marketing Solutions
.
Timothy J. Gay, DC, director of Ultimate Practice, said “A wellness practice is talking to patients about the things they can do beyond chiropractic care and how to implement them into their lives.”
MARKETING A WELLNESS PRACTICE
The consultants offer a variety of suggestions on how to market a wellness practice. Among them: Attend or host external events, offer a wide variety of wellness services, hold internal events, hire a public-relations firm, and properly advertise.
Provide external events.
President of Integrity Management, Keith Maule, along with John Madeira, DC, of Madeira Success Strategies, believe community outreach programs are some of the best ways to market your practice.
Speaking engagements at health fairs, local chambers of commerce, expos, libraries, local businesses, and corporations, as well as giving wellness talks, health screenings, and attending conferences, all maximize your exposure and build brand awareness.
“Doing lectures on any topic, such as arthritis, digestive problems, sleep disorders, and fatigue, promoted as a wellness solution to these problems is the way to present not only oneself, but to reshape the way people perceive you,” said David Singer, DC, founder of David Singer Enterprises. “Knowing how to present a wellness program not only allows you to double and triple your new patients, but also allows you to become involved with corporate America on a level which only wellness programs could provide.”
External events, or events that take place outside of your practice, also provide opportunities to network with healthcare professionals that provide noncompetitive services and/or services for which you provide synergy.
Jason A. Deitch, DC, chief wellness officer for The Masters Circle and co-author of Discover Wellness, said, “The most cost-effective and time-efficient way to educate people is through professional, informative, and inspiring wellness presentations … in the office, at local employers, churches, community centers, and other providers’ offices.”
Offer other services.
In addition to chiropractic, the consultants suggest offering nutritional evaluations, supplements, massage, acupuncture, physical therapy, biofeedback, Pilates, and yoga. They also suggest providing ongoing educational programs related to nutrition, stretching and strengthening exercises, ergonomics, stress management and reduction, and weight loss.
Host internal events.
Events held in your office can include hosting dinners for patients and their friends or co-workers, so they can learn more about the benefits of chiropractic care. Other internal events include sending e-newsletters, posting articles in your office or on your Web site, mailing out a wellness-oriented newsletter, and conducting special “health” days or events in your practice every month.
Deitch added that DCs who offer educational material provide continuing education, and then stay in touch with people through periodic e-mail newsletters. They position themselves to become perceived as “the” wellness resource in the community.
Hire a PR team.
According to Laura Carabello, principal of CPR Strategic Marketing Communications, “Hiring an effective public relations team is key to building your practice and reaching your market segments.” She said a PR team can help you create specific media announcements, events, press releases, and media advisories which would target consumers, local town media, and even mainstream national media to spread the word about your wellness practice.
Advertise properly.
“When a member of the general public sees a sign on a chiropractic office (or anywhere else) that says ‘Wellness Center,’” said Ty Talcott, DC, president of Power Strategies Inc., “they have no idea what to expect if they were to walk in the door — therefore, all too often, their reaction is, ‘Why walk in the door?’”
Talcott and Gay believe that to be successful, you need to properly advertise properly the specific benefits an individual will gain by visiting your facility.
Carabello said not to be vague about the services you offer: Specify on your Web site or within your office the variety and types of services you offer to clients, so they understand the full array of what you provide.
ACTIVITIES TO AVOID
In a perfect world, there would be no mistakes. Since we do not live in a perfect world, the consultants offer advice on things to avoid when marketing your wellness practice.
• Avoid focusing on symptoms.
According to Shawn Powers, DC, of Powersource Coaching, you want to avoid focusing on treating conditions or symptoms. “I do not use a symptom-oriented case history,” she said. “If a new practice member has a symptom or condition, I ask for permission to explain how the body works before discussing anything, so they have a better knowledge base to make their family’s healthcare decisions.”
Madeira and Mertz also said to stay away from symptom-based advertising.
“Make sure not to market or teach on symptomatic-relief care or you will destroy any chance of becoming a highly successful wellness center,” said Mertz.
Heggie agreed by saying “headaches and low-back pain are both common roads chiropractors use to attract new patients into their office. But, the fact is, this type of advertising promotes short-term patients. When the patient’s pain is gone and the patient feels they received what they were looking for, they will terminate care.”
• Avoid improper names.
“An effective branding strategy begins with an evaluation of the practice name, logo, and image the office projects,” advised Deitch. “Marketing experts agree that if a DC is seeking to position a practice as a ‘wellness practice,’ then the word wellness should be in the name of the practice.”
Gay agreed, “If you want to make your practice a wellness-based practice, then put wellness in your clinic name and also involve other natural healthcare practitioners.”
Lawton W. Howell, CEO of WellnessOne Corporation, said the first key step is the right brand name. “When your brand name is focused on ‘chiropractic,’ such as Jones Chiropractic, the unstated message is that you only provide chiropractic care, not holistic or wellness care.”
Singer said practitioners need to change not only the name of their practices, but also their signs, stationery, cards, and programs. Doing so sends a consistent message.
• Don’t limit yourself.
If you are going to market yourself a wellness practice, then don’t limit yourself to one or two services, said Talcott. “In other words, say what you do and do what you say. If you are going to be all-encompassing, then potentially label yourself as a wellness practice.”
Singer said that when doctors of chiropractic market themselves as chiropractors they have to accept the image or branding that the vast majority of people have of who and what a chiropractor is. “They perceive chiropractic as a limited specialty within the area of back treatment. You need to become a chiropractic wellness center or a wellness clinic.”
Howell added that you should not limit your practice to only chiropractic or avoid interaction and alliances with other healthcare professionals.
LAST WORDS OF ADVICE
“To achieve the desired results of a wellness clinic, the doctor must have a good report of findings and do proper re-exams to help support the treatment as the patient progresses through care,” said Ed Sharp, president of Sharp Management Consulting. “If patients do not get through their corrective levels of care, they will not be there to get on to wellness care.”
Mertz suggested visiting a practice that is fully functioning in wellness and begin modeling it. He also suggested hiring a coach to determine the correct actions and strategies that transition a nonwellness practice into a highly functioning wellness-based practice.
“Building a wellness brand is more than just providing the same chiropractic experience you have always provided and just adding the word wellness to your conversations,” said Deitch. “It requires a mental and structural makeover of your communications, procedures, and fee structure.”
Talcott recommended pricing and packaging services to be attractive and self explanatory, highlighting the benefits to the patient that can be easily explained to others.
He also said it is not always profitable to place advertisements in the same sections of the newspaper that other healthcare professionals use. “You may find more success placing ads where you see spas, health clubs, yoga, or alternative providers.”
Schwartz summed up marketing by saying, “DCs who want to have a wellness practice should be doing everything mentioned earlier — and they should avoid anything that is inconsistent with those activities.”
Ask them how to market a wellness practice and you’ll learn about a number of approaches.
Ask them what not to do, and you’ll want to listen closely
Chiropractic Economics asked a number of practice-management consultants what a wellness practice means to them and for advice on what should and should not happen when marketing a wellness practice.
DEFINING A WELLNESS PRACTICE
Consultants define “wellness practice” in a variety of ways. However, one element common to all definitions is education.
Whether wellness hinges on lifestyle changes, making healthier choices, or changing patients’ perspectives of chiropractic from pain relief to a higher quality of life, education assumes a predominant role.
Michelle Geller-Vino, owner and president of MGV Marketing, said a wellness practice “continually educates its patients on becoming aware of and practicing healthy choices to create a successful balance in their lives.”
She added, “Wellness is a choice and a process of seeking more information on how to improve a person’s physical, emotional, spiritual, social, and environmental well-being.”
C. J. Mertz, DC, president and CEO of Team WLP — The Waiting List Practice , agreed, but added that a wellness-based practice should focus on family and provide solutions for thinking well, eating well, and moving well for life.
“A wellness chiropractor will educate patients with tools for lifelong changes,” said John Heggie, DC, founder and president of Lakeside Chiropractic Seminars, Inc.. “This education should include stretching exercises, strengthening exercises, home and office ergonomics, nutrition, healthy eating habits, organic food advice, and stress management.”
Wellness is not just a state of being; it is the doctor’s wellness philosophy reflected in the services offered and embraces the principles of a healthy life, stated Mark Sanna, DC, CEO of Breakthrough Coaching, and Len Schwartz, DC, president and CEO of ChiroPractice Marketing Solutions
.
Timothy J. Gay, DC, director of Ultimate Practice, said “A wellness practice is talking to patients about the things they can do beyond chiropractic care and how to implement them into their lives.”
MARKETING A WELLNESS PRACTICE
The consultants offer a variety of suggestions on how to market a wellness practice. Among them: Attend or host external events, offer a wide variety of wellness services, hold internal events, hire a public-relations firm, and properly advertise.
Provide external events.
President of Integrity Management, Keith Maule, along with John Madeira, DC, of Madeira Success Strategies, believe community outreach programs are some of the best ways to market your practice.
Speaking engagements at health fairs, local chambers of commerce, expos, libraries, local businesses, and corporations, as well as giving wellness talks, health screenings, and attending conferences, all maximize your exposure and build brand awareness.
“Doing lectures on any topic, such as arthritis, digestive problems, sleep disorders, and fatigue, promoted as a wellness solution to these problems is the way to present not only oneself, but to reshape the way people perceive you,” said David Singer, DC, founder of David Singer Enterprises. “Knowing how to present a wellness program not only allows you to double and triple your new patients, but also allows you to become involved with corporate America on a level which only wellness programs could provide.”
External events, or events that take place outside of your practice, also provide opportunities to network with healthcare professionals that provide noncompetitive services and/or services for which you provide synergy.
Jason A. Deitch, DC, chief wellness officer for The Masters Circle and co-author of Discover Wellness, said, “The most cost-effective and time-efficient way to educate people is through professional, informative, and inspiring wellness presentations … in the office, at local employers, churches, community centers, and other providers’ offices.”
Offer other services.
In addition to chiropractic, the consultants suggest offering nutritional evaluations, supplements, massage, acupuncture, physical therapy, biofeedback, Pilates, and yoga. They also suggest providing ongoing educational programs related to nutrition, stretching and strengthening exercises, ergonomics, stress management and reduction, and weight loss.
Host internal events.
Events held in your office can include hosting dinners for patients and their friends or co-workers, so they can learn more about the benefits of chiropractic care. Other internal events include sending e-newsletters, posting articles in your office or on your Web site, mailing out a wellness-oriented newsletter, and conducting special “health” days or events in your practice every month.
Deitch added that DCs who offer educational material provide continuing education, and then stay in touch with people through periodic e-mail newsletters. They position themselves to become perceived as “the” wellness resource in the community.
Hire a PR team.
According to Laura Carabello, principal of CPR Strategic Marketing Communications, “Hiring an effective public relations team is key to building your practice and reaching your market segments.” She said a PR team can help you create specific media announcements, events, press releases, and media advisories which would target consumers, local town media, and even mainstream national media to spread the word about your wellness practice.
Advertise properly.
“When a member of the general public sees a sign on a chiropractic office (or anywhere else) that says ‘Wellness Center,’” said Ty Talcott, DC, president of Power Strategies Inc., “they have no idea what to expect if they were to walk in the door — therefore, all too often, their reaction is, ‘Why walk in the door?’”
Talcott and Gay believe that to be successful, you need to properly advertise properly the specific benefits an individual will gain by visiting your facility.
Carabello said not to be vague about the services you offer: Specify on your Web site or within your office the variety and types of services you offer to clients, so they understand the full array of what you provide.
ACTIVITIES TO AVOID
In a perfect world, there would be no mistakes. Since we do not live in a perfect world, the consultants offer advice on things to avoid when marketing your wellness practice.
• Avoid focusing on symptoms.
According to Shawn Powers, DC, of Powersource Coaching, you want to avoid focusing on treating conditions or symptoms. “I do not use a symptom-oriented case history,” she said. “If a new practice member has a symptom or condition, I ask for permission to explain how the body works before discussing anything, so they have a better knowledge base to make their family’s healthcare decisions.”
Madeira and Mertz also said to stay away from symptom-based advertising.
“Make sure not to market or teach on symptomatic-relief care or you will destroy any chance of becoming a highly successful wellness center,” said Mertz.
Heggie agreed by saying “headaches and low-back pain are both common roads chiropractors use to attract new patients into their office. But, the fact is, this type of advertising promotes short-term patients. When the patient’s pain is gone and the patient feels they received what they were looking for, they will terminate care.”
• Avoid improper names.
“An effective branding strategy begins with an evaluation of the practice name, logo, and image the office projects,” advised Deitch. “Marketing experts agree that if a DC is seeking to position a practice as a ‘wellness practice,’ then the word wellness should be in the name of the practice.”
Gay agreed, “If you want to make your practice a wellness-based practice, then put wellness in your clinic name and also involve other natural healthcare practitioners.”
Lawton W. Howell, CEO of WellnessOne Corporation, said the first key step is the right brand name. “When your brand name is focused on ‘chiropractic,’ such as Jones Chiropractic, the unstated message is that you only provide chiropractic care, not holistic or wellness care.”
Singer said practitioners need to change not only the name of their practices, but also their signs, stationery, cards, and programs. Doing so sends a consistent message.
• Don’t limit yourself.
If you are going to market yourself a wellness practice, then don’t limit yourself to one or two services, said Talcott. “In other words, say what you do and do what you say. If you are going to be all-encompassing, then potentially label yourself as a wellness practice.”
Singer said that when doctors of chiropractic market themselves as chiropractors they have to accept the image or branding that the vast majority of people have of who and what a chiropractor is. “They perceive chiropractic as a limited specialty within the area of back treatment. You need to become a chiropractic wellness center or a wellness clinic.”
Howell added that you should not limit your practice to only chiropractic or avoid interaction and alliances with other healthcare professionals.
LAST WORDS OF ADVICE
“To achieve the desired results of a wellness clinic, the doctor must have a good report of findings and do proper re-exams to help support the treatment as the patient progresses through care,” said Ed Sharp, president of Sharp Management Consulting. “If patients do not get through their corrective levels of care, they will not be there to get on to wellness care.”
Mertz suggested visiting a practice that is fully functioning in wellness and begin modeling it. He also suggested hiring a coach to determine the correct actions and strategies that transition a nonwellness practice into a highly functioning wellness-based practice.
“Building a wellness brand is more than just providing the same chiropractic experience you have always provided and just adding the word wellness to your conversations,” said Deitch. “It requires a mental and structural makeover of your communications, procedures, and fee structure.”
Talcott recommended pricing and packaging services to be attractive and self explanatory, highlighting the benefits to the patient that can be easily explained to others.
He also said it is not always profitable to place advertisements in the same sections of the newspaper that other healthcare professionals use. “You may find more success placing ads where you see spas, health clubs, yoga, or alternative providers.”
Schwartz summed up marketing by saying, “DCs who want to have a wellness practice should be doing everything mentioned earlier — and they should avoid anything that is inconsistent with those activities.”
Friday, May 23, 2008
Angies List Rating Chiropractors
Some people are making a list and checking it twice — Angie’s List, that is. And they are checking it for reports on chiropractors, medical doctors, dentists, hospitals, and urgent-care centers.
Angie’s List is a word-of-mouth network of consumers who submit reports and rate local businesses. Until recently, reports covered many different categories, ranging from accountants to wrought-iron fabricators. Businesses do not pay to be on the list.
Cheryl Reed with Angie’s List told Chiropractic Economics that the company only added “medical providers” as a category a few weeks ago. She said, “We’ve been collecting reports on healthcare providers for a just few weeks now and have had overwhelming response nationwide across all healthcare categories ... Part of our service — which is unique to most other ratings services — is that we have human review of each report before it’s posted. So the reports don’t appear instantly; we first ensure they meet our guidelines.”
Reed cited Portland, Ore., and Columbus, Ohio, as having the most medical reports. Each listed reviews of seven DCs listed. All the DCs received an “A” grade.
Angie’s List is a word-of-mouth network of consumers who submit reports and rate local businesses. Until recently, reports covered many different categories, ranging from accountants to wrought-iron fabricators. Businesses do not pay to be on the list.
Cheryl Reed with Angie’s List told Chiropractic Economics that the company only added “medical providers” as a category a few weeks ago. She said, “We’ve been collecting reports on healthcare providers for a just few weeks now and have had overwhelming response nationwide across all healthcare categories ... Part of our service — which is unique to most other ratings services — is that we have human review of each report before it’s posted. So the reports don’t appear instantly; we first ensure they meet our guidelines.”
Reed cited Portland, Ore., and Columbus, Ohio, as having the most medical reports. Each listed reviews of seven DCs listed. All the DCs received an “A” grade.
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